title: Impact of delay on telesurgical performance: study on the robotic simulator dV-Trainer.
abstract: OBJECTIVE
  To determine the impact of communication latency on telesurgical performance using the robotic simulator dV-Trainer®.
  
  
  METHODS
  Surgeons were enrolled during three robotic congresses. They were randomly assigned to a delay group (ranging from 100 to 1000 ms). Each group performed three times a set of four exercises on the simulator: the first attempt without delay (Base) and the last two attempts with delay (Warm-up and Test). The impact of different levels of latency was evaluated.
  
  
  RESULTS
  Thirty-seven surgeons were involved. The different latency groups achieved similar baseline performance with a mean task completion time of 207.2 s (p > 0.05). In the Test stage, the task duration increased gradually from 156.4 to 310.7 s as latency increased from 100 to 500 ms. In separate groups, the task duration deteriorated from Base for latency stages at delays ≥300 ms, and the errors increased at 500 ms and above (p < 0.05). The subjects' performance tended to improve from the Warm-up to the Test period. Few subjects completed the tasks with a delay higher than 700 ms.
  
  
  CONCLUSIONS
  Gradually increasing latency has a growing impact on performances. Measurable deterioration of performance begins at 300 ms. Delays higher than 700 ms are difficult to manage especially in more complex tasks. Surgeons showed the potential to adapt to delay and may be trained to improve their telesurgical performance at lower-latency levels.
authors.affiliation: IADI Laboratory-INSERM-U947, Lorraine University, Allée du Morvan, 54500, Vandoeuvre-les-Nancy, France. m.perez@chu-nancy.fr.|General and Emergency Surgery Department, University Hospital of Nancy, Avenue du Maréchal de Lattre de Tassigny, 54035, Nancy, France. m.perez@chu-nancy.fr.|Florida Hospital Nicholson Center, 404 Celebration Place, Celebration, FL, 34747, USA. m.perez@chu-nancy.fr.|Hôpital Central Service de Chirurgie Générale et Urgences, Avenue du Maréchal de Lattre de Tassigny, 54035, Nancy, France. m.perez@chu-nancy.fr.
authors.forename: Manuela
authors.initials: M
authors.lastname: Perez
authors.affiliation: IADI Laboratory-INSERM-U947, Lorraine University, Allée du Morvan, 54500, Vandoeuvre-les-Nancy, France.|Urology Department, University Hospital of Nancy, Allée du Morvan, 54511, Vandoeuvre-les-Nancy, France.
authors.forename: Song
authors.initials: S
authors.lastname: Xu
authors.affiliation: Center for Evidence Based Simulation, Baylor University Medical Center, Dallas, TX, USA.|Associate Professor Texas A&M Health Science Center, College Station, TX, USA.
authors.forename: Sanket
authors.initials: S
authors.lastname: Chauhan
authors.affiliation: Florida Hospital Nicholson Center, 404 Celebration Place, Celebration, FL, 34747, USA.
authors.forename: Alyssa
authors.initials: A
authors.lastname: Tanaka
authors.affiliation: Florida Hospital Nicholson Center, 404 Celebration Place, Celebration, FL, 34747, USA.
authors.forename: Khara
authors.initials: K
authors.lastname: Simpson
authors.affiliation: Florida Hospital Nicholson Center, 404 Celebration Place, Celebration, FL, 34747, USA.
authors.forename: Haidar
authors.initials: H
authors.lastname: Abdul-Muhsin
authors.affiliation: Florida Hospital Nicholson Center, 404 Celebration Place, Celebration, FL, 34747, USA.
authors.forename: Roger
authors.initials: R
authors.lastname: Smith
mesh_terms: D002983:Clinical Competence; D003198:Computer Simulation; D004503:Education, Medical, Graduate / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D012371:Robotics; D013514:Surgical Procedures, Operative / Q000193:education*
keywords: Computer simulation; Internet; Robotic simulator; Telemedicine/methods; Telesurgery