title: Influence of visual force feedback on tissue handling in minimally invasive surgery.
abstract: BACKGROUND
  Force feedback might improve surgical performance during minimally invasive surgery. This study sought to determine whether training with force feedback shortened the tissue-handling learning curve, and examined the influence of real-time visual feedback compared with postprocessing feedback.
  
  
  METHODS
  Medical students without experience of minimally invasive surgery were randomized into three groups: real-time force feedback, postprocessing force feedback and no force feedback (control). All performed eight suturing tasks consecutively, of which the first and eighth were the premeasurement and postmeasurement tasks respectively (no feedback). Depending on randomization, either form of feedback was given during the second to seventh task. Time, mean force non-zero and maximum force were measured with a force sensor. Results of the groups were compared with one-way ANOVA, and intragroup improvement using a paired-samples t test.
  
  
  RESULTS
  A total of 72 students took part. Both intervention groups used significantly lower interaction forces than the control group during the knot-tying phase of the postmeasurement task and improved their interaction forces significantly during the knot-tying phase. The form of feedback did not influence its effectiveness.
  
  
  CONCLUSIONS
  The tissue-handling skills of medical students improved significantly when they were given force feedback of their performance. This effect was seen mainly during the knot-tying phase of the suturing task.
authors.affiliation: Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: S P
authors.initials: SP
authors.lastname: Rodrigues
authors.forename: T
authors.initials: T
authors.lastname: Horeman
authors.forename: P
authors.initials: P
authors.lastname: Sam
authors.forename: J
authors.initials: J
authors.lastname: Dankelman
authors.forename: J J
authors.initials: JJ
authors.lastname: van den Dobbelsteen
authors.forename: F-W
authors.initials: FW
authors.lastname: Jansen
mesh_terms: D000704:Analysis of Variance; D004504:Education, Medical, Undergraduate / Q000379:methods*; D005246:Feedback; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000193:education* / Q000592:standards; D059032:Learning Curve; D008297:Male; D013048:Specimen Handling / Q000592:standards*; D013536:Suture Techniques / Q000193:education / Q000592:standards; D013663:Teaching / Q000379:methods; D055815:Young Adult