Factors influencing forces during laparoscopic pinching: Towards the design of virtual simulator.
BACKGROUND
The design of good virtual simulators for laparoscopic training requires realistic visual and tactile perception. This is a study to characterize the factors that contribute to forces during laparoscopic pinching.


METHODS
Surgeons were divided into four groups according to years of experience in laparoscopic surgery. They were asked to grasp six different types of porcine abdominal tissue in a randomly sequenced manner, using two different types of sensorized graspers, under two regimes of perceptual feedback (with and without visual feedback). The forces (grasper handle force and grasper tip force) and grasper handle angle were recorded and analyzed.


RESULTS
The factors that determine forces during laparoscopic pinching can be ranked as follows: surgical experience (p < .001), tissue type (p = .007) and visual feedback (p = .033), but not grasper type (p = .071). Handle force depends significantly on surgical experience (p < .001), tissue type (p = .001) and visual feedback (p = .019), but not on grasper type (p = .203). Tip force depends significantly on surgical experience (p < .001) and marginally on tissue type (p = .082) and visual feedback (p = .053) but not on the grasper type (p = .180).


CONCLUSIONS
Forces during laparoscopic pinching depend on surgical experience, tissue type and presence of visual feedback but not on grasper type. Our data can be an input in the design of virtual simulators with force feedback, for training laparoscopic pinching.
Department of Bioengineering, Christian Medical College Vellore, Tamil Nadu, India; Department of Biotechnology, Indian Institute of Technology Madras, Tamil Nadu, India.
Wils K
WK
Susmitha
Medical Sciences Group, University of Pelita Harapan Medical Sciences, Tangerang, Indonesia.
George
G
Mathew
Department of Bioengineering, Christian Medical College Vellore, Tamil Nadu, India. Electronic address: surdev@cmcvellore.ac.in.
Suresh R
SR
Devasahayam
Department of Surgery, Christian Medical College Vellore, Tamil Nadu, India.
Benjamin
B
Perakath
Department of Biostatistics, Christian Medical College Vellore, Tamil Nadu, India.
Saravana Kumar
SK
Velusamy
D000818:Animals; D002983:Clinical Competence; D003194:Computer-Assisted Instruction; D056228:Feedback, Sensory; D018737:Hand Strength / Q000502:physiology*; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000193:education / Q000295:instrumentation*; D013552:Swine; D014584:User-Computer Interface
Laparoscopic forces; Laparoscopic pinching; Sensorized graspers; Virtual simulator; Visual feedbacks