Movement-level process modeling of microsurgical bimanual and unimanual tasks

PURPOSE: Microsurgical techniques require highly skilled manual handling of specialized surgical instruments. Surgical process models are central for objective evaluation of these skills, enabling data-driven solutions that can improve intraoperative efficiency. METHOD: We built a surgical process model, defined at movement level in terms of elementary surgical actions ([Formula: see text] ) and targets ([Formula: see text] ). The model also included nonproductive movements, which enabled us to evaluate suturing efficiency and bi-manual dexterity. The elementary activities were used to investigate differences between novice ([Formula: see text] ) and expert surgeons ([Formula: see text] ) by comparing the cosine similarity of vector representations of a microsurgical suturing training task and its different segments. RESULTS: Based on our model, the experts were significantly more efficient than the novices at using their tools individually and simultaneously. At suture level, the experts were significantly more efficient at using their left hand tool, but the differences were not significant for the right hand tool. At the level of individual suture segments, the experts had on average 21.0 % higher suturing efficiency and 48.2 % higher bi-manual efficiency, and the results varied between segments. Similarity of the manual actions showed that expert and novice surgeons could be distinguished by their movement patterns. CONCLUSIONS: The surgical process model allowed us to identify differences between novices’ and experts’ movements and to evaluate their uni- and bi-manual tool use efficiency. Analyzing surgical tasks in this manner could be used to evaluate surgical skill and help surgical trainees detect problems in their performance computationally.