A. D. D’Angelo1, D. N. Rutherford1,2, R. D. Ray1, A. Mason2, C. M. Pugh1 1University Of Wisconsin,Department Of Surgery, School Of Medicine And Public Health,Madison, WI, USA 2University Of Wisconsin,Department Of Kinesiology, School Of Education,Madison, WI, USA
Introduction: Objective measures of surgical skills are needed. Motion capture technology allows for quantification of psychomotor performance. The study aim was to evaluate how tissue characteristics influence psychomotor performance during a suturing task. Our hypothesis was that participants would alter their technique to improve performance with each subsequent stitch placed while suturing.
Methods: Surgical attendings (N=6), residents (N=4) and medical students (N=5) performed three interrupted sutures on three simulated tissue types: foam (dense connective tissue), rubber balloons (artery) and tissue paper (friable tissue). An optical motion tracking system captured performance data from participants’ bilateral hand movements. In prior studies, these three tissue types were able to differentiate experience level using path length and total procedure time. Additionally, longer path lengths and suture time helped to confirm that suturing on tissue paper (friable tissue) was the more difficult task compared to foam and balloon. In the current study, path length and suture time were stratified by stitch number to investigate changes in performance with each subsequent stitch. Repeated measures ANOVA was used to evaluate for main effects of stitch order on path length and suture time and interactions between stitch order, material and experience.
Results:When participants sutured the tissue paper (friable tissue), they changed their path length in a linear fashion with the first stitch on the tissue paper having the longest path length and the third stitch the shortest (F(4,44)=4.64, p=.003) (Table 1). Similarly, it took participants less time to perform subsequent stitches in the tissue paper, with the first stitch taking the most time and the third stitch taking the least of time (F(4,44)=5.14, p=.017). Participants did not change their path lengths and suture times when placing the first through third stitches in the foam and balloon materials (p=.910, p=.769). The interaction of experience level and stitch order was non-significant for both path length and suture time (F(4,22)=1.18, p=.345; F(4,22)=1.28, p=.316).
Conclusion:This study demonstrates quantifiable real time adaptation by participants to material characteristics while performing a suturing task. Participants had longer path lengths and took more time to place sutures in the friable tissue paper. Importantly they improved their performance on these measures with each subsequent stitch, indicating changes in psychomotor planning or performance. This adaptation did not occur with the less difficult suturing tasks. Motion capture technology is a promising method for investigating surgical performance and understanding how surgeons adapt to operative complexity.
