Revisiting sylvian fissure dissection - A preliminary investigation into surgical process modelling for evaluating surgical proficiency

IF 2.5 Q3 CLINICAL NEUROLOGY

Brain & spine Pub Date : 2025-01-01 DOI:10.1016/j.bas.2025.104284

Félix Buyck , Jef Vandemeulebroucke , Ine Dirks , Jan Frederick Cornelius , Johnny Duerinck , Sebastien Froelich , Henry Schroeder , Wietse Geens , Frederick Van Gestel , Michaël Bruneau

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Abstract

Introduction

Understanding the factors that contribute to efficient surgical behaviour and the prevention of technical errors poses a significant challenge in neurosurgery. Current training curricula lack proficiency-centred training and objective tools to assess surgical performance, leading to considerable variability in surgical competencies and practices among neurosurgeons. This study aims to evaluate the determinants of proficient surgical behaviour exhibited by expert surgeons, with the goal of establishing a set of surgical performance metrics serving as a foundation for objective assessment and benchmarking of surgical performance.

Material and methods

Eight aneurysm clipping cases by three senior neurosurgeons were recorded via a surgical microscope. Surgeons' actions, workflow parameters, and adverse events during Sylvian fissure dissection were catalogued into Surgical Process Models (SPMs). Performance metrics were extracted, compared, and analysed using clustering analysis to assess proficiency differences.

Results

23 parameters were identified as potential metrics of surgical proficiency. Proficient surgeons exhibited predominant bimanual activity, optimal non-dominant hand use, a limited tool repertoire, minimal instrument changes, and efficient microscope use with minimal adjustments. Despite varying instrument and microscope usage, practitioners achieved consistent outcomes across metrics, indicating similar surgical proficiency.

Discussion and conclusion

Findings illustrate that performance metrics derived from surgical video analysis can reliably contribute to the assessment of surgical skills. SPMs offer a structured understanding of the factors that contribute to surgical proficiency. This approach provides an optimal framework for objective assessment of performance metrics, demonstrating potential for automated and objective analysis of surgical performance.

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重访侧裂解剖-评估手术熟练程度的手术过程模型的初步研究

了解影响高效手术行为和预防技术错误的因素是神经外科的一个重大挑战。目前的培训课程缺乏以熟练程度为中心的培训和客观的工具来评估手术表现，导致神经外科医生的手术能力和实践存在相当大的差异。本研究旨在评估专家外科医生表现出的熟练手术行为的决定因素，目的是建立一套手术表现指标，作为客观评估和手术表现基准的基础。材料与方法在手术显微镜下记录了3名资深神经外科医生的8例动脉瘤夹闭病例。外科医生的行动，工作流程参数，以及在Sylvian裂缝解剖期间的不良事件被编目到手术过程模型（SPMs）中。使用聚类分析提取、比较和分析性能指标，以评估熟练程度差异。结果23个参数被确定为手术熟练程度的潜在指标。熟练的外科医生表现出主要的双手活动，最佳的非优势手使用，有限的工具，最小的仪器更换，最小的调整和有效的显微镜使用。尽管不同的仪器和显微镜的使用，从业人员取得一致的结果跨越指标，表明类似的手术熟练程度。讨论和结论研究结果表明，手术视频分析得出的性能指标可以可靠地评估手术技能。SPMs提供了有助于手术熟练程度的因素的结构化理解。该方法为客观评估手术性能指标提供了最佳框架，展示了自动和客观分析手术性能的潜力。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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