title: Effects of laparoscopic instrument and finger on force perception: a first step towards laparoscopic force-skills training.
abstract: BACKGROUND
  In laparoscopic surgery, no external feedback on the magnitude of the force exerted is available. Hence, surgeons and residents tend to exert excessive force, which leads to tissue trauma. Ability of surgeons and residents to perceive their own force output without external feedback is a critical factor in laparoscopic force-skills training. Additionally, existing methods of laparoscopic training do not effectively train residents and novices on force-skills. Hence, there is growing need for the development of force-based training curriculum.
  
  
  OBJECTIVE
  As a first step towards force-based laparoscopic skills training, this study analysed force perception difference between laparoscopic instrument and finger in contralateral bimanual passive probing task.
  
  
  METHODS
  The study compared the isometric force matching performance of novices, residents and surgeons with finger and laparoscopic instrument. Contralateral force matching paradigm was employed to analyse the force perception capability in terms of relative (accuracy), and constant errors in force matching.
  
  
  RESULTS
  Force perception of experts was found to be better than novices and residents. Interestingly, laparoscopic instrument was more accurate in discriminating the forces than finger. The dominant hand attempted to match the forces accurately, whereas non-dominant hand (NH) overestimated the forces. Further, the NH of experts was found to be most accurate. Furthermore, excessive forces were applied at lower force levels and at very high force levels.
  
  
  CONCLUSIONS
  Due to misperception of force, novices and residents applied excessive forces. However, experts had good control over force with both dominant and NHs. These findings suggest that force-based training curricula should not only have proprioception tasks, but should also include bimanual force-skills training exercises in order to improve force perception ability and hand skills of novices and residents. The results can be used as a performance metric in both box and virtual reality based force-skills training.
authors.affiliation: Haptics Lab, Biomedical Engineering Group, Department of Applied Mechanics, Indian Institute of Technology Madras, Chennai, 600036, Tamil Nadu, India.
authors.forename: M S
authors.initials: MS
authors.lastname: Raghu Prasad
authors.forename: M
authors.initials: M
authors.lastname: Manivannan
authors.forename: S M
authors.initials: SM
authors.lastname: Chandramohan
mesh_terms: D002983:Clinical Competence; D003198:Computer Simulation; D003479:Curriculum; D004501:Education, Medical / Q000379:methods*; D005385:Fingers / Q000502:physiology*; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D010465:Perception