Force feedback and basic laparoscopic skills

Abstract

Background Not much is known about the exact role of force feedback in laparoscopy. This study aimed to determine whether force feedback influences movements of instruments during training in laparoscopic tasks and whether force feedback is required for training in basic laparoscopic force application tasks. Methods A group of 19 gynecologic residents, randomly divided into two groups, performed three laparoscopic tasks in both the box trainer and the virtual reality (VR) trainer. The box-VR group began with the box trainer, whereas the VR-box group began with the VR trainer. The three selected tasks included different levels of force application. The box trainer provides natural force feedback, whereas the VR trainer does not provide force feedback. The performance of the two groups was compared with regard to time, path length, and depth perception. Results For the tasks in which force plays hardly a role, no differences between box-VR group and the VR-box group were found. During a task in which force application (pulling and pushing forces) plays a role, the box-VR group outperformed VR-box group in the box trainer. Moreover, training with the box trainer had a positive effect on subsequent performance of the task with the VR trainer. This was not found the other way around. No differences were found between box-VR and the VR-box group in tasks not requiring force application. Conclusion Force feedback influences basic laparoscopic skills during tasks in which pulling and pushing forces are applied. For these tasks, the switch from the trainer without force feedback to the one with natural force feedback has a detrimental effect on performance. Therefore, training for tasks in which forces play an important role (e.g., stretching, grasping) should be done using systems with natural force feedback, whereas eye-hand coordination can be trained without force feedback.

Methods and Tools for Objective Assessment of Psychomotor Skills in Laparoscopic Surgery

“…On the one hand, simulators such as MIST-VR's "Core Skill" module (Mentice AB, Goteborg, Sweden) or SIMENDO (Simendo, Rotterdam, The Netherlands) focus on formation of psychomotor skills rather than on developing complex anatomical scenarios. On the other, VR simulators such as LapMentor (Simbionix, Lod, Israel) or LapSim (Surgical Science Ltd., Goteborg, Sweden) adopt the trend of simple task training, but make a wider use of available computer resources (e.g., realistic scenarios [23], forcé feedback [79,80]) to enhance user interaction.…”

EVA: Laparoscopic Instrument Tracking Based on Endoscopic Video Analysis for Psychomotor Skills Assessment

“…The TrEndo tracking system was used for concurrent validation [9]. This optical sensor-based tracking system has been validated in a number of studies [32][33][34][35] and is currently employed for gynecologic resident training at Leiden University Medical Centre (LUMC, Leiden, The Netherlands).…”

Utilidad de un sistema de seguimiento óptico de instrumental en cirugía laparoscópica para evaluación de destrezas motoras

“…Esto nos lleva a pensar que no es posible determinar de forma precisa el nivel de pericia del cirujano con una única medida de evaluación para las 3 tareas evaluadas 10 . Chmarra et al, en estudios previos, también establecieron que sería recomendable llevar a cabo la evaluación de las habilidades psicomotoras del cirujano con, al menos, 2 parámetros de evaluación 8 .…”

“…Principalmente, estos sistemas se clasifican en 2 grandes grupos: sistemas virtuales y físicos 6 . En este trabajo nos centraremos en los sistemas físicos de formación y evaluación quirúrgica por su mayor realismo en el uso del instrumental, así como en la interacción con el entorno de trabajo 7,8 . Actualmente, se dispone de sistemas con diversas características y aplicaciones tanto comerciales como académicos.…”