Objective assessment of colonoscope manipulation skills in colonoscopy training

Matthew S. Holden, Chang Nancy Wang, Kyle MacNeil, Ben Church, Lawrence Hookey, Gabor Fichtinger, Tamas Ungi

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Objective: Manipulation of the colonoscope is a technical challenge for novice clinicians which is best learned in a simulated environment. It involves the coordination of scope tip steering with scope insertion, using a rotated image as reference. The purpose of this work is to develop and validate a system which objectively assesses colonoscopy technical skills proficiency in an arbitrary training environment, allowing novices to assess their technical proficiency prior to real patient encounters. Methods: We implemented a motion tracking setup to objectively analyze and assess the way operators perform colonoscopies, including an analysis of wrist and elbow joint motions. Subsequently, we conducted a validation study to verify whether our motion analysis could discriminate novice colonoscopists from experts. Participants navigated a wooden bench-top model using a standard colonoscope while their motions were tracked. Results: The developed motion tracking setup allowed colonoscopists of varying levels of proficiency to have their colonoscope manipulation assessed, and was able to be operated by a trained non-technical operator. Novice operators had significantly greater median times (101.5 vs. 31.5 s) and number of hand movements (62.0 vs. 21.5) than experts. Experts, however, spent a significantly greater proportion of time in extreme ranges of wrist and elbow joint motion than novices. Conclusion: We have developed and implemented a hand and joint motion analysis system that is able to discriminate novices from experts based on objective measures of motion. These metrics could, thus, serve as proxies for technical proficiency during training.

Original languageEnglish (US)
Pages (from-to)1-10
Number of pages10
JournalInternational journal of computer assisted radiology and surgery
StateAccepted/In press - Oct 30 2017
Externally publishedYes


  • Colonoscopy
  • Medical education
  • Objective skill assessment
  • Simulation-based training

ASJC Scopus subject areas

  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Health Informatics


Dive into the research topics of 'Objective assessment of colonoscope manipulation skills in colonoscopy training'. Together they form a unique fingerprint.

Cite this