Introduction: Minimally invasive surgery has revolutionized surgical practice, but challenges remain. Trainees must acquire complex technical skills while minimizing patient risk, and surgeons must maintain their skills for rare procedures. These challenges are magnified in pediatric surgery due to the smaller spaces, finer tissue, and relative dearth of both inanimate and virtual simulators. To build technical expertise, trainees need opportunities for deliberate practice with specific performance feedback, which is typically provided via tedious human grading. This study aimed to validate a novel motion-tracking system and machine learning algorithm for automatically evaluating trainee performance on a pediatric laparoscopic suturing task using a 1–5 OSATS Overall Skill rating.
Methods: Subjects (n=14) ranging from medical students to fellows per- formed one or two trials of an intracorporeal suturing task in a custom pediatric laparoscopy training box (Fig. 1) after watching a video of ideal performance by an expert. The position and orientation of the tools and endoscope were recorded over time using Ascension trakSTAR magnetic motion-tracking sensors, and both instrument grasp angles were recorded over time using flex sensors on the handles. The 27 trials were video-recorded and scored on the OSATS scale by a senior fellow; ratings ranged from 1 to 4. The raw motion data from each trial was processed to calculate over 200 preliminary motion parameters. Regularized least-squares regression (LASSO) was used to identify the most predictive parameters for inclusion in a regression tree. Model performance was evaluated by leave-one-subject-out cross validation, wherein the automatic scores given to each subject’s trials (by a model trained on all other data) are compared to the corresponding human rater scores.
Results: The best-performing LASSO algorithm identified 14 predictive parameters for inclusion in the regression tree, including completion time, linear path length, angular path length, angular acceleration, grasp velocity, and grasp acceleration. The final model’s raw output showed a strong positive correlation of 0.87 with the reviewer-generated scores, and rounding the output to the nearest integer yielded a leave-one-subject-out cross-validation accuracy of 77.8%. Results are summarized in the confusion matrix (Table 1).
Conclusions: Our novel motion-tracking system and regression model automatically gave previously unseen trials overall skill scores that closely match scores from an expert human rater. With additional data and further development, this system may enable creation of a motion-based training platform for pediatric laparoscopic surgery and could yield insights into the fundamental components of surgical skill.