Background The term microsurgery has come to mean surgery performed using miniaturized instruments and a microscope. In the present age, most neurosurgical procedures are performed using microsurgical instruments and microscope. Video recording of microsurgical procedures allows an opportunity to develop technique to quantify neurosurgical skills. This study attempts to explore the neurosurgical video recording to develop objective methods to assess neurosurgical skills. Methods The ANVIL annotation software was found to be useful for annotation of surgical videos. The software was open source and was downloaded from thee website.: http://www.anvil- software.org/index.html. The package was installed on Mackintosh machine running on an Intel i5 processor. Java platform version 7, 8 were installed on the system. The Java Development Kit version 10 was installed as a pre-requisite for running the ANVIL software. Video collection of surgeries of patients operated in the department of Neurosurgery, NIMHANS, by a single surgeon over a period of 5 years. Results Different elements were used for annotation of videos. Of the various parameters evaluated, we have found that the period of ‘no activity’ to be of much importance. It has been observed that the time taken to adjust the microscope has reduced whereas fine adjustments for the better delineation of the anatomical structures has increased. Conclusion Hence surgical video analysis performed in real time has the highest peer rating index for assessment of surgical skills. As many surgeries performed are video recorded presently, they provide an opportunity to demonstrate surgical procedure and to assess surgical skills.

microscope, neurosurgical video, surgical skills.