Visual force feedback in laparoscopic training

BackgroundTo improve endoscopic surgical skills, an increasing number of surgical residents practice on box or virtual reality (VR) trainers. Current training is focused mainly on hand–eye coordination. Training methods that focus on applying the right amount of force are not yet available.MethodsThe aim of this project is to develop a low-cost training system that measures the interaction force between tissue and instruments and displays a visual representation of the applied forces inside the camera image. This visual representation continuously informs the subject about the magnitude and the direction of applied forces. To show the potential of the developed training system, a pilot study was conducted in which six novices performed a needle-driving task in a box trainer with visual feedback of the force, and six novices performed the same task without visual feedback of the force. All subjects performed the training task five times and were subsequently tested in a post-test without visual feedback.ResultsThe subjects who received visual feedback during training exerted on average 1.3 N (STD 0.6 N) to drive the needle through the tissue during the post-test. This value was considerably higher for the group that received no feedback (2.6 N, STD 0.9 N). The maximum interaction force during the post-test was noticeably lower for the feedback group (4.1 N, STD 1.1 N) compared with that of the control group (8.0 N, STD 3.3 N).ConclusionsThe force-sensing training system provides us with the unique possibility to objectively assess tissue-handling skills in a laboratory setting. The real-time visualization of applied forces during training may facilitate acquisition of tissue-handling skills in complex laparoscopic tasks and could stimulate proficiency gain curves of trainees. However, larger randomized trials that also include other tasks are necessary to determine whether training with visual feedback about forces reduces the interaction force during laparoscopic surgery.

[1]  Max Mulder,et al.  Measuring the Performance of the SIMONA Research Simulator's Motion System , 2005 .

[2]  John J. van den Dobbelsteen,et al.  Force feedback and basic laparoscopic skills , 2008, Surgical Endoscopy.

[3]  K. Moorthy,et al.  Laparoscopic skills training and assessment , 2004, The British journal of surgery.

[4]  Ryugo Kijima,et al.  A Development of Reflex HMD - HMD with time delay compensation capability , 2001 .

[5]  Jenny Dankelman,et al.  Force measurement platform for training and assessment of laparoscopic skills , 2010, Surgical Endoscopy.

[6]  Christian Laugier,et al.  Realistic haptic rendering for highly deformable virtual objects , 2001, Proceedings IEEE Virtual Reality 2001.

[7]  J. Jakimowicz,et al.  Virtual reality surgical laparoscopic simulators , 2003, Surgical Endoscopy And Other Interventional Techniques.

[8]  S. Botden,et al.  The importance of haptic feedback in laparoscopic suturing training and the additive value of virtual reality simulation , 2008, Surgical Endoscopy.

[9]  A. Castellanos,et al.  Force Feedback Plays a Significant Role in Minimally Invasive Surgery: Results and Analysis , 2005, Annals of surgery.

[10]  References , 1971 .

[11]  Ernst L. Leiss,et al.  Kinesthetic and visual force display for telerobotics , 2002, Proceedings 2002 IEEE International Conference on Robotics and Automation (Cat. No.02CH37292).

[12]  D. Yuh,et al.  Effects of visual force feedback on robot-assisted surgical task performance. , 2008, The Journal of thoracic and cardiovascular surgery.

[13]  Max Mulder,et al.  Measuring Time Delays in Simulator Displays , 2007 .

[14]  John F. Canny,et al.  Haptic interaction with global deformations , 2000, Proceedings 2000 ICRA. Millennium Conference. IEEE International Conference on Robotics and Automation. Symposia Proceedings (Cat. No.00CH37065).