Objective Motion Analysis of Simulated Thoracoscopic Repair of Esophageal Atresia with Tracheoesophageal Fistula

Background Objective assessment of technical performance remains challenging in neonatal minimally invasive surgery. Instrument motion analysis may complement conventional assessment during simulation-based training. Objective To explore relationships among instrument motion parameters during simulated thoracoscopic repair of esophageal atresia with tracheoesophageal fistula and characterize patterns according to surgical experience and simulation model. Methods In this prospective observational study, 30 participants were stratified by surgical experience into experienced (n = 18) and inexperienced (n = 12) groups and randomly assigned to one of two synthetic esophageal atresia models. Following standardized video instruction, participants performed fistula closure and division, proximal pouch opening, and esophageal anastomosis within a 30-minute limit. The Laparo Analytic system continuously recorded instrument movements to quantify motion efficiency, smoothness, spatial utilization, and bimanual coordination. Spearman correlation analysis examined relationships among motion metrics within surgical experience and simulation model subgroups. Results Thirty participants were enrolled: 18 experienced and 12 inexperienced surgeons. Correlations were numerically stronger among experienced surgeons for economy of area versus path length (ρ = −0.98 versus − 0.79), depth perception versus economy of volume (ρ = −0.97 versus − 0.86), and clamp distance versus path length (ρ = 0.86 versus 0.71). Excessive acceleration correlated closely with hectic time in both groups (ρ = 0.98 and 0.96), whereas bimanual dexterity showed little association with path length (ρ = 0.13 and − 0.07). Strong inverse correlations between economy of volume and path length were observed with both models (ρ = −0.98 and − 0.94). Conclusion Motion analysis revealed interrelated spatial and kinematic parameters, with exploratory differences in correlation patterns according to surgical experience. These findings support further investigation of motion metrics as complementary assessment tools; their ability to discriminate proficiency requires validation in larger cohorts.