No abstract

The simulator was able to differentiate the force-skills of residents and surgeons, and objectively evaluate the effects of handedness on laparoscopic force-skills. Competency-based laparoscopic skills assessment curriculum should be updated to meet the requirements of bimanual force-based training.

Due to misperception of force, novices and residents applied excessive forces. However, experts had good control over force with both dominant and NHs. These findings suggest that force-based training curricula should not only have proprioception tasks, but should also include bimanual force-skills training exercises in order to improve force perception ability and hand skills of novices and residents. The results can be used as a performance metric in both box and virtual reality based force-skills training.

Laparoscopic instruments have limited haptics feedback. Hence, novices tend to exert excessive force which leads to tissue trauma. In laparoscopic surgery, no external information is available on the magnitude of excessive force. Therefore, novices should be trained to accurately perceive their own force output. This study analyzed the force perception of 18 novices in the absence of external information, by comparing the isometric force matching performance of index finger (i.e. used in conventional procedures) in extended arm posture with that of laparoscopic instrument in a force-based probing task. The study also examined the effect of handedness on force perception. A contra-lateral force matching paradigm was employed to analyze the matching performance of the novice subjects. Interestingly, matching error was found to be lower for laparoscopic instrument. An effect of handedness was visible for laparoscopic instrument only. The dominant hand overestimated the forces of non-dominant hand. The results can be used as a performance metric to evaluate the force perception of novices in laparoscopic force skills-training tasks.

Laparoscopic surgery has widely replaced open surgery due to the advantages it has for patients both during surgery and post-surgery recovery. Due to inversion and remote access to the surgical site, haptics feedback is altered with laparoscopic surgical instruments [1]. This leads to excessive exertion of force [2]. Many intra operative errors like tissue injury in laparoscopic surgery are due to texertion of large forces [2]. Over the years, virtual reality (VR) based laparoscopic surgical simulators with haptics feedback have been instrumental in teaching basic and advanced laparoscopic skills to residents and surgeons [3]. However, a major limitation in modern day VR based simulator training systems is that they do not effectively teach the bimanual impedance-based laparoscopic skills. Past studies on VR based laparoscopic training have captured the skills sets of residents and surgeons using force and psychomotor metrics [3, 4]. However, till date none have explored the effects of experience on impedance based training. In this study, we analyze the impedance skills of residents and surgeons using custom developed novel bimanual laparoscopic skills trainer.