{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T02:54:06Z","timestamp":1790996046764,"version":"4.1.0"},"reference-count":26,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:00:00Z","timestamp":1790899200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:00:00Z","timestamp":1790899200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Surgical assessment often relies on subjective expert observation, which may introduce bias. We aimed to objectively differentiate skill levels in a complex simulated operative procedure using hand\u2010tracking metrics through a wearable mixed reality headset.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n A validated paediatric open inguinal herniotomy simulator was used to simulate a surgical task composed of multiple sequential operative steps. Novices (medical students) and experts (paediatric surgeons) were recruited. After completing a pre\u2010task questionnaire, participants performed the task while wearing the mixed reality headset (Microsoft HoloLens 2). A post\u2010task questionnaire was completed. Metrics collected included total path length, average path length, average movement velocity and total time. Data are reported as mean (\u00b1\u2009SD) and analysis included descriptive statistics, frequency counts and comparative testing using\n t<\/jats:italic>\n \u2010tests. A\n p<\/jats:italic>\n \u2010value of <\u20090.05 was considered significant.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 33 participants were recruited (9 experts, 24 novices). The expert group had a shorter mean total path length: 287.0\u2009\u00b1\u200960.0\u2009cm versus 450.1\u2009\u00b1\u200955.7\u2009cm (\n p<\/jats:italic>\n \u2009<\u20090.0001). They also had a shorter mean path length; 71.8\u2009\u00b1\u200915.1\u2009cm versus 112.5\u2009\u00b1\u200913.9\u2009cm (\n p<\/jats:italic>\n \u2009<\u20090.0001). The expert mean velocity of movement was 0.17\u2009\u00b1\u20090.07\u2009cm\/s versus 0.14\u2009\u00b1\u20090.02\u2009cm\/s in novices (\n p<\/jats:italic>\n \u2009=\u20090.13). Experts took less time to complete the task: 458.1\u2009\u00b1\u200965.8\u2009s versus 836.0\u2009\u00b1\u200970.0\u2009s (\n p<\/jats:italic>\n \u2009<\u20090.0001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n This study objectively demonstrated that experts had a more efficient economy of movement and that hand\u2010tracking metrics can differentiate between novice and expert performance during a simulated complex surgical task.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/ans.70988","type":"journal-article","created":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T02:05:58Z","timestamp":1790993158000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Using Motion\u2010Tracking to Objectively Assess Skill in Surgery"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-5818-8100","authenticated-orcid":false,"given":"Tanay","family":"Bapna","sequence":"first","affiliation":[{"name":"Department of Paediatric Surgery, Monash Children's Simulation Monash Children's Hospital Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5763-2696","authenticated-orcid":false,"given":"Samuel J. A.","family":"Robinson","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery, Monash Children's Simulation Monash Children's Hospital Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Valles","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery, Monash Children's Simulation Monash Children's Hospital Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damir","family":"Ljuhar","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery, Monash Children's Simulation Monash Children's Hospital Melbourne Australia"},{"name":"Departments of Paediatrics & Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences Monash University Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1744-2581","authenticated-orcid":false,"given":"Taiqing","family":"Zhang","sequence":"additional","affiliation":[{"name":"Virtual and Augmented Reality Services (VARS), eSolutions, Monash University Clayton Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"McIntosh","sequence":"additional","affiliation":[{"name":"Virtual and Augmented Reality Services (VARS), eSolutions, Monash University Clayton Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1259-4304","authenticated-orcid":false,"given":"Maurizio","family":"Pacilli","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery, Monash Children's Simulation Monash Children's Hospital Melbourne Australia"},{"name":"Departments of Paediatrics & Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences Monash University Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4438-0263","authenticated-orcid":false,"given":"Ramesh M.","family":"Nataraja","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery, Monash Children's Simulation Monash Children's Hospital Melbourne Australia"},{"name":"Departments of Paediatrics & Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences Monash University Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,2]]},"reference":[{"key":"e_1_2_9_2_1","volume-title":"The (r) Evolution of Surgical Education in the Twenty\u2010First Century: Replacing the Traditional Paradigm of \u201cSee One, Do One, Teach One\u201d With Competency\u2010Based, Lifelong Learning","author":"Hultman C.","year":"2010"},{"issue":"3","key":"e_1_2_9_3_1","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.ijsu.2010.01.011","article-title":"Surgical Training and the European Working Time Directive: The Role of Informal Workplace Learning","volume":"8","author":"Giles J. A.","year":"2010","journal-title":"International Journal of Surgery"},{"key":"e_1_2_9_4_1","volume-title":"Guide for Safe Working Hours and Conditions","author":"Royal Australasian College of Surgeons","year":"2021"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa1810642"},{"issue":"5","key":"e_1_2_9_6_1","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1308\/003588406X116927","article-title":"Teaching and Assessing Surgical Competence","volume":"88","author":"Thomas W. E.","year":"2006","journal-title":"Annals of the Royal College of Surgeons of England"},{"issue":"1","key":"e_1_2_9_7_1","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.jsurg.2010.08.004","article-title":"Surgical Training: The Impact of Changes in Curriculum and Experience","volume":"68","author":"Parsons B. A.","year":"2011","journal-title":"Journal of Surgical Education"},{"issue":"1","key":"e_1_2_9_8_1","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1046\/j.1365-2168.2000.01327.x","article-title":"Acquiring Surgical Skills","volume":"87","author":"Hamdorf J. M.","year":"2000","journal-title":"British Journal of Surgery"},{"key":"e_1_2_9_9_1","unstructured":"Royal Australasian College of Surgeons \u201cGuide to SET\u20142023 A Comparative Guide of Surgical Specialities and an Overview of Surgical Education and Training \u201d2022 https:\/\/www.surgeons.org\/en\/Trainees\/the\u2010set\u2010program."},{"issue":"3","key":"e_1_2_9_10_1","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1016\/j.jsurg.2022.01.006","article-title":"Overcoming Gender Bias in Assessment of Surgical Skills","volume":"79","author":"Fj\u00f8rtoft K.","year":"2022","journal-title":"Journal of Surgical Education"},{"issue":"1","key":"e_1_2_9_11_1","first-page":"e49","article-title":"Work\u2010Based Assessments in Higher General Surgical Training Program: A Mixed Methods Study Exploring Trainers' and Trainees' Views and Experiences","volume":"6","author":"Aryal K. R.","year":"2020","journal-title":"Surgical Journal"},{"issue":"8","key":"e_1_2_9_12_1","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1016\/j.jsurg.2023.05.012","article-title":"The Use, Effectiveness, and Impact of Workplace\u2010Based Assessments on Teaching, Supervision and Feedback Across Surgical Specialties","volume":"80","author":"Baboolal S. O.","year":"2023","journal-title":"Journal of Surgical Education"},{"issue":"6","key":"e_1_2_9_13_1","doi-asserted-by":"crossref","first-page":"1629","DOI":"10.1016\/j.jsurg.2019.06.011","article-title":"Automated Methods of Technical Skill Assessment in Surgery: A Systematic Review","volume":"76","author":"Levin M.","year":"2019","journal-title":"Journal of Surgical Education"},{"issue":"6","key":"e_1_2_9_14_1","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1080\/13645700701702135","article-title":"Systems for Tracking Minimally Invasive Surgical Instruments","volume":"16","author":"Chmarra M. K.","year":"2007","journal-title":"Minimally Invasive Therapy & Allied Technologies"},{"issue":"8","key":"e_1_2_9_15_1","doi-asserted-by":"crossref","first-page":"1477","DOI":"10.1007\/s11548-022-02637-9","article-title":"Robust Hand Tracking for Surgical Telestration","volume":"17","author":"M\u00fcller L. R.","year":"2022","journal-title":"International Journal of Computer Assisted Radiology and Surgery"},{"issue":"11","key":"e_1_2_9_16_1","doi-asserted-by":"crossref","first-page":"1224","DOI":"10.1177\/00034894211059310","article-title":"Hand Motion Analysis Illustrates Differences When Drilling Cadaveric and Printed Temporal Bone","volume":"131","author":"Hochman J. B.","year":"2022","journal-title":"Annals of Otology, Rhinology, and Laryngology"},{"issue":"6","key":"e_1_2_9_17_1","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1016\/j.jpedsurg.2022.01.029","article-title":"The Role of Motion Tracking in Assessing Technical Skill Acquisition Using a Neonatal 3D\u2010Printed Thoracoscopic Esophageal Atresia\/Tracheo\u2010Esophageal Fistula Simulator","volume":"57","author":"Choi C.","year":"2022","journal-title":"Journal of Pediatric Surgery"},{"key":"e_1_2_9_18_1","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1016\/j.media.2016.09.003","article-title":"Vision\u2010Based and Marker\u2010Less Surgical Tool Detection and Tracking: A Review of the Literature","volume":"35","author":"Bouget D.","year":"2017","journal-title":"Medical Image Analysis"},{"issue":"12","key":"e_1_2_9_19_1","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1007\/s10916-022-01891-3","article-title":"Assessment of Core Surgical Skills Using a Mixed Reality Headset\u2014The MoTOR Study","volume":"46","author":"Valles J.","year":"2022","journal-title":"Journal of Medical Systems"},{"key":"e_1_2_9_20_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.ijsu.2022.106813","article-title":"Does Speed Equal Quality? Time Pressure Impairs Minimally Invasive Surgical Skills in a Prospective Crossover Trial","volume":"104","author":"Bechtolsheim F.","year":"2022","journal-title":"International Journal of Surgery"},{"key":"e_1_2_9_21_1","first-page":"19","volume-title":"Motion Tracking and Gesture Recognition","author":"Shazrinizam S.","year":"2017"},{"issue":"10","key":"e_1_2_9_22_1","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1177\/000313481608201002","article-title":"Surgical Hand Tracking in Open Surgery Using a Versatile Motion Sensing System: Are we There Yet?","volume":"82","author":"Genovese B.","year":"2016","journal-title":"American Surgeon"},{"issue":"3","key":"e_1_2_9_23_1","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1097\/SIH.0b013e318277803a","article-title":"Quantification of Surgical Technique Using an Inertial Measurement Unit","volume":"8","author":"Watson R. A.","year":"2013","journal-title":"Simulation in Healthcare: Journal of the Society for Simulation in Healthcare"},{"issue":"4","key":"e_1_2_9_24_1","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1067\/mob.2002.122145","article-title":"Surgical Skills Assessment: A Blinded Examination of Obstetrics and Gynecology Residents","volume":"186","author":"Goff B. A.","year":"2002","journal-title":"American Journal of Obstetrics and Gynecology"},{"issue":"5","key":"e_1_2_9_25_1","first-page":"407","article-title":"Comparison of Objective, Structured Assessment of Technical Skills With a Virtual Reality Hysteroscopy Trainer and Standard Latex Hysteroscopy Model","volume":"52","author":"Goff B. A.","year":"2007","journal-title":"Journal of Reproductive Medicine"},{"issue":"4","key":"e_1_2_9_26_1","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1111\/j.1365-2923.2009.03295.x","article-title":"Conceptual Frameworks to Illuminate and Magnify","volume":"43","author":"Bordage G.","year":"2009","journal-title":"Medical Education"},{"key":"e_1_2_9_27_1","unstructured":"Microsoft \u201cHoloLens 2 \u201d2023 https:\/\/www.microsoft.com\/en\u2010us\/hololens\/hardware."}],"container-title":["ANZ Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ans.70988","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ans.70988","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ans.70988","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T02:06:08Z","timestamp":1790993168000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ans.70988"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,2]]},"references-count":26,"alternative-id":["10.1111\/ans.70988"],"URL":"https:\/\/doi.org\/10.1111\/ans.70988","archive":["Portico"],"relation":{},"ISSN":["1445-1433","1445-2197"],"issn-type":[{"value":"1445-1433","type":"print"},{"value":"1445-2197","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,2]]},"assertion":[{"value":"2026-08-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-18","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-02","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"ans.70988"}}