Automated objective surgical skill assessment in the operating room from unstructured tool motion in septoplasty

Narges Ahmidi, Piyush Poddar, Jonathan D. Jones, S. Swaroop Vedula, Lisa Ishii, Gregory D. Hager, Masaru Ishii

Research output: Contribution to journalArticlepeer-review

39 Scopus citations


Purpose: Previous work on surgical skill assessment using intraoperative tool motion has focused on highly structured surgical tasks such as cholecystectomy and used generic motion metrics such as time and number of movements. Other statistical methods such as hidden Markov models (HMM) and descriptive curve coding (DCC) have been successfully used to assess skill in structured activities on bench-top tasks. Methods to assess skill and provide effective feedback to trainees for unstructured surgical tasks in the operating room, such as tissue dissection in septoplasty, have yet to be developed. Methods: We proposed a method that provides a descriptive structure for septoplasty by automatically segmenting it into higher-level meaningful activities called strokes. These activities characterize the surgeon’s tool motion pattern. We constructed a spatial graph from the sequence of strokes in each procedure and used its properties to train a classifier to distinguish between expert and novice surgeons. We compared the results from our method with those from HMM, DCC, and generic metric-based approaches. Results: We showed that our method—with an average accuracy of 91 %—performs better or equal than these state-of-the-art methods, while simultaneously providing surgeons with an intuitive understanding of the procedure. Conclusions: In this study, we developed and evaluated an automated approach to objectively assess surgical skill during unstructured task of tissue dissection in nasal septoplasty.

Original languageEnglish (US)
Pages (from-to)981-991
Number of pages11
JournalInternational Journal of Computer Assisted Radiology and Surgery
Issue number6
StatePublished - Jun 1 2015


  • Feature extraction
  • Feedback
  • Partially observed time series
  • Septoplasty
  • Surgical skill assessment
  • Unstructured activities

ASJC Scopus subject areas

  • Surgery
  • Biomedical Engineering
  • Radiology Nuclear Medicine and imaging
  • Computer Vision and Pattern Recognition
  • Health Informatics
  • Computer Science Applications
  • Computer Graphics and Computer-Aided Design


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