Abstract:BackgroundIt is generally assumed that safety of tissue manipulations during (laparoscopic) surgery is related to the magnitude of force that is exerted on the tissue. To provide trainees with performance feedback about tissue-handling skills, it is essential to define objective criteria for judging the safety of applied forces. To be of clinical relevance, these criteria should relate the applied forces to the risk of tissue damage. This experimental study was conducted to determine which tractive forces duri… Show more
“…9,10 A maximum allowable peak force of 1.5 N was assigned for both tasks, and the number of times this threshold was breached in each task repetition was regarded as the force error. This value was based on data reported by Rodrigues et al, 14 who determined that macroscopic tissue damage was visible when >1.5 N of tractive force was applied to suture through fresh porcine intestine. Modified scoring metrics (fPLS) were calculated post hoc that imposed additional penalties based on force error.…”
“…9,10 A maximum allowable peak force of 1.5 N was assigned for both tasks, and the number of times this threshold was breached in each task repetition was regarded as the force error. This value was based on data reported by Rodrigues et al, 14 who determined that macroscopic tissue damage was visible when >1.5 N of tractive force was applied to suture through fresh porcine intestine. Modified scoring metrics (fPLS) were calculated post hoc that imposed additional penalties based on force error.…”
“…The CFF group received continuous feedback about their applied force. Participants in the BFF group were only presented with visual force feedback when their applied force exceeded the threshold of 5.3 N. The threshold was based on a previous study that defined the critical force level that causes tissue damage [19]. Once the visual force feedback was presented, it lingered for 10 s to give the participants the opportunity to notice the feedback and to correct their actions accordingly.…”
Section: Methodsmentioning
confidence: 99%
“…Warning triangles were presented in each corner of the display if extreme force was applied to prevent rupture of the strips. Since the elasticity of the artificial tissue (silicon) is close to that of uterus tissue, the safety thresholds associated with uterus tissue were used in the colour scheme of the force feedback [19]. Fig.…”
BackgroundVisual force feedback allows trainees to learn laparoscopic tissue manipulation skills. The aim of this experimental study was to find the most efficient visual force feedback method to acquire these skills. Retention and transfer validity to an untrained task were assessed.MethodsMedical students without prior experience in laparoscopy were randomized in three groups: Constant Force Feedback (CFF) (N = 17), Bandwidth Force Feedback (BFF) (N = 16) and Fade-in Force Feedback (N = 18). All participants performed a pretest, training, post-test and follow-up test. The study involved two dissimilar tissue manipulation tasks, one for training and one to assess transferability. Participants performed six trials of the training task. A force platform was used to record several force parameters.ResultsA paired-sample t test showed overall lower force parameter outcomes in the post-test compared to the pretest (p < .001). A week later, the force parameter outcomes were still significantly lower than found in the pretest (p < .005). Participants also performed the transfer task in the post-test (p < .02) and follow-up (p < .05) test with lower force parameter outcomes compared to the pretest. A one-way MANOVA indicated that in the post-test the CFF group applied 50 % less Mean Absolute Nonzero Force (p = .005) than the BFF group.ConclusionAll visual force feedback methods showed to be effective in decreasing tissue manipulation force as no major differences were found between groups in the post and follow-up trials. The BFF method is preferred for it respects individual progress and minimizes distraction.
“…In both pre-and post-course assessments in this study, it was observed that all participants exceeded the safety thresholds for tissue damage. Previous research of Horeman et al [31] showed that tissue damage occurs relatively quickly in porcine intestines when pulling a suture. Considering these outcomes and the results of our present study, the repetitive practicing of this surgical technique in a safe simulation environment outside the OR is highly recommended.…”
Section: Portal Force and Torquementioning
confidence: 96%
“…The suture was placed near the ForceSense sensor. Previous studies showed that the maximum needle/suture loading force before the rupture of the large intestine lies between 1 and 3 N [27,30,31]. From the comprehensive data, the mean and max force (Fft) on the intestine were recorded to relate performances to a risk of bowel leaks due to ruptured tissue at the suture site.…”
Background Transanal total mesorectal excision (TaTME) is associated with a relatively long learning curve. Force, motion, and time parameters are increasingly used for objective assessment of skills to enhance laparoscopic training efficacy. The aim of this study was to identify relevant metrics for accurate skill assessment in more complex transanal purse-string suturing. Methods A box trainer was designed for TaTME and equipped with two custom made multi-DOF force/torque sensors. These sensors measured the applied forces in the axial direction of the instruments (Fz), instrument load orientation expressed in torque (Mx and My) on the entrance port, and the full tissue interaction force (Fft) at the intestine fixation point. In a construct validity study, novices for TaTME performed a purse-string suture to investigate which parameters can be used best to identify meaningful events during tissue manipulation and instrument handling. Results Significant differences exist between pre-and post-training assessment for the mean axial force at the entrance port Fz (p = 0.01), mean torque in the entrance port Mx (p = 0.03) and mean force on the intestine during suturing Fft (p = 0.05). Furthermore, force levels during suturing exceed safety threshold values, potentially leading to dangerous complications such as rupture of the rectum. Conclusions Forces and torque measured at the entrance port, and the tissue interaction force signatures provide detailed insight into instrument handling, instrument loading, and tissue handling during purse-string suturing in a TaTME training setup. This newly developed training setup for single-port laparoscopy that enables objective feedback has the potential to enhance surgical training in TaTME.
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