Revisiting sylvian fissure dissection - A preliminary investigation into surgical process modelling for evaluating surgical proficiency

Félix Buyck; Jef Vandemeulebroucke; Ine Dirks; Jan Frederick Cornelius; Johnny Duerinck; Sebastien Froelich; Henry W S Schroeder; Wietse Geens; Frederick Van Gestel; Michaël Bruneau

doi:10.1016/j.bas.2025.104284

Revisiting sylvian fissure dissection - A preliminary investigation into surgical process modelling for evaluating surgical proficiency

Félix Buyck, Jef Vandemeulebroucke, Ine Dirks, Jan Frederick Cornelius, Johnny Duerinck, Sebastien Froelich, Henry W S Schroeder, Wietse Geens, Frederick Van Gestel, Michaël Bruneau

Research output: Contribution to journal › Article › peer-review

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.

Original language	English
Article number	104284
Number of pages	7
Journal	Brain and spine
Volume	5
Issue number	104284
DOIs	https://doi.org/10.1016/j.bas.2025.104284
Publication status	Published - 16 May 2025

Bibliographical note

Publisher Copyright:
© 2025 The Authors

Keywords

surgical process modelling
skill assessment
surgical video analysis
Sylvian fissure dissection
proficiency

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10.1016/j.bas.2025.104284

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Buyck, F., Vandemeulebroucke, J., Dirks, I., Cornelius, J. F., Duerinck, J., Froelich, S., Schroeder, H. W. S., Geens, W., Van Gestel, F., & Bruneau, M. (2025). Revisiting sylvian fissure dissection - A preliminary investigation into surgical process modelling for evaluating surgical proficiency. Brain and spine , 5(104284), Article 104284. https://doi.org/10.1016/j.bas.2025.104284

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title = "Revisiting sylvian fissure dissection - A preliminary investigation into surgical process modelling for evaluating surgical proficiency",

abstract = "Introduction: Understanding the factors that contribute to efficient surgical behaviour and the prevention oftechnical errors poses a significant challenge in neurosurgery. Current training curricula lack proficiency-centredtraining and objective tools to assess surgical performance, leading to considerable variability in surgical competenciesand practices among neurosurgeons. This study aims to evaluate the determinants of proficient surgicalbehaviour exhibited by expert surgeons, with the goal of establishing a set of surgical performance metricsserving 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 surgicalmicroscope. Surgeons{\textquoteright} actions, workflow parameters, and adverse events during Sylvian fissure dissection werecatalogued into Surgical Process Models (SPMs). Performance metrics were extracted, compared, and analysedusing clustering analysis to assess proficiency differences.Results: 23 parameters were identified as potential metrics of surgical proficiency. Proficient surgeons exhibitedpredominant bimanual activity, optimal non-dominant hand use, a limited tool repertoire, minimal instrumentchanges, and efficient microscope use with minimal adjustments. Despite varying instrument and microscopeusage, practitioners achieved consistent outcomes across metrics, indicating similar surgical proficiency.Discussion and conclusion: Findings illustrate that performance metrics derived from surgical video analysis canreliably contribute to the assessment of surgical skills. SPMs offer a structured understanding of the factors thatcontribute to surgical proficiency. This approach provides an optimal framework for objective assessment ofperformance metrics, demonstrating potential for automated and objective analysis of surgical performance.",

keywords = "surgical process modelling, skill assessment, surgical video analysis, Sylvian fissure dissection, proficiency",

author = "F{\'e}lix Buyck and Jef Vandemeulebroucke and Ine Dirks and Cornelius, {Jan Frederick} and Johnny Duerinck and Sebastien Froelich and Schroeder, {Henry W S} and Wietse Geens and {Van Gestel}, Frederick and Micha{\"e}l Bruneau",

note = "Publisher Copyright: {\textcopyright} 2025 The Authors",

year = "2025",

month = may,

day = "16",

doi = "10.1016/j.bas.2025.104284",

language = "English",

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AU - Buyck, Félix

AU - Vandemeulebroucke, Jef

AU - Dirks, Ine

AU - Cornelius, Jan Frederick

AU - Duerinck, Johnny

AU - Froelich, Sebastien

AU - Schroeder, Henry W S

AU - Geens, Wietse

AU - Van Gestel, Frederick

AU - Bruneau, Michaël

PY - 2025/5/16

Y1 - 2025/5/16

N2 - Introduction: Understanding the factors that contribute to efficient surgical behaviour and the prevention oftechnical errors poses a significant challenge in neurosurgery. Current training curricula lack proficiency-centredtraining and objective tools to assess surgical performance, leading to considerable variability in surgical competenciesand practices among neurosurgeons. This study aims to evaluate the determinants of proficient surgicalbehaviour exhibited by expert surgeons, with the goal of establishing a set of surgical performance metricsserving 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 surgicalmicroscope. Surgeons’ actions, workflow parameters, and adverse events during Sylvian fissure dissection werecatalogued into Surgical Process Models (SPMs). Performance metrics were extracted, compared, and analysedusing clustering analysis to assess proficiency differences.Results: 23 parameters were identified as potential metrics of surgical proficiency. Proficient surgeons exhibitedpredominant bimanual activity, optimal non-dominant hand use, a limited tool repertoire, minimal instrumentchanges, and efficient microscope use with minimal adjustments. Despite varying instrument and microscopeusage, practitioners achieved consistent outcomes across metrics, indicating similar surgical proficiency.Discussion and conclusion: Findings illustrate that performance metrics derived from surgical video analysis canreliably contribute to the assessment of surgical skills. SPMs offer a structured understanding of the factors thatcontribute to surgical proficiency. This approach provides an optimal framework for objective assessment ofperformance metrics, demonstrating potential for automated and objective analysis of surgical performance.

AB - Introduction: Understanding the factors that contribute to efficient surgical behaviour and the prevention oftechnical errors poses a significant challenge in neurosurgery. Current training curricula lack proficiency-centredtraining and objective tools to assess surgical performance, leading to considerable variability in surgical competenciesand practices among neurosurgeons. This study aims to evaluate the determinants of proficient surgicalbehaviour exhibited by expert surgeons, with the goal of establishing a set of surgical performance metricsserving 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 surgicalmicroscope. Surgeons’ actions, workflow parameters, and adverse events during Sylvian fissure dissection werecatalogued into Surgical Process Models (SPMs). Performance metrics were extracted, compared, and analysedusing clustering analysis to assess proficiency differences.Results: 23 parameters were identified as potential metrics of surgical proficiency. Proficient surgeons exhibitedpredominant bimanual activity, optimal non-dominant hand use, a limited tool repertoire, minimal instrumentchanges, and efficient microscope use with minimal adjustments. Despite varying instrument and microscopeusage, practitioners achieved consistent outcomes across metrics, indicating similar surgical proficiency.Discussion and conclusion: Findings illustrate that performance metrics derived from surgical video analysis canreliably contribute to the assessment of surgical skills. SPMs offer a structured understanding of the factors thatcontribute to surgical proficiency. This approach provides an optimal framework for objective assessment ofperformance metrics, demonstrating potential for automated and objective analysis of surgical performance.

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ER -

Revisiting sylvian fissure dissection - A preliminary investigation into surgical process modelling for evaluating surgical proficiency

Abstract

Bibliographical note

Keywords

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