Prediction of surgical skill and limitations from basic performance capacities using nonlinear causal resource analysis

Laparoscopic surgery imposes greater demands on surgeon capacities and abilities. The current study investigates the use of a novel method (Nonlinear Causal Resource Analysis, NCRA) for operative performance prediction and limiting resource identification. Basic performance resources were measured for 20 urology residents with 13 validated measures. Operative performance was measured during porcine laparoscopic nephrectomies using the Global Rating of Operative Performance Scale. NCRA models of the surgical task were built and used to predict operative performance. NCRA predicted the same rank order as experts and achieved excellent agreement for the poorest performers. These methods provide encouraging results for objectively predicting operative performance and identifying situations where a particular performance resource (e.g., coordination) limits HILT performance. Selection of surgical candidates, training, and educational curriculum could be impacted.