Surgical Skill Assessment Using Machine Learning Algorithms

Abstract Objective Surgical skill is correlated with clinical outcomes. Therefore, the assessment of surgical skill is of major importance to improve clinical outcomes and increase patient safety. However, surgical skill assessment often lacks objectivity and reproducibility. Furthermore, it is time-consuming and expensive. Therefore, we developed an automated surgical skill assessment using machine learning algorithms. Methods Surgical skills were assessed in videos of laparoscopic cholecystectomy using a three-step machine learning algorithm. First, a three-dimensional convolutional neural network was trained to localize and classify the instruments within the videos. Second, movement patterns of the instruments were recorded over time and extracted. Third, the movement patterns were correlated with human surgical skill ratings using a linear regression model to predict surgical skill ratings automatically. Machine ratings were compared against human ratings of four board certified surgeons using a score ranging from 1 (poor skills) to 5 (excellent skills). Results Human raters and machine learning algorithms assessed surgical skills in 242 videos. Inter-rater reliability for human raters was excellent (79%, 95%CI 72-85%). Instrument detection showed an average precision of 78% and average recall of 82%. Machine learning algorithms showed an 87% accuracy in predicting good or poor surgical skills, when compared to human raters. Conclusion Machine learning algorithms can be trained to distinguish good and poor surgical skills with high accuracy. This work was published in Sci Rep 11, 5197 (2021). https://doi.org/10.1038/s41598-021-84295-6