“Stand-up straight!”: human pose estimation to evaluate postural skills during orthopedic surgery simulations

Purpose Surgery simulators can be used to learn technical and non-technical skills and, to analyse posture. Ergonomic skill can be automatically detected with a Human Pose Estimation algorithm to help improve the surgeon’s work quality. The objective of this study was to analyse the postural behaviour of surgeons and identify expertise-dependent movements. Our hypothesis was that hesitation and the occurrence of surgical instruments interfering with movement (defined as interfering movements) decrease with expertise. Material and methods Sixty surgeons with three expertise levels (novice, intermediate, and expert) were recruited. During a training session using an arthroscopic simulator, each participant’s movements were video-recorded with an RGB camera. A modified OpenPose algorithm was used to detect the surgeon's joints. The detection frequency of each joint in a specific area was visualized with a heatmap-like approach and used to calculate a mobility score. Results This analysis allowed quantifying surgical movements. Overall, the mean mobility score was 0.823, 0.816, and 0.820 for novice, intermediate and expert surgeons, respectively. The mobility score alone was not enough to identify postural behaviour differences. A visual analysis of each participants’ movements highlighted expertise-dependent interfering movements. Conclusion Video-recording and analysis of surgeon’s movements are a non-invasive approach to obtain quantitative and qualitative ergonomic information in order to provide feedback during training. Our findings suggest that the interfering movements do not decrease with expertise but differ in function of the surgeon’s level.