Measurement of surgical dexterity using motion analysis of simple bench tasks

The possibility of using quantitative motion analysis for objective assessment of simple surgical dexterity is investigated using the Imperial College Surgical Assessment Device (ICSAD) with qualitative analysis undertaken by inspection. Bench-top knot tying and suturing skills were performed and examined for the ability to discriminate between surgeons of varying experience. These exercises were found to discriminate significantly between junior and senior surgeons in terms of both time taken and the number of movements required. The relation between time and motion was found to be variable depending on what skill was being undertaken: simple suturing, suturing at depth, or knot tying (1.71 vs. 1.86 vs. 2.36; p = 0.002 for 1 vs. 2; p < 0.001 for others). When the number of movements in a minute (standardized movements per minute) were considered, both groups were found to work at a similar rate, depending on the task, implying that the more experienced surgeon is more economical, performing the same exercise with fewer moves rather than with higher speed. Motion analysis exhibits face and construct validity and is a reliable assessment of simple surgical dexterity. Its use for objective assessment of dexterity and competence should be encouraged.