1. ICSAD: Imperial College Surgical Assessment Device Objective assessment of surgical dexterity Dept of Surgical Oncology and Technology, Imperial College of Science Technology and Medicine, London, UK

2. ICSAD Department of Surgical Oncology and Technology Imperial College, London Commercially available motion tracking system (Isotrak II, Polhemus, USA) Signal generator (A) and two sensors (B) on the surgeon’s hands A B

3. Bespoke software: ‘Track 3D’- retrieves Cartesian positional data-x,y and z co-ordinates ‘Track’- positional data to dexterity measures Path length- economy of movement Number of movements Time taken Speed Department of Surgical Oncology and Technology Imperial College, London ICSAD

4. Department of Surgical Oncology and Technology Imperial College, London Validation of ICSAD-Lap suturing P= 0.009 1-experts 2- skilled 3- lap skills, knowledge 4- no lap skills, knowledge

5. Department of Surgical Oncology and Technology Imperial College, London Validation of ICSAD N = EXPERIENCE CODE EDCBA MOVEMENTS BOWEL 3000 2000 1000 0 11 12 N = EXPERIENCE CODE CONSULTANTSEN SPRJUN SPRSHO NO OF MOVEMENTS 3000 2000 1000 0 1 24 17 34 13 25

6. Department of Surgical Oncology and Technology Imperial College, London Correlation of motion analysis with qualitative assessment- OSATS

7. Department of Surgical Oncology and Technology Imperial College, London For small bowel anastomosis N = EXPERIENCE CODE EDCBA MOVEMENTS BOWEL 3000 2000 1000 0 11 12 N = EXPERIENCE CODE CONSULTANTSEN SPRJUN SPRSHO NO OF MOVEMENTS 3000 2000 1000 0 1 24 17 34 13 25 11 12 N = EXPERIENCE CODE CONSULTANTSEN SPRJUN SPRSHO GLOBAL SCORE 40 30 20 10 18 38 20 19 Spearman correlation= -0.71, p<0.001

8. Department of Surgical Oncology and Technology Imperial College, London Correlation of motion analysis with qualitative assessment- Laparoscopic suturing Spearman’s co-efficient: - 0.70, p<0.001

9. Department of Surgical Oncology and Technology Imperial College, London ICSAD- Training Motion data of experts- standard for trainees Provide objective feedback

10. Department of Surgical Oncology and Technology Imperial College, London

11. Department of Surgical Oncology and Technology Imperial College, London

12. Department of Surgical Oncology and Technology Imperial College, London ROVIMAS ( Robotic Video Motion Analysis Software ):

13. Department of Surgical Oncology and Technology Imperial College, London ACKNOWLEDGEMENTS N Taffinder, A Wan, S Smith, J Torkington, T Brown, V Datta, S Bann, J Shah, S Mackay, Y Munz, A Dosis, A Chang, C Sutton, Prof Guang Zhong Yang, Dr. D. Gillies, Dr. F. Bello, Professor A Darzi