Instrument Tracking as a Modality for Determining Surgical Autonomy and Progression in Endoscopic Endonasal Surgery

Introduction: Surgical training has long relied on the apprenticeship model of education (McDougall 2007). However, with changing ACGME work-hour requirements and the increasing scope of endoscopic endonasal surgery, a thoughtful and graduated approach to endoscopic endonasal surgery is essential. There has been little research looking into the competence and confidence of neurosurgical trainees in endoscopic endonasal surgery. Our own preliminary data suggests that endoscopic endonasal skills may be more emphasized in otolaryngology residents compared to neurosurgery residents ([Figs. 1] and [2]). However, besides subjective assessments of resident autonomy and case minimums, there are no objective methods for determining resident involvement in a case. We plan to use instrument tracking to determine neurosurgical resident involvement in endoscopic endonasal cases and to identify transitional moments where control of instruments is given over to the attendings.

Methods: We will conduct a pilot program to use instrument tracking as a way of assessing autonomy and progression of surgical skills in endoscopic endonasal surgery in neurosurgical residents. Neurosurgical residents assigned to the endoscopic endonasal cases will be prospectively included in the study. We will plan to record the cases (both from an endoscope and from a camera recording the surgical field) and use the color of the gloves as tags (green for residents and white for attendings). We will then go through this data to tag portions of the case that the resident performed and correlate that with the resident autonomy data. As our pilot is conducted, only one type of surgical case will be included to provide proof of concept: endoscopic endonasal resection for sellar region masses. We intend to document a total of 10 cases for preliminary analysis.

Results: Several key questions can be answered with this data. Which instruments can serve as a proxy for certain portions of a case? Can we rigorously define for a given segment of the procedure what the resident’s role is? We are particularly interested in transitional events where the instruments transition from resident to attending, since those events indicate the next step in progression of surgical autonomy.

Conclusion: This project represents a pilot program to evaluate the utility of instrument tracking in resident education. If successful, such a model can be applied to other surgical procedures to improve efficiency in surgical education.

Fig. 1 Neurosurgery resident comfort with key operative skills.

Fig. 2 ENT resident comfort with key operative skills.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
05 February 2024