A Haptic Laparoscopic Trainer Based on Affine Velocity Analysis: Engineering and Preliminary Results

Abstract

Background: General agreement exists upon the importance of acquiring laparoscopic skills outside the operation room. During the past two decades, simulation-based training and simulators have been more extensively used in surgeons’ training. Nevertheless learning through simulation-based systems is hindered by several flaws. High-fidelity simulators are cost-prohibitive which limits training opportunities. Their use also elicits a high cognitive load. Low-fidelity simulators lack in haptic, direct and summative feedback. Our goal is to develop a new low fidelity simulator integrating effective learning features as a new assessment variable while limiting the associated costs. We also aim at assessing its primary validity. Methods: We engineered a low fidelity simulator for teaching basic laparoscopic skills taking into account psychomotor skills, direct and summative feedback and engineering key features (haptic feedback and complementary assessment variables). Afterward, 77 participants with 4 different surgical skill levels (17 experts; 12 intermediates; 28 inexperienced interns and 20 novices) tested the simulator. We checked the content validity using a 10 point Likert scale. We also assessed the simulator discriminative power by comparing the 4 groups’ performance over two sessions. To do so, we used 3 variables: time, number of errors (collisions) and affine velocity. Results: The content validation mean value score was 7.57/10. The statistical analysis yielded performance discrepancies on the selected variables among the groups (p<0.001). Conclusion: We developed an affordable and validated simulator for testing and learning basic laparoscopic skills. The results exhibit three levels of performance on the selected variables. Experts and intermediates outperformed the inexperienced interns who in turn outperformed the novices. Results show that the embedded evaluation variables are complimentary and provide realistic results. The inclusion of a new variable and, meanwhile, haptic, direct and summative feedback is innovative regarding low-fidelity simulators. Limitations and implementation conditions of the simulator in the surgical curricula are discussed.