title: The role of haptic feedback in laparoscopic training using the LapMentor II.
abstract: BACKGROUND
  Laparoscopic surgery has become the standard of care for many surgical diseases. Haptic (tactile) feedback (HFB) is considered an important component of laparoscopic surgery. Virtual reality simulation (VRS) is an alternative method to teach surgical skills to surgeons in training. Newer VRS trainers such as the Simbionix Lap Mentor II provide significantly improved tactile feedback. However, VRSs are expensive and adding HFB software adds an estimated cost of $30,000 to the commercial price. The HFB provided by the Lap Mentor II has not been validated by an independent party. We used the Simbionix Lap Mentor II in this study to demonstrate the effect of adding an HFB mechanism in the VRS trainer.
  
  
  METHODS
  The study was approved by the University of Cincinnati Institutional Review Board. Twenty laparoscopically novice medical students were enrolled. Each student was asked to perform three different tasks on the Lap Mentor II and repeat each one five times. The chosen tasks demanded significant amount of traction and counter traction. The first task was to pull leaking tubes enough and clip them. The second task was stretching a jelly plate enough to see its attachments to the floor and cut these attachments. In the third task, the trainee had to separate the gallbladder from its bed on the liver. The students were randomized into two groups to perform the tasks with and without HFB. We used accuracy, speed, and economy of movement as scales to compare the performance between the two groups. The participants also completed a simple questionnaire that highlighted age, sex, and experiences in videogame usage.
  
  
  RESULTS
  The two groups were comparable in age, sex, and videogame playing. No differences in the accuracy, the economy, and the speed of hand movement were noticed. In fact, adding HFB to the Lap Mentor II simulator did not contribute to any improvement in the performance of the trainees. Interestingly, we found that videogame expert players tend to have faster and more economic motion in their dominant hands. However, the performance accuracy was not significantly affected.
  
  
  CONCLUSIONS
  The presence of HFB has less effect than it thought to be on the performance of the novice trainees. This may suggest that better HFB is still needed. However, there may be visual compensation for the lack of haptics. Playing videogames has a positive impact on economy, and the speed of the dominant had motion without affecting its accuracy. Further research is needed to clarify the value of haptics to the expert surgeon and compare it to the new trainees.
authors.affiliation: Division of Urology, Department of Surgery, University of Cincinnati, Cincinnati, Ohio, USA. mhdsalkini@gmail.com
authors.forename: Mohamad W
authors.initials: MW
authors.lastname: Salkini
authors.forename: Charles R
authors.initials: CR
authors.lastname: Doarn
authors.forename: Nicholai
authors.initials: N
authors.lastname: Kiehl
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Broderick
authors.forename: James F
authors.initials: JF
authors.lastname: Donovan
authors.forename: Krishnanath
authors.initials: K
authors.lastname: Gaitonde
mesh_terms: D000328:Adult; D004503:Education, Medical, Graduate; D005246:Feedback; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D014110:Touch; D014584:User-Computer Interface; D018910:Video Games