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Quantifying surgical complexity: how smoothness metrics vary in robotic cholecystectomy
Elizabeth W Tindal1,2,3, Mattia Ballo4,5, Jeffrey E Nussbaum6,5
1Department of Surgery, Lenox Hill Hospital, Northwell Health, 186 E 76Th Street, 1St Fl, New York, NY, 10021, USA. liztindal@gmail.com.
Surgical Endoscopy
|January 9, 2026
Summary
Robotic surgery smoothness metrics reveal that complex cholecystectomy cases show reduced instrument movement quality. These objective performance indicators (OPIs) can help identify surgeons needing assistance during challenging procedures.
Area of Science:
- Robotic Surgery
- Surgical Performance Metrics
- Minimally Invasive Procedures
Background:
- Objective performance indicators (OPIs) measure instrument movement during robotic surgery.
- Movement smoothness is a key OPI for assessing surgical skill.
- This study investigates smoothness metrics during cholecystectomy.
Purpose of the Study:
- To analyze smoothness metrics in cholecystectomy.
- To determine if longer, more complex tasks correlate with reduced movement smoothness.
- To evaluate the impact of case complexity and arm function on OPIs.
Main Methods:
- Analyzed cholecystectomy videos using Parkland grading for severity.
- Categorized cases into complex dissection (CD) vs. standard dissection (SD) based on operative step duration.
- Evaluated smoothness OPIs (MAPR, spalength, normspeed, SPR, nlognJerk) for Calot triangle dissection (CTD) and liver bed dissection (LBD), stratified by arm function (dominant arm vs. active retraction).
Main Results:
- Fifty-four cholecystectomy videos were analyzed.
- Complex dissection cases had significantly higher Parkland grades during Calot triangle dissection.
- Smoothness profiles differed between dominant arm and active retraction in complex dissection cases for both CTD and LBD, with significant reductions in specific OPIs.
Conclusions:
- Case difficulty significantly impacts smoothness metrics in robotic cholecystectomy.
- Smoothness OPIs can serve as indicators of surgical difficulty or surgeon struggle.
- These metrics may guide intraoperative support or post-case performance reviews.
