Automated Performance Metrics on the Cyrano Simulator Differentiate Expertise in Endoscopic Endonasal Surgery

Background: Simulation provides a safe and standardized environment for surgical training. The Cyrano simulator has demonstrated face and construct validity. Its latest version integrates automated motion tracking and scoring, offering the potential for objective assessment of surgical skills. Objective: To determine whether automated performance scores on the Cyrano simulator can distinguish between intermediate and expert surgeons, as defined by video-based Objective Structured Assessment of Technical Skills (OSATS-v). Methods: Twenty-nine residents and ENT surgeons completed four endoscopic endonasal exercises on the Cyrano simulator: Target the Target (telescope navigation), Captain Hook and Drag’n Drop (forceps/telescope precision), and Chicken Run (drilling precision). Automated global and sub-scores (amplitude, fluidity, tremor, precision, safety) were derived from motion sensors and task-specific metrics. Independent blinded experts rated anonymized videos using OSATS-v. Participants were categorized as intermediate (IP, OSATS-v ≤15) or expert (EP, OSATS-v ≥16). Group differences were tested using Mann–Whitney U (p