Objective Technical Proficiency Assessment in Ultrasound-Guided Lumpectomy

Lumpectomy is a challenging procedure that requires careful excision of the tumor so as to ensure negative margins. This is especially difficult in cases where the tumor is non-palpable and ultrasound is required. We aimed to assess whether primitive measures of skill could discriminate between novices, intermediates, and experts.

Ten novice, ten intermediate, and ten expert participants performed lumpectomy on two palpable and two non-palpable tumors. Participants’ ultrasound, scalpel, and hands were tracked relative to a needle that loaclized thbe tumour. From this tracking information, we objectively assessed participants margins, the number of times they entered the tumor, and the completeness of their ultrasound scan, as well as generic hand motion. We also measured the amount of time spent in each phases of the lumpectomy, the mass of the tumor removed, and whether there were positive margins.

Our training setup showed that such primitve metrics derived from motion tracking data are both reliable and valid. This was indicated by strong test-retest reliability and significantly different metric values for the different groups.

The proposed training setup is a reliable and valid tool for technical skills assessment in lumpectomy. This can be used to track trainee learning curves as they progress through a training course. We believe that this platform could be further extended to other types of resection.

Related Publications

Yeo, C. T., Ring, J., Holden, M. S., Ungi, T., Toprak, A., Fichtinger, G., Zevin, B. (2019). Surgery Tutor for Computational Assessment of Technical Proficiency in Soft-Tissue Tumor Resection in a Simulated Setting. Journal of surgical education 76 (3) 872-880.