LAUSR

Background: During carotid endarterectomies (CEA), perioperative stroke and cranial or cervical nerve injuries are the most common major complications. Many experts have emphasized the importance of careful and gentle manipulation around carotid plaques. However, there have been no methodological assessments that quantitatively measure ‘gentleness’. This study was aimed to propose a novel metric for gentle surgical maneuvers during CEA. Methods: Using surgical video-based motion software, the motion of the carotid artery around plaque was analyzed and quantified during a CEA. Kinematic parameters (minimum and maximum acceleration, and maximum and mean velocity) were compared among the surgical tasks and techniques, as well as between novice and expert surgeons. Results: The surgical tasks of dissecting the common carotid artery, passing the proximal vessel loops, and ligating vessels showed the highest absolute values of kinematic parameters. Dissections perpendicular to the line of the internal carotid artery tended to show higher kinematic parameters than those in the parallel direction, with blunt dissections typically higher than sharp dissections. The kinematic parameters of novice surgeons were significantly higher than those of experts, and receiver operating curve analysis showed a strong discriminative power. The kinematic parameters in the case of postoperative ischemic stroke also showed the highest absolute values. Conclusions: This study shows that tissue motion parameters could be a novel and feasible surrogate marker for the objective assessment on the ‘gentleness’ of surgical performance in CEA. Such an objective measurement might be applicable towards enhancing surgical education and risk management.