title: Objective differentiation of force-based laparoscopic skills using a novel haptic simulator.
abstract: BACKGROUND
  There is a growing need for effective surgical simulators to train the novice resident with a core skill set that can be later used in advanced operating room training. The most common simulator-based laparoscopic skills curriculum, the Fundamentals of Laparoscopic Skills (FLS), has been demonstrated to effectively teach basic surgical skills; however, a key deficiency in current surgical simulators is lack of validated training for force-based or haptic skills. In this study, a novel haptic simulator was examined for construct validity by determining its ability to differentiate between the force skills of surgeons and novices.
  
  
  METHODS
  A total of 34 participants enrolled in the study and were divided into two groups: novices, with no previous surgical experience and surgeons, with some level of surgical experience (including upper level residents and attendings). All participants performed a force-based task using grasping, probing, or sweeping motions with laparoscopic tools on the simulator. In the first session, participants were given 3 trials to learn specific forces associated with locations on a graphic; after this, they were asked to reproduce forces at each of the locations in random order. A force-based metric (score) was used to record performance.
  
  
  RESULTS
  On probing and grasping tasks, novices applied significantly greater overall forces than surgeons. When analyzed by force levels, novices applied greater forces on the probing task at lower and mid-range forces, for grasping at low-range forces ranges and, for sweeping at high-range forces.
  
  
  CONCLUSIONS
  The haptic simulator successfully differentiated between novice and surgeon force skill level at specific ranges for all 3 salient haptic tasks, establishing initial construct validity of the haptic simulator. Based on these results, force-based simulator metrics may be used to objectively measure haptic skill level and potentially train residents. Haptic simulator development should focus on the 3 salient haptic skills (grasping, probing, and sweeping) where precise force application is necessary for successful task outcomes.
authors.affiliation: Institute for Biological Interfaces of Engineering, Clemson, SC, USA. rsingap@clemson.edu
authors.forename: Ravikiran B
authors.initials: RB
authors.lastname: Singapogu
authors.forename: Dane E
authors.initials: DE
authors.lastname: Smith
authors.forename: Lindsay O
authors.initials: LO
authors.lastname: Long
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Burg
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Pagano
authors.forename: Karen J L
authors.initials: KJ
authors.lastname: Burg
mesh_terms: D002983:Clinical Competence; D003198:Computer Simulation; D010535:Laparoscopy / Q000193:education*; D055595:Mechanical Phenomena; D014110:Touch