Development of a Sensor Technology to Objectively Measure Dexterity for Cardiac Surgical Proficiency

Background Technical skill is essential for good outcomes in cardiac surgery. However, no objective methods exist to measure dexterity while performing surgery. The purpose of this study was to validate sensor-based hand motion analysis (HMA) of technical dexterity while performing a graft anastomosis within a validated simulator. Methods Surgeons at various training levels performed an anastomosis while wearing flexible sensors (BioStamp nPoint, MC10 Inc) with integrated accelerometers and gyroscopes on each hand to quantify HMA kinematics. Groups were stratified as experts (n = 8) or novices (n = 18). The quality of the completed anastomosis was scored using the 10 Point Microsurgical Anastomosis Rating Scale (MARS10). HMA parameters were compared between groups and correlated with quality. Logistic regression was used to develop a predictive model from HMA parameters to distinguish experts from novices. Results Experts were faster (11 +/- 6 minutes vs 21 +/- 9 minutes; P = .012) and used fewer movements in both dominant (340 +/- 166 moves vs 699 +/- 284 moves; P = .003) and nondominant (359 +/- 188 moves vs 567 +/- 201 moves; P = .02) hands compared with novices. Experts' anastomoses were of higher quality compared with novices (9.0 +/- 1.2 MARS10 vs 4.9 +/- 3.2 MARS10; P = .002). Higher anastomosis quality correlated with 9 of 10 HMA parameters, including fewer and shorter movements of both hands (dominant, r = -0.65, r = -0.46; nondominant, r = -0.58, r = -0.39, respectively). Conclusions Sensor-based HMA can distinguish technical dexterity differences between experts and novices, and correlates with quality. Objective quantification of hand dexterity may be a valuable adjunct to training and education in cardiac surgery training programs.