van der Meijden O A J, Schijven M P
Department of Surgery, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
Surg Endosc. 2009 Jun;23(6):1180-90. doi: 10.1007/s00464-008-0298-x. Epub 2009 Jan 1.
BACKGROUND: Virtual reality (VR) as surgical training tool has become a state-of-the-art technique in training and teaching skills for minimally invasive surgery (MIS). Although intuitively appealing, the true benefits of haptic (VR training) platforms are unknown. Many questions about haptic feedback in the different areas of surgical skills (training) need to be answered before adding costly haptic feedback in VR simulation for MIS training. This study was designed to review the current status and value of haptic feedback in conventional and robot-assisted MIS and training by using virtual reality simulation. METHODS: A systematic review of the literature was undertaken using PubMed and MEDLINE. The following search terms were used: Haptic feedback OR Haptics OR Force feedback AND/OR Minimal Invasive Surgery AND/OR Minimal Access Surgery AND/OR Robotics AND/OR Robotic Surgery AND/OR Endoscopic Surgery AND/OR Virtual Reality AND/OR Simulation OR Surgical Training/Education. RESULTS: The results were assessed according to level of evidence as reflected by the Oxford Centre of Evidence-based Medicine Levels of Evidence. CONCLUSIONS: In the current literature, no firm consensus exists on the importance of haptic feedback in performing minimally invasive surgery. Although the majority of the results show positive assessment of the benefits of force feedback, results are ambivalent and not unanimous on the subject. Benefits are least disputed when related to surgery using robotics, because there is no haptic feedback in currently used robotics. The addition of haptics is believed to reduce surgical errors resulting from a lack of it, especially in knot tying. Little research has been performed in the area of robot-assisted endoscopic surgical training, but results seem promising. Concerning VR training, results indicate that haptic feedback is important during the early phase of psychomotor skill acquisition.
背景:虚拟现实(VR)作为一种手术训练工具,已成为微创手术(MIS)技能培训与教学的一项前沿技术。尽管从直观上看很有吸引力,但触觉(VR训练)平台的真正益处尚不清楚。在将成本高昂的触觉反馈添加到用于MIS训练的VR模拟中之前,关于手术技能(训练)不同领域中触觉反馈的许多问题都需要得到解答。本研究旨在通过使用虚拟现实模拟来回顾触觉反馈在传统和机器人辅助MIS及训练中的现状与价值。 方法:使用PubMed和MEDLINE对文献进行系统回顾。使用了以下检索词:触觉反馈或触觉或力反馈以及/或者微创手术以及/或者小切口手术以及/或者机器人技术以及/或者机器人手术以及/或者内镜手术以及/或者虚拟现实以及/或者模拟或手术训练/教育。 结果:根据牛津循证医学中心证据水平所反映的证据级别对结果进行评估。 结论:在当前文献中,对于触觉反馈在进行微创手术中的重要性尚未达成坚定共识。尽管大多数结果显示对力反馈的益处给予了积极评价,但在这个问题上结果存在矛盾且并不一致。当涉及机器人手术时,益处的争议最小,因为目前使用的机器人没有触觉反馈。人们认为添加触觉功能可减少因缺乏触觉反馈而导致的手术失误,尤其是在打结方面。在机器人辅助内镜手术训练领域开展的研究很少,但结果似乎很有前景。关于VR训练,结果表明在心理运动技能习得的早期阶段,触觉反馈很重要。
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