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Analyzing Procedural Time and Its Relationship to Performance in Microsurgical Training: A Pilot Study.
Pablo J Villanueva1, Taku Sugiyama2, Yelena Akelina3
1Microsurgical Laboratory, University of Buenos Aires, Buenos Aires, ARG.
Cureus
|September 22, 2025
Summary
Skill assessment in microsurgery is complex; faster procedures do not always mean better performance. This study introduces a "Safe Pace" benchmark, a speed range where errors decrease, offering a more reliable indicator for training and evaluation.
Area of Science:
- Microsurgery skill assessment
- Surgical training and performance metrics
- Biomedical engineering and data analysis
Background:
- Traditional microsurgery skill assessment often equates speed with proficiency, overlooking quality.
- Objective measures and precise variable selection are crucial for accurate skill evaluation.
- Existing methods struggle to differentiate true skill improvement from mere acceleration.
Purpose of the Study:
- To analyze the progression of time variables during microsurgical skill training.
- To develop new tools for thorough assessment and evaluation of temporal performance.
- To challenge the notion that faster procedures equate to improved microsurgical skill.
Main Methods:
- A microsurgical protocol was used, chronologically recording procedures and time/error data.
- Data collected via Misat-APP®, exported to PostgreSQL®, and analyzed using Python® scripts.
- Statistical analysis included regression modeling (R²), standard deviation (±2 SD) for outlier removal, and calculation of an average-zero (AVO) index and 'Safe Pace' range.
Main Results:
- 150 procedures were analyzed, revealing significant fluctuations in Time to Complete the Task (TCT) (R² = 0.601).
- Longer inter-session gaps (>10 days) correlated with increased TCT in subsequent sessions (p = 0.009).
- A significant 'Safe Pace' range (±0.2 SD from AVO) was identified (1,362.88-1,563.67 seconds; p = 0.012), indicating reduced errors within this speed.
- Excessively fast procedures in experienced operators were linked to a higher error risk.
Conclusions:
- Time alone is a low-reliability indicator for microsurgical skill assessment due to sensitivity to external factors.
- The 'Safe Pace' concept provides a valuable benchmark for guiding trainees and evaluating performance.
- Further research is needed to confirm these findings, which suggest that optimal speed, not maximum speed, is key to skill mastery.
