Comparative Study of Surgical Techniques

Abstract

Surgical technique variation -- differences in how operations are performed by different surgeons, at different institutions, and across different health systems -- is one of the most underappreciated drivers of surgical outcome variation. While attention focuses on which operation to perform, the question of how to perform it receives far less scrutiny, despite growing evidence that technical execution quality explains more outcome variance than patient case-mix or hospital volume. We conducted a multicentre comparative analysis of surgical technique variation across 14,826 matched procedures at five European academic surgical centres (Stockholm, Tallinn, Paris, Zurich, and Milan) from 2016 to 2022, covering four index procedures: laparoscopic cholecystectomy, colorectal anastomosis, thyroidectomy, and inguinal hernia repair. We compared five technique evaluation frameworks: intraoperative video-based performance assessment, standardised operative metrics (time, blood loss, conversion), complication-based outcome scoring, patient-reported functional outcomes, and AI-assisted surgical video analysis using computer vision. Our Surgical Technique Quality Score (STQS) integrates technical proficiency, operative efficiency, complication avoidance, functional outcomes, and reproducibility. AI-assisted video analysis achieved the highest STQS (0.928) by identifying subtle technique-outcome associations invisible to human observers, while intraoperative video assessment (STQS 0.912) provided the most actionable feedback for surgeon development through structured rating of critical operative steps