Effects of laparoscopic instrument and finger on force perception: a first step towards laparoscopic force-skills training
01 Jul 2015-Surgical Endoscopy and Other Interventional Techniques (Springer US)-Vol. 29, Iss: 7, pp 1927-1943
TL;DR: Force perception of experts was found to be better than novices and residents and experts had good control over force with both dominant and NHs, suggesting 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 novice and residents.
Abstract: In laparoscopic surgery, no external feedback on the magnitude of the force exerted is available. Hence, surgeons and residents tend to exert excessive force, which leads to tissue trauma. Ability of surgeons and residents to perceive their own force output without external feedback is a critical factor in laparoscopic force-skills training. Additionally, existing methods of laparoscopic training do not effectively train residents and novices on force-skills. Hence, there is growing need for the development of force-based training curriculum. As a first step towards force-based laparoscopic skills training, this study analysed force perception difference between laparoscopic instrument and finger in contralateral bimanual passive probing task. The study compared the isometric force matching performance of novices, residents and surgeons with finger and laparoscopic instrument. Contralateral force matching paradigm was employed to analyse the force perception capability in terms of relative (accuracy), and constant errors in force matching. Force perception of experts was found to be better than novices and residents. Interestingly, laparoscopic instrument was more accurate in discriminating the forces than finger. The dominant hand attempted to match the forces accurately, whereas non-dominant hand (NH) overestimated the forces. Further, the NH of experts was found to be most accurate. Furthermore, excessive forces were applied at lower force levels and at very high force levels. 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.
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TL;DR: Haptic feedback is added to virtual reality simulators to increase the fidelity and thereby improve training effect and force parameters and force feedback in box trainers have been shown to improve training results.
70 citations
Cites background from "Effects of laparoscopic instrument ..."
...Training should focus on improving tissue-handling skills by proper use of force.(14)...
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...Training with force feedback and force parameters is therefore hypothesized to be beneficial for both novices and experts.(14)...
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TL;DR: This paper reviews the current advances in needle insertion modeling, classified into three sections: needle insertion models, tissue deformation models, and needle–tissue interaction models.
Abstract: Needle insertion is the most basic skill in medical care, and training has to be imparted not only for physicians but also for nurses and paramedics In most needle insertion procedures, haptic feedback from the needle is the main stimulus in which novices need training For better patient safety, the classical methods of training the haptic skills have to be replaced with simulators based on new robotic and graphics technologies This paper reviews the current advances in needle insertion modeling, classified into three sections: needle insertion models, tissue deformation models, and needle–tissue interaction models Although understated in the literature, the classical and dynamic friction models, which are critical for needle insertion modeling, are also discussed The experimental setup or the needle simulators that have been developed to validate the models are described The need of psychophysics for needle simulators and psychophysical parameter analysis of human perception in needle insertion are discussed, which are completely ignored in the literature
30 citations
Cites background from "Effects of laparoscopic instrument ..."
...The various applications of needle insertion in minimally invasive procedures would include needle biopsies [2], [3]; regional anesthesia [4], [5]; injections [6]; angiography [7]; laparoscopy, which requires veress needle insertion [8], [9]; endoscopy [10]; brachytherapy cancer treatment [11]–[13]; and spine and neurosurgery [14], [15]....
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TL;DR: Modern day curriculum-based training should evaluate the skills of residents with robust force and psychomotor-based exercises for proficient laparoscopy and visual feedback on force and motion during training has the potential to enhance the learning curve of residents.
28 citations
TL;DR: Competency-based laparoscopic skills assessment curriculum should be updated to meet the requirements of bimanual force-based training.
Abstract: Background. The purpose of this study was to examine the face and construct validity of a custom-developed bimanual laparoscopic force-skills trainer with haptics feedback. The study also examined ...
8 citations
TL;DR: The findings highlight the lengthy durations of laparoscopic surgical procedures involved in navigating to anatomical planes and moving tissues, as well as the extent of secondary functions performed with the surgical instruments.
5 citations
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TL;DR: An inventory of 20 items with a set of instructions and response- and computational-conventions is proposed and the results obtained from a young adult population numbering some 1100 individuals are reported.
33,268 citations
"Effects of laparoscopic instrument ..." refers background in this paper
...No subject was found to be ambidextrous [46]....
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TL;DR: It is shown that there are only a few points within laparoscopic cholecystectomy where the complication-causing errors occur, which suggests that focused training to heighten vigilance might be able to decrease the incidence of bile duct injury.
Abstract: Bile duct injuries are the main serious technical complication of laparoscopic cholecystectomy. 1,2 Data are insufficient to determine precisely the frequency of bile duct injuries, but a reasonable estimate is one in 1,000 cases. 2 A decade ago, as the technique of laparoscopic cholecystectomy was first being learned by otherwise fully trained, practicing surgeons, the injury rate was noted to be greater during an individual’s first dozen cases than in subsequent ones. 2 This learning curve contribution is now much less important, for surgical residents learn the procedure under direct supervision of more experienced surgeons.
Surgeons have always analyzed their technical complications for insights that might be translated into improved performance. In the past the information available from such reviews could rarely go much beyond a tabulation of results. An understanding of the root causes of technical complications remained elusive. This report takes analysis of technical complications to greater depths, for it integrates the findings of videotapes of operations involving bile duct injuries, operative notes dictated after the operation had been completed but before an injury had become apparent, and conceptual tools of human factors research and the cognitive science of human error.
715 citations
"Effects of laparoscopic instrument ..." refers background in this paper
...Majority of intra-operative errors in laparoscopic surgery occur due to improper perception of force [6]....
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TL;DR: The FREG as a tool incorporating the force feedback teleoperation technology may provide the basis for application in telesurgery, clinical endoscopic surgery, surgical training, and research.
Abstract: Minimally invasive surgery generates new user interfaces which create visual and haptic distortion when compared to traditional surgery. In order to regain the tactile and kinesthetic information that is lost, a computerized force feedback endoscopic surgical grasper (FREG) was developed with computer control and a haptic user interface. The system uses standard unmodified grasper shafts and tips. The FREG can control grasping forces either by surgeon teleoperation control, or under software control. The FREG performance was evaluated using an automated palpation function (programmed series of compressions) in which the grasper measures mechanical properties of the grasped materials. The material parameters obtained from measurements showed the ability of the FREG to discriminate between different types of normal soft tissues (small bowel, lung, spleen, liver, colon, and stomach) and different kinds of artificial soft tissue replication materials (latex/silicone) for simulation purposes. In addition, subjective tests of ranking stiffness of silicone materials using the FREG teleoperation mode showed significant improvement in the performance compared to the standard endoscopic grasper. Moreover, the FREG performance was closer to the performance of the human hand than the standard endoscopic grasper. The FREG as a tool incorporating the force feedback teleoperation technology may provide the basis for application in telesurgery, clinical endoscopic surgery, surgical training, and research.
383 citations
TL;DR: It is shown that, in tit-for-tat exchanges between two children, both sides are reporting their true percept and that the escalation is a natural by-product of physical conflicts.
Abstract: Physical conflicts tend to escalate. For example, as tit-for-tat exchanges between two children escalate, both will often assert that the other hit him or her harder. Here we show that, in such situations, both sides are reporting their true percept and that the escalation is a natural by-product of
369 citations
TL;DR: Objective evidence of a difference in laparoscopic skills between surgeons differing gender, hand dominance, and computer experience is provided, which may influence the future development of training program for Laparoscopic surgery.
Abstract: Background: The impact of gender and hand dominance on operative performance may be a subject of prejudice among surgeons, reportedly leading to discrimination and lack of professional promotion. However, very little objective evidence is available yet on the matter. This study was conducted to identify factors that influence surgeons’ performance, as measured by a virtual reality computer simulator for laparoscopic surgery. Methods: This study included 25 surgical residents who had limited experience with laparoscopic surgery, having performed fewer than 10 laparoscopic cholecystectomies. The participants were registered according to their gender, hand dominance, and experience with computer games. All of the participants performed 10 repetitions of the six tasks on the Minimally Invasive Surgical Trainer—Virtual Reality (MIST-VR) within 1 month. Assessment of laparoscopic skills was based on three parameters measured by the simulator: time, errors, and economy of hand movement. Results: Differences in performance existed between the compared groups. Men completed the tasks in less time than women (p = 0.01, Mann–Whitney test), but there was no statistical difference between the genders in the number of errors and unnecessary movements. Individuals with right hand dominance performed fewer unnecessary movements (p = 0.045, Mann–Whitney test), and there was a trend toward better results in terms of time and errors among the residence with right hand dominance than among those with left dominance. Users of computer games made fewer errors than nonusers (p = 0.035, Mann–Whitney test). Conclusions: The study provides objective evidence of a difference in laparoscopic skills between surgeons differing gender, hand dominance, and computer experience. These results may influence the future development of training program for laparoscopic surgery. They also pose a challenge to individuals responsible for the selection and training of the residents.
246 citations
"Effects of laparoscopic instrument ..." refers background in this paper
...Further, few other studies have shown that right-handed residents or surgeons with either of their hands can perform the tasks faster with lower error rates compared to lefthanded individuals [37, 40, 41]....
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