title: Auditory force feedback substitution improves surgical precision during simulated ophthalmic surgery.
abstract: OBJECTIVE
  To determine the extent that auditory force feedback (AFF) substitution improves performance during a simulated ophthalmic peeling procedure.
  
  
  METHODS
  A 25-gauge force-sensing microforceps was linked to two AFF modes. The "alarm" AFF mode sounded when the force reached 9 mN. The "warning" AFF mode made beeps with a frequency proportional to the generated force. Participants with different surgical experience levels were asked to peel a series of bandage strips off a platform as quickly as possible without exceeding 9 mN of force. In study arm A, participants peeled with alarm and warning AFF modes, the order randomized within the experience level. In study arm B, participants first peeled without AFF, then alarm or warning AFF (order randomized within the experience level), and finally without AFF.
  
  
  RESULTS
  Of the 28 "surgeon" participants, AFF improved membrane peeling performance, reducing average force generated (P < 0.01), SD of forces (P < 0.05), and force × time above 9 mN (P < 0.01). Short training periods with AFF improved subsequent peeling performance when AFF was turned off, with reductions in average force, SD of force, maximum force, time spent above 9 mN, and force × time above 9 mN (all P < 0.001). Except for maximum force, peeling with AFF reduced all force parameters (P < 0.05) more than peeling without AFF after completing a training session.
  
  
  CONCLUSIONS
  AFF enables the surgeon to reduce the forces generated with improved precision during phantom membrane peeling, regardless of surgical experience. New force-sensing surgical tools combined with AFF offer the potential to enhance surgical training and improve surgical performance.
authors: Wilmer Eye Institute, Johns Hopkins School of Medicine, 400 N. Broadway, Baltimore, MD 21287-9277, USA.
authors: Nathan
authors: N
authors: Cutler
authors: Marcin
authors: M
authors: Balicki
authors: Mark
authors: M
authors: Finkelstein
authors: Jiangxia
authors: J
authors: Wang
authors: Peter
authors: P
authors: Gehlbach
authors: John
authors: J
authors: McGready
authors: Iulian
authors: I
authors: Iordachita
authors: Russell
authors: R
authors: Taylor
authors: James T
authors: JT
authors: Handa
mesh_terms: D003198:Computer Simulation; D056228:Feedback, Sensory / Q000502:physiology*; D006801:Humans; D015203:Reproducibility of Results; D012371:Robotics; D025321:Surgery, Computer-Assisted / Q000592:standards*; D013647:Task Performance and Analysis