Analysis of Instrument Motion and the Impact of Residency Level and Concurrent Distraction on Laparoscopic Skills.

OBJECTIVE: Using a laparoscopic box trainer fitted with motion analysis trackers and software, we aim to identify differences between junior and senior residents performing the peg transfer task, and the impact of a distracting secondary task on performance. DESIGN: General surgery residents were asked to perform the laparoscopic peg transfer task on a trainer equipped with a motion tracker. They were also asked to perform the laparoscopic task while completing a secondary task. Extreme velocity and acceleration events of instrument movement in the 3 rotational degrees of freedom were measured during task completion. The number of extreme events, defined as velocity or acceleration exceeding 1 SD above or below their own mean, were tabulated. The performance of junior residents was compared to senior residents. SETTING: Simulation learning institute, Beaumont Hospital, Royal Oak, Michigan. PARTICIPANTS: Thirty-seven general surgery residents from Beaumont Hospital, Royal Oak. RESULTS: When completing the primary task alone, senior residents executed significantly fewer extreme motion events specific to acceleration in pitch (16.63 vs. 20.69, p = 0.04), and executed more extreme motion events specific to velocity in roll (16.14 vs. 15.11, p = 0.038), when compared to junior residents. With addition of a secondary task, senior residents had fewer extreme acceleration events specific to pitch, (14.69 vs. 22.22, p < 0.001). CONCLUSIONS: While junior and senior residents completed the peg transfer task with similar times, motion analysis identified differences in extreme motion events between the groups, even when a secondary task was added. Motion analysis may prove useful for real-time feedback during laparoscopic skill acquisition.