Objective Assessment of Laparoscopic Force and Psychomotor Skills in a Novel Virtual Reality-Based Haptic Simulator.
BACKGROUND
Most of the commercially available virtual reality-based laparoscopic simulators do not effectively evaluate combined psychomotor and force-based laparoscopic skills. Consequently, the lack of training on these critical skills leads to intraoperative errors.


OBJECTIVE
To assess the effectiveness of the novel virtual reality-based simulator, this study analyzed the combined psychomotor (i.e., motion or movement) and force skills of residents and expert surgeons. The study also examined the effectiveness of real-time visual force feedback and tool motion during training.


METHODS
Bimanual fundamental (i.e., probing, pulling, sweeping, grasping, and twisting) and complex tasks (i.e., tissue dissection) were evaluated. In both tasks, visual feedback on applied force and tool motion were provided. The skills of the participants while performing the early tasks were assessed with and without visual feedback. Participants performed 5 repetitions of fundamental and complex tasks. Reaction force and instrument acceleration were used as metrics.


METHODS
Surgical Gastroenterology, Government Stanley Medical College and Hospital; Institute of Surgical Gastroenterology, Madras Medical College and Rajiv Gandhi Government General Hospital.


METHODS
Residents (N = 25; postgraduates and surgeons with <2 years of laparoscopic surgery) and expert surgeons (N = 25; surgeons with >4 and ≤10 years of laparoscopic surgery).


RESULTS
Residents applied large forces compared with expert surgeons and performed abrupt tool movements (p < 0.001). However, visual + haptic feedback improved the performance of residents (p < 0.001). In complex tasks, visual + haptic feedback did not influence the applied force of expert surgeons, but influenced their tool motion (p < 0.001). Furthermore, in complex tissue sweeping task, expert surgeons applied more force, but were within the tissue damage limits. In both groups, exertion of large forces and abrupt tool motion were observed during grasping, probing or pulling, and tissue sweeping maneuvers (p < 0.001).


CONCLUSIONS
Modern day curriculum-based training should evaluate the skills of residents with robust force and psychomotor-based exercises for proficient laparoscopy. Visual feedback on force and motion during training has the potential to enhance the learning curve of residents.
Haptics Lab, Biomedical Engineering Group, Department of Applied Mechanics, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India. Electronic address: raghuprasad.m.s@gmail.com.
M S Raghu
MS
Prasad
Haptics Lab, Biomedical Engineering Group, Department of Applied Mechanics, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India; Department of Bioengineering, Christian Medical College, Vellore, Tamil Nadu, India.
Muniyandi
M
Manivannan
Department of Surgical Gastroenterology, Government Stanley Medical College and Hospital, Chennai, Tamil Nadu, India.
Govindan
G
Manoharan
Institute of Surgical Gastroenterology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India.
S M
SM
Chandramohan
D002983:Clinical Competence; D003194:Computer-Assisted Instruction; D003479:Curriculum; D006801:Humans; D007194:India; D010535:Laparoscopy / Q000193:education*; D011597:Psychomotor Performance; D000066908:Simulation Training / Q000379:methods*; D014110:Touch; D014584:User-Computer Interface
Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; construct validity; force-based laparoscopic training; haptics; laparoscopic simulator; performance metric; virtual reality