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Recording of Surgical Processes: A Study Comparing Senior and Junior Neurosurgeons During Lumbar Disc Herniation Surgery

Riffaud, Laurent MD1; Neumuth, Thomas PhD2; Morandi, Xavier MD1; Trantakis, Christos MD3; Meixensberger, Jürgen MD, PhD3; Burgert, Oliver PhD2; Trelhu, Brivael MSc4; Jannin, Pierre PhD4

doi: 10.1227/NEU.0b013e3181f741d7
Instrumentation Assessment

BACKGROUND: Evaluating surgical practice in the operating room is difficult, and its assessment is largely subjective.

OBJECTIVE: Recording of standardized spine surgery processes was conducted to ascertain whether any significant differences in surgical practice could be observed between senior and junior neurosurgeons.

METHODS: Twenty-four procedures of lumbar discectomies were consecutively recorded by a senior neurosurgeon. In 12 cases, surgery was entirely performed by a senior neurosurgeon with the aid of a resident, and in the 12 remaining cases, surgery was performed by a resident with the aid of a senior neurosurgeon. The data recorded were general parameters (operating time for the whole procedure and for each step), and general and specific parameters of the surgeon's activities (number of manual gestures, number and duration of actions performed, use of the instruments, and use of interventions on anatomic structures). The Mann-Whitney U test was used for comparison between the 2 groups of neurosurgeons.

RESULTS: The operating time was statistically lower for the group of senior surgeons. The seniors statistically demonstrated greater economy in time and in gestures during the closure step, for sewing and for the use of scissors, needle holders, and forceps. The senior surgeons statistically worked for a shorter time on the skin and used fewer manual gestures on the thoracolumbalis fascia. The number of changes in microscope position was also statistically lower for this group.

CONCLUSION: There is a relationship between surgical practice, as determined by a method of objective measurement using observation software, and surgical experience: gesture economy evolves with seniority.

1Department of Neurosurgery, Rennes University Hospital, INSERM, U746, Faculty of Medicine, INRIA, VisAGeS Unit/Project, CNRS, UMR 6074, IRISA, University of Rennes I, Rennes, France

2Innovation Center Computer Assisted Surgery, University of Leipzig, Leipzig, Germany

3Innovation Center Computer Assisted Surgery, University of Leipzig, Department of Neurosurgery, Leipzig University Hospital, Leipzig, Germany

4INSERM, U746, Faculty of Medicine, INRIA, VisAGeS Unit/Project, CNRS, UMR 6074, IRISA, University of Rennes I, Rennes, France

Received, May 10, 2009.

Accepted, April 19, 2010.

Reprint requests: Laurent Riffaud, MD, Service de Neurochirurgie, Hôpital Pontchaillou, rue Henri Le Guilloux, 35033 Rennes cédex 9, France. E-mail:

Copyright © by the Congress of Neurological Surgeons