Objective classification of psychomotor laparoscopic skills of surgeons based on three different approaches

  • Fernando Pérez-Escamirosa
  • Antonio Alarcón-ParedesEmail author
  • Gustavo Adolfo Alonso-Silverio
  • Ignacio Oropesa
  • Oscar Camacho-Nieto
  • Daniel Lorias-Espinoza
  • Arturo Minor-Martínez
Original Article



The determination of surgeons’ psychomotor skills in minimally invasive surgery techniques is one of the major concerns of the programs of surgical training in several hospitals. Therefore, it is important to assess and classify objectively the level of experience of surgeons and residents during their training process. The aim of this study was to investigate three classification methods for establishing automatically the level of surgical competence of the surgeons based on their psychomotor laparoscopic skills.


A total of 43 participants, divided into an experienced surgeons group with ten experts (> 100 laparoscopic procedures performed) and non-experienced surgeons group with 24 residents and nine medical students (< 10 laparoscopic procedures performed), performed three tasks in the EndoViS training system. Motion data of the instruments were captured with a video-tracking system built into the EndoViS simulator and analyzed using 13 motion analysis parameters (MAPs). Radial basis function networks (RBFNets), K-star (K*), and random forest (RF) were used for classifying surgeons based on the MAPs’ scores of all participants. The performance of the three classifiers was examined using hold-out and leave-one-out validation techniques.


For all three tasks, the K-star method was superior in terms of accuracy and AUC in both validation techniques. The mean accuracy of the classifiers was 93.33% for K-star, 87.58% for RBFNets, and 84.85% for RF in hold-out validation, and 91.47% for K-star, 89.92% for RBFNets, and 83.72% for RF in leave-one-out cross-validation.


The three proposed methods demonstrated high performance in the classification of laparoscopic surgeons, according to their level of psychomotor skills. Together with motion analysis and three laparoscopic tasks of the Fundamental Laparoscopic Surgery Program, these classifiers provide a means for objectively classifying surgical competence of the surgeons for existing laparoscopic box trainers.


Laparoscopic surgery Training Motion analysis Objective assessment Classification Video-based tracking 



The authors want to thank all the surgeons, residents, and medical students for their enthusiastic and kindly participation in this study.


The authors declare that no grants or funding sources were received for this work.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

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


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Copyright information

© CARS 2019

Authors and Affiliations

  1. 1.Instituto de Ciencias Aplicadas y Tecnología (ICAT)Universidad Nacional Autónoma de México (UNAM)Ciudad de MéxicoMexico
  2. 2.Department of Biomedical Informatics, Faculty of MedicineUniversidad Nacional Autónoma de México (UNAM)Ciudad de MéxicoMexico
  3. 3.Laboratory of Computing Technologies and Electronics, Faculty of EngineeringUniversidad Autónoma de GuerreroChilpancingoMexico
  4. 4.Biomedical Engineering and Telemedicine Centre (GBT), ETSI Telecomunicación, Center for Biomedical TechnologyUniversidad Politécnica de Madrid (UPM)MadridSpain
  5. 5.Intelligent Computing LaboratoryCentro de Innovación y Desarrollo Tecnológico en Computación (CIDETEC-IPN)Ciudad de MéxicoMexico
  6. 6.Department of Electrical Engineering, Bioelectronics SectionCentro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV–IPN)Ciudad de MéxicoMexico

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