title: Effects of experience on force perception threshold in minimally invasive surgery.
abstract: BACKGROUND
  Distorted haptic feedback by the surgical instrumentation is a major problem in minimally invasive surgery (MIS). Friction force generated by the rubber seal in the trocars masks the haptic information needed to perceive the properties and structure of the target tissue, resulting in an increased haptic perception threshold in naïve subjects. This can lead to over application of forces in surgery.
  
  
  OBJECTIVE
  This paper examines the effect of surgical experience on the psychophysics of force perception and force application efficiency in MIS.
  
  
  METHODS
  A controlled experiment was conducted using a mixed design, with friction and vision as independent within-subjects factors, experience as a between-subjects factor, and applied force and detection time as dependent measures. Fourteen subjects (eight novices and six experienced surgeons) performed a simulated tissue probing task. Performance data were recorded by a custom-built force-sensing system.
  
  
  RESULTS
  When friction was present, higher thresholds and longer detection times were observed for both experienced and inexperienced subjects. In all cases, experienced surgeons applied a greater force than novices, but were quicker to detect contact with tissue, resulting in higher force application efficiency.
  
  
  CONCLUSIONS
  Surgeons seem to have adapted to the higher threshold in haptic perception by reacting faster, even while applying more force to the tissue, keeping within the limits of safety.
authors: Department of Mechanical Engineering, Tufts University, Medford, MA 02155, USA.
authors: M
authors: M
authors: Zhou
authors: J
authors: J
authors: Perreault
authors: S D
authors: SD
authors: Schwaitzberg
authors: C G L
authors: CG
authors: Cao
mesh_terms: D055592:Biophysical Phenomena; D001703:Biophysics; D002983:Clinical Competence; D013502:General Surgery; D010535:Laparoscopy; D019060:Minimally Invasive Surgical Procedures; D011601:Psychophysics; D014110:Touch
references: Surg Endosc. 2005 Jan;19(1):95-100
references: 15772876
references: Surg Endosc. 1999 Sep;13(9):869-73
references: 10449841
references: Ann Surg. 2001 Oct;234(4):549-58; discussion 558-9
references: 11573048
references: Stud Health Technol Inform. 2006;119:288-92
references: 16404064
references: Ann Surg. 2003 Apr;237(4):460-9
references: 12677139
references: IEEE Trans Biomed Eng. 2002 Jan;49(1):49-54
references: 11794771
references: Surgery. 2002 Nov;132(5):826-35
references: 12464867
references: Hum Factors. 2006 Fall;48(3):574-86
references: 17063970
references: Endosc Surg Allied Technol. 1995 Aug;3(4):210-3
references: 8846039
references: IEEE Trans Biomed Eng. 1999 Oct;46(10):1212-21
references: 10513126
references: J Gastrointest Surg. 1999 May-Jun;3(3):278-85
references: 10481120
references: Surg Endosc. 2007 Aug;21(8):1338-43
references: 17165115
references: J Am Coll Surg. 1999 Oct;189(4):349-55
references: 10509459
references: Ann Surg. 1999 Apr;229(4):458-9
references: 10203076
references: J Am Coll Surg. 1995 Jan;180(1):101-25
references: 8000648
references: Am J Surg. 1993 Jan;165(1):9-14
references: 8418705
references: Surg Endosc. 2000 Sep;14(9):791-8
references: 11000356
references: J Am Coll Surg. 1997 Jun;184(6):571-8
references: 9179112