Abstract
INTRODUCTION: Understanding the factors that contribute to efficient surgical behaviour and the prevention of technical errors poses a significant challenge in neurosurgery. Current training curricula lack proficiency-centred training and objective tools to assess surgical performance, leading to considerable variability in surgical competencies and practices among neurosurgeons. This study aims to evaluate the determinants of proficient surgical behaviour exhibited by expert surgeons, with the goal of establishing a set of surgical performance metrics serving as a foundation for objective assessment and benchmarking of surgical performance. MATERIAL AND METHODS: Eight aneurysm clipping cases by three senior neurosurgeons were recorded via a surgical microscope. Surgeons' actions, workflow parameters, and adverse events during Sylvian fissure dissection were catalogued into Surgical Process Models (SPMs). Performance metrics were extracted, compared, and analysed using clustering analysis to assess proficiency differences. RESULTS: 23 parameters were identified as potential metrics of surgical proficiency. Proficient surgeons exhibited predominant bimanual activity, optimal non-dominant hand use, a limited tool repertoire, minimal instrument changes, and efficient microscope use with minimal adjustments. Despite varying instrument and microscope usage, practitioners achieved consistent outcomes across metrics, indicating similar surgical proficiency. DISCUSSION AND CONCLUSION: Findings illustrate that performance metrics derived from surgical video analysis can reliably contribute to the assessment of surgical skills. SPMs offer a structured understanding of the factors that contribute to surgical proficiency. This approach provides an optimal framework for objective assessment of performance metrics, demonstrating potential for automated and objective analysis of surgical performance.