Haptic exploration improves performance of a laparoscopic training task

Abstract

Background Laparoscopy has reduced tactile and visual feedback compared to open surgery. There is increasing evidence that visual and haptic information converge to form a more robust mental representation of an object. We investigated whether tactile exploration of an object prior to executing a laparoscopic action on it improves performance. Methods A prospective cohort study with 20 medical students randomized in two different groups was conducted. A silicone ileocecal model, on which a laparoscopic action had to be performed, was used inside an outside a ForceSense box trainer. During the pre-test, students either did a combined manual and visual exploration or only visual exploration of the caecum model. To track performance during the trials of the study we used force, motion and time parameters as representatives of technical skills development. The final trial data were used for statistical comparison between groups. Results All included time and motion parameters did not show any clear differences between groups. However, the force parameters Mean force non-zero (p = 004), Maximal force (p = 0.01) Maximal impulse (p = 0.02), Force volume (p = 0.02) and SD force (p = 0.01) showed significant lower values in favour of the tactile exploration group for the final trials. Conclusions By adding haptic sensation to the existing visual information during training of laparoscopic tasks on lifelike models, tissue manipulation skills improve during training.

Design of a feedback restoring balanced compliant laparoscopic grasper

“…Jan-Willem Klok*, Roelf Postema, Asþor T. Steinþorsson, Jenny Dankelman, Tim Horeman I quality of force feedback and haptic feedback that a surgeon can obtain from his hands decreases, potentially influencing performance [6]. In combination with high pressures at the end effector [7], this increases the risk of unintended tissue damage [5].…”

“…As the compliant tip does not have any mechanical play it has the potential to restore some of the haptic feedback during laparoscopic surgery. However, in the aforementioned papers [5,6], the compliant tip was not integrated into a clinically feasible instrument, because balancing the relatively high forces required to open the tip proved to be challenging. These internal compliant forces (𝐹 𝑖,𝑐 ) are introduced by the elastic deflection of the compliant elements of the grasper tip.…”

“…However, there are much more perspectives regarding haptic feedback. Therefore, indepth validation of haptic feedback in relation to other (tractive) interaction forces, is needed of the instrument inside a validated box trainer task in order to measure performance in a clinically relevant setting [18,19]. Also, other boundary conditions for clinical conditions should be met, such as the ability to disassemble and assemble the instrument for cleaning and inspection [20] and how the components withstand the cleaning and sterilisation processes.…”

Design and Evaluation of a Balanced Compliant Laparoscopic Grasper

“…A major difference between open and laparoscopic surgery is that with laparoscopic surgery, the intra-abdominal tissue is manipulated using an intermediate instrument, in contrast to open surgery where palpation of tissue by the surgeon’s hands is also possible. When the forces that act on the tissue are distorted due to the internal component interactions and transmissions, the quality of force feedback and haptic feedback that a surgeon can obtain from his hands decreases, potentially influencing performance [6] . In combination with high pressures at the end effector [7] , this increases the risk of unintended tissue damage [5] .…”

“…As the compliant tip does not have any mechanical play it has the potential to restore some of the haptic feedback during laparoscopic surgery. However, in the aforementioned papers [5] , [6] , the compliant tip was not integrated into a clinically feasible instrument, because balancing the relatively high forces required to open the tip proved to be challenging. These internal compliant forces ( \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{upgreek} \usepackage{mathrsfs} \setlength{\oddsidemargin}{-69pt} \begin{document} $F_{i,c}$\end{document} ) are introduced by the elastic deflection of the compliant elements of the grasper tip.…”