Influence of Surgeon's Expertise on the Duration of Approach and Closure during Osteosynthesis of Distal Radius Fractures

Abstract

Background The aim of this study was to determine whether the duration of the approach (PII) and closure (PV) phases for minimally invasive plate osteosynthesis (MIPO) of distal radius fractures varied according to the surgeon's level of expertise. The main hypothesis was that the PII or PV duration was inversely proportional to the level of expertise.

Materials and Methods The method measured the duration of PII and PV for 50 videos of MIPO operated by one surgeon with level 3^E expertise, three with level 4^E, and one with level 5^E. The videos were viewed to identify any technical errors.

Results The average PII duration was 3 minutes 8 seconds for level 5^E, 4 minutes 7 seconds for 4^E, and 6 minutes 19 seconds for 3^E. Average PV duration was 2 minutes 12 seconds for level 5^E, 2 minutes 36 seconds for 4^E, and 2 minutes 41 seconds for 3^E. The average duration of PII + PV was 5 minutes 20 seconds for level 5^E, 6 minutes 37 seconds for 4^E, and 9 minutes for 3^E. These findings indicate that both PII and PV duration was the longest in the level 3^E surgeons' practice. Six technical errors were identified for levels 3^E and 4^E during PII (hemostasis control, multiple incisions, instrument handling, improper use of the fluoroscope, time-outs) and PV (intradermal reattachment).

Clinical Relevance The main hypothesis was verified since the duration of PII or PV was inversely proportional to the surgeon's level of expertise. This study identified technical errors in hand surgery practices of new surgeons. By early identification and correcting these minor errors, it would be possible to speed up the learning curve. We recommend surgical videos to be systematically recorded and analyzed to improve hand surgery practices.

Type of Study/Level of Evidence Therapeutic/Level IIIa.

Keywords

operative time - surgical videos - approach - closure - expertise - distal radius fracture

Authors' Contributions

All authors contributed to the study. Conception and design were done by L.C., T.L., N.P., and P.L.). Material preparation, data collection and analysis were performed by C.G., L.E.A.. The first draft of the manuscript was written by P.L., L.C., and C.G.. Statistics was done by N. M.. Language editing was done by D.A.. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Ethical Approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Strasbourg University Hospitals.

Patients' Consent

Informed consent was obtained from the patients included in the study.

Publication History

Received: 15 July 2023

Accepted: 26 December 2023

Article published online:
08 March 2024

• References

• 1 Quick JA, Bukoski AD, Doty J. et al. Case difficulty, postgraduate year, and resident surgeon stress: effects on operative times. J Surg Educ 2019; 76 (02) 354-361
• 2 Johnson JJ, Thurman JB, Garwe T, Wallace K, Anastakis DJ, Lees JS. Variations in procedure time based on surgery resident postgraduate year level. J Surg Res 2013; 185 (02) 570-574
• 3 Garrow CR, Kowalewski KF, Li L. et al. Machine learning for surgical phase recognition: a systematic review. Ann Surg 2021; 273 (04) 684-693
• 4 Tang JB, Giddins G. Why and how to report surgeons' levels of expertise. J Hand Surg Eur Vol 2016; 41 (04) 365-366
• 5 Graëff C, Daiss A, Lampert T. et al. Preliminary stage in the development of an artificial intelligence algorithm: variations between 100 surgeons in phase annotation in a video of internal fixation of distal radius fracture. Orthop Traumatol Surg Res 2023; 109 (06) 103564
• 6 Liverneaux PA. The minimally invasive approach for distal radius fractures and malunions. J Hand Surg Eur Vol 2018; 43 (02) 121-130
• 7 Chowdhury MM, Dagash H, Pierro A. A systematic review of the impact of volume of surgery and specialization on patient outcome. Br J Surg 2007; 94 (02) 145-161
• 8 Cushen SE, Turkyilmaz I. Impact of operator experience on the accuracy of implant placement with stereolithographic surgical templates: an in vitro study. J Prosthet Dent 2013; 109 (04) 248-254
• 9 Sastry AV, Swet JH, Murphy KJ. et al. A novel 3-dimensional electromagnetic guidance system increases intraoperative microwave antenna placement accuracy. HPB (Oxford) 2017; 19 (12) 1066-1073
• 10 Weinstein JL, El-Gabalawy F, Sarwar A. et al. Analysis of kinematic differences in hand motion between novice and experienced operators in IR: a pilot study. J Vasc Interv Radiol 2021; 32 (02) 226-234
• 11 Yamaguchi S, Yoshida D, Kenmotsu H. et al. Objective assessment of laparoscopic suturing skills using a motion-tracking system. Surg Endosc 2011; 25 (03) 771-775
• 12 Milcent PAA, Kulcheski AL, Rosa FM, Dau L, Stieven Filho E. Construct validity and experience of using a low-cost arthroscopic knee surgery simulator. J Surg Educ 2021; 78 (01) 292-301
• 13 Dammerer D, Putzer D, Wurm A, Liebensteiner M, Nogler M, Krismer M. Progress in knee arthroscopy skills of residents and medical students: a prospective assessment of simulator exercises and analysis of learning curves. J Surg Educ 2018; 75 (06) 1643-1649
• 14 Tanaka T, Shimada Y, Furumoto H. et al. Comparative analysis of the results of video-assisted thoracic surgery lobectomy simulation using the three-dimensional-printed Biotexture wet-lung model and surgeons' experience. Interact Cardiovasc Thorac Surg 2021; 32 (02) 284-290
• 15 Ducournau F, El Amiri L, Vernet P, Sapa MC, Liverneaux P. Methods of assessment of the level of surgeons for minimally invasive fixation of distal radius fractures: “expertise” versus “performance”. Int Orthop 2023; 47 (01) 193-199
• 16 Graeff C, Lampert T, Mazellier JP, Padoy N, El Amiri L, Liverneaux P. The preliminary stage in developing an artificial intelligence algorithm: a study of the inter- and intra-individual variability of phase annotations in internal fixation of distal radius fracture videos. Art Int Surg 2023; 3: 147-159