Comparative analysis of surgical processes for image-guided endoscopic sinus surgery

  • Takaaki Sugino
  • Ryoichi NakamuraEmail author
  • Akihito Kuboki
  • Osamu Honda
  • Masashi Yamamoto
  • Nobuyoshi Ohtori
Original Article



This study proposes a method to analyze surgical performance by modeling, aligning, and comparing surgical processes. This method is intended to serve as a means to support the enhancement of surgical skills for endoscopic sinus surgeries (ESSs). We focus on surgical navigation systems used in image-guided ESSs and aim to construct a comparative analysis method for surgical processes based on the information about the surgical instruments motion obtained from the navigation system.


The proposed method consists of the following three parts: quantification of surgical features, modeling of surgical processes, and alignment and comparison of surgical process models (SPMs). First, we defined time-series parameters using the navigation-based surgical data. Second, we created SPMs by applying the defined parameters and the relative positional information of the instruments to the patient’s anatomy. Third, we constructed a method to align and compare SPMs based on dynamic time warping with barycenter averaging.


The proposed method was validated on a dataset containing surgical data obtained by an optical tracking system from 14 clinical ESS cases. We evaluated the validity of the comparative analysis by aligning and comparing SPMs between experts and residents. The validation results suggested that the proposed method could achieve proper alignment of the SPMs and clarify the differences in surgical processes between experts and residents.


We developed a method to enable a time-series comparative analysis of surgical processes based on the surgical data from the navigation system. This method can allow surgeons to identify differences between their procedures and reference procedures such as experts’ procedures.


Surgical workflow analysis Surgical process modeling Surgical skill evaluation Surgical navigation system Endoscopic sinus surgery 



This research was supported by the Grants-in-Aid (KAKENHI) from the Ministry of Education, Culture, Sports, Science and Technology (MEXT; Nos. 24103704 and 15H03029), JST PRESTO (JPMJPR16D9), and the Research Grant (C) from the Tateishi Science and Technology Foundation.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© CARS 2018

Authors and Affiliations

  1. 1.Graduate School of EngineeringChiba UniversityChibaJapan
  2. 2.Center for Frontier Medical EngineeringChiba UniversityChibaJapan
  3. 3.Faculty of EngineeringChiba UniversityChibaJapan
  4. 4.PRESTO, Japan Science and Technology AgencySaitamaJapan
  5. 5.Department of OtorhinolaryngologyThe Jikei University School of MedicineTokyoJapan

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