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Ostetrics and Gynecology


OBJECTIVE: To demonstrate the feasibility of using video motion analysis to quantitate a key step of vaginal hysterectomy and define measurable differences between novice and experienced surgical trainees during vaginal hysterectomy.

METHODS: Analyses focused on clamping, transecting, and suturing the left uterosacral ligament. Using a cutoff of 25, trainees were grouped as experienced (n=14) and novice (n=9) based on the total number of vaginal hysterectomies performed by each trainee. Contrasting-groups analysis was used to determine cutoff values that separated novices from experts.

RESULTS: Novice trainees took longer (112 seconds compared with 84 seconds) and had greater cumulative translational motion (92 cm compared with 49 cm, P=.05) while performing the task. Experienced trainees placed the Heaney clamp closer to a right angle to the vertical axis (experienced 96° compared with novice 109°, P=.03) while passing the needle through the uterosacral ligament. Trainees move from novice to experts when the steps occur in 112 or fewer seconds, cumulative translational motion is at or less than 75 cm, and the angle between the clamp to bladder retractor is at or below 105°.

CONCLUSION: Video motion analysis is a feasible technique to quantify and compare surgical skills objectively during vaginal surgery. There are measurable differences between novice and more experienced surgical trainees performing vaginal hysterectomy that can be quantified using motion analysis.


Presented at the 29th Annual Scientific Meeting of the American Urogynecologic Society, September 4–6, 2008, Chicago, Illinois, and at the Annual Meeting of the Association of Professors of Gynecology and Obstetrics and Council on Resident Education in Obstetrics and Gynecology, March 11–14, 2009, San Diego, California.