Enhanced Training Benefits of Video Recording Surgery With Automated Hand Motion Analysis

Colin F. Mackenzie*, Shiming Yang, Evan Garofalo, Peter Fu Ming Hu, Darcy Watts, Rajan Patel, Adam Puche, George Hagegeorge, Valerie Shalin, Kristy Pugh, Guinevere Granite, Lynn G. Stansbury, Stacy Shackelford, Samuel Tisherman

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Background: Hand motion analysis by video recording during surgery has potential for evaluation of surgical performance. The aim was to identify how technical skill during open surgery can be measured unobtrusively by video recording during a surgical procedure. We hypothesized that procedural-step timing, hand movements, instrument use and Shannon entropy differ with expertise and training and are concordant with a performance-based validated individual procedure score. Methods: Surgeon and non-surgeon participants with varying training and levels of expertise were video recorded performing axillary artery exposure and control (AA) on un-preserved cadavers. Color-coded gloves permitted motion-tracking and automated extraction of entropy data from recordings. Timing and instrument-use metrics were obtained through observational video reviews. Shannon entropy measured speed, acceleration and direction by computer-vision algorithms. Findings were compared with individual procedure score for AA performance Results: Experts had lowest entropy values, idle time, active time and shorter time to divide pectoralis minor, using fewer instruments. Residents improved with training, without reaching expert levels, and showed deterioration 12–18 months later. Individual procedure scores mirrored these results. Non-surgeons differed substantially. Conclusions: Hand motion entropy and timing metrics discriminate levels of surgical skill and training, and these findings are congruent with individual procedure score evaluations. These measures can be collected using consumer-level cameras and analyzed automatically with free software. Hand motion with video timing data may have widespread application to evaluate resident performance and can contribute to the range of evaluation and testing modalities available to educators, training course designers and surgical quality assurance programs.

Original languageEnglish
Pages (from-to)981-987
Number of pages7
JournalWorld Journal of Surgery
Issue number4
StatePublished - Apr 2021
Externally publishedYes


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