Based on currently available evidence, most methods of skills assessment are valid for feedback or measuring progress of training, but few can be used for examination or credentialing. The purpose of the assessment determines the choice of method.

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This article gives an overview of research performed in the field of haptic information feedback during minimally invasive surgery (MIS). Literature has been consulted from 1985 to present. The studies show that currently, haptic information feedback is rare, but promising, in MIS. Surgeons benefit from additional feedback about force information. When it comes to grasping forces and perceiving slip, little is known about the advantages additional haptic information can give to prevent tissue trauma during manipulation. Improvement of haptic perception through augmented haptic information feedback in MIS might be promising.

Box trainers equipped with sensors may help in acquiring objective information about a trainee's performance while performing training tasks with real instruments. The main aim of this study is to investigate the added value of force parameters with respect to commonly used motion and time parameters such as path length, motion volume, and task time. Two new dynamic bimanual positioning tasks were developed that not only requiring adequate motion control but also appropriate force control successful completion. Force and motion data for these tasks were studied for three groups of participants with different experience levels in laparoscopy (i.e., 11 novices, 19 intermediates, and 12 experts). In total, 10 of the 13 parameters showed a significant difference between groups. When the data from the significant motion, time, and force parameters are used for classification, it is possible to identify the skills level of the participants with 100% accuracy. Furthermore, the force parameters of many individuals in the intermediate group exceeded the maximum values in the novice and expert group. The relatively high forces used by the intermediates argue for the inclusion of training and assessment of force application during tissue handling in future laparoscopic skills training programs.

BackgroundFrom the clinical point of view, it is important to recognize residents’ level of expertise with regard to basic psychomotor skills. For that reason, surgeons and surgical organizations (e.g., Acreditation Council for Graduate Medical Education, ACGME) are calling for assessment tools that credential residents as technically competent. Currently, no method is universally accepted or recommended for classifying residents as “experienced,” “intermediates,” or “novices” according to their technical abilities. This study introduces a classification method for recognizing residents’ level of experience in laparoscopic surgery based on psychomotor laparoscopic skills alone.MethodsFor this study, 10 experienced residents (>100 laparoscopic procedures performed), 10 intermediates (10–100 procedures performed), and 11 novices (no experience) performed four tasks in a box trainer. The movements of the laparoscopic instruments were recorded with the TrEndo tracking system and analyzed using six motion analysis parameters (MAPs). The MAPs of all participants were submitted to principal component analysis (PCA), a data reduction technique. The scores of the first principal components were used to perform linear discriminant analysis (LDA), a classification method. Performance of the LDA was examined using a leave-one-out cross-validation.ResultsOf 31 participants, 23 were classified correctly with the proposed method, with 7 categorized as experienced, 7 as intermediates, and 9 as novices.ConclusionsThe proposed method provides a means to classify residents objectively as experienced, intermediate, or novice surgeons according to their basic laparoscopic skills. Due to the simplicity and generalizability of the introduced classification method, it is easy to implement in existing trainers.