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Up to half of the technical errors made by surgical trainees result from improper tool forces on tissue [1]. This skill inadequacy is exacerbated in robotic min- imally invasive surgery (RMIS) due to the perpetual technical barriers prohibiting robust haptic (touch) sen- sations in clinical RMIS systems. Expert RMIS surgeons have developed a unique skill, termed visual-haptic acuity, that enables them to visually estimate the absent haptic sensations [2]. RMIS experts have developed this visual-haptic acuity through years of repeated surgi- cal practice, on real patient tissue. For current RMIS trainees, limitations on working hours and caseloads severely constrain practice with real patient tissue [3]. Given that skill gained in virtual reality simulation does not always transfer to the real world [4], there is a critical need for a focus on visual-haptic acuity development. Previous research has shown that supplemental hap- tic feedback provided during simulation-based RMIS training helps surgical trainees to reduce their applied forces when completing RMIS training tasks [5], and that this effect is sustained even when haptic feedback is removed [6]. In addition, supplemental haptic feedback has demonstrated the potential to help RMIS trainees increase accuracy (reduce applied forces) while also increasing speed (reducing task completion time) during RMIS training [7]. Unfortunately, the benefits of sup- plemental haptic feedback have not been demonstrated beyond basic simulated training environments. Addition- ally, we lack validated objective methods for specifically assessing an RMIS trainee’s ability to visually estimate haptic sensations when operating on real patient tissue. In light of this need, we are developing a modular data acquisition and multimodality haptic feedback system (as shown in Figure 1) to catalyze visual-haptic acuity development for novice RMIS trainees.

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Current robotic minimally invasive surgery (RMIS) platforms provide surgeons with no haptic feedback of the robot's physical interactions. This limitation forces surgeons to rely heavily on visual feedback and can make it challenging for surgical trainees to manipulate tissue gently. Prior research has demonstrated that haptic feedback can increase task accuracy in RMIS training. However, it remains unclear whether these improvements represent a fundamental improvement in skill, or if they simply stem from re-prioritizing accuracy over task completion time. In this study, we provide haptic feedback of the force applied by the surgical instruments using custom wristsqueezing devices. We hypothesize that individuals receiving haptic feedback will increase accuracy (produce less force) while increasing their task completion time, compared to a control group receiving no haptic feedback. To test this hypothesis, N=21 novice participants were asked to repeatedly complete a ring rollercoaster surgical training task as quickly as possible. Results show that participants receiving haptic feedback apply significantly less force (0.67 N) than the control group, and they complete the task no faster or slower than the control group after twelve repetitions. Furthermore, participants in the feedback group decreased their task completion times significantly faster (7.68%) than participants in the control group (5.26%). This form of haptic feedback, therefore, has the potential to help trainees improve their technical accuracy without compromising speed.

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