New ‘Black Box’ Device Puts Surgeons’ Skills to the Test


A new tracking device may find its way into the operating room and measure – by video and movement – how well a surgeon performs during a robotic surgery.

Similar to a black box recorder that keeps track of an airplane’s status and whereabouts, the new device captures “surgeon performance metrics” that can assess the level of proficiency of a given surgeon, according to a study in The Journal of Urology.

Andrew Hung, M.D., with the “black box” recorder and da Vinci Surgical System. Credit: Ricardo Carrasco III

The recording device may not only monitor a physician’s skills but also can serve as a learning tool as more surgeons provide robotic surgery in the coming years, a trend that continues to proliferate.

Easing the learning curve may help standardize surgical preparation and techniques across the country, noted researchers from the Keck School of Medicine at the University of Southern California, who assessed the black box device on about 100 prostate surgeries.

“Robotic surgery has been widely adopted by urologic surgeons, but methods of assessing proficiency vary widely between institutions,” said lead author Dr. Andrew Hung, assistant professor of clinical urology at Keck Medicine.

What establishes a physician as an expert in one institution may differ from the criteria required elsewhere, noted Hung. As robotic surgeries emerge as the go-to method for many types of procedures, a closer look at data and metrics could help create a baseline level of competence. That, in turn, could promote patient safety and improved health outcomes.

“In order to be credentialed by institutions to use the robotic system, surgeons must be evaluated by their peers for a handful of procedures, but the evaluations are not ongoing, and sometimes evaluators don’t agree on what constitutes proficiency,” added Hung.

Measuring a Surgeon’s Skills

The Keck Medicine research team used the recording device, known as the dVLogger, on 100 prostate surgeries performed by 20 physicians of varying skill levels. Half of the surgeons were considered experts, with an average of 800 surgeries performed, and the other half were relative newbies, with only about 30-some surgeries under their belts.

The dVLogger device tracked a range of measurements and movements, including the speed of an operation, the distance a surgical instrument traveled, the amount of “idle time” (when an instrument was not in use), and the length and frequency of camera movements.

The goal of the technology is to gain a real-time sense of a physician’s competency and skill level.

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“The dVLogger records the surgeon’s movements, capturing where the instruments are and how the surgeon is moving the instruments,” said Hung.

Ultimately, the researchers found that the group of expert surgeons were “more efficient” and precise in their movements during the robotic surgery. The researchers believe that the device, developed by Intuitive Surgical, a prominent robotic-surgery manufacturer, may “lay the foundation for developing standardized metrics for surgeon training and assessment.”

In the near future, the researchers plan to focus on how closely the device’s analysis matches up with patient health outcomes. “We now have an opportunity to put surgeon proficiency under the microscope and see what role it plays in patient outcomes,” Hung said.