Salkini Mohamad W, Doarn Charles R, Kiehl Nicholai, Broderick Timothy J, Donovan James F, Gaitonde Krishnanath
Division of Urology, Department of Surgery, University of Cincinnati, Cincinnati, Ohio, USA.
J Endourol. 2010 Jan;24(1):99-102. doi: 10.1089/end.2009.0307.
Laparoscopic surgery has become the standard of care for many surgical diseases. Haptic (tactile) feedback (HFB) is considered an important component of laparoscopic surgery. Virtual reality simulation (VRS) is an alternative method to teach surgical skills to surgeons in training. Newer VRS trainers such as the Simbionix Lap Mentor II provide significantly improved tactile feedback. However, VRSs are expensive and adding HFB software adds an estimated cost of $30,000 to the commercial price. The HFB provided by the Lap Mentor II has not been validated by an independent party. We used the Simbionix Lap Mentor II in this study to demonstrate the effect of adding an HFB mechanism in the VRS trainer.
The study was approved by the University of Cincinnati Institutional Review Board. Twenty laparoscopically novice medical students were enrolled. Each student was asked to perform three different tasks on the Lap Mentor II and repeat each one five times. The chosen tasks demanded significant amount of traction and counter traction. The first task was to pull leaking tubes enough and clip them. The second task was stretching a jelly plate enough to see its attachments to the floor and cut these attachments. In the third task, the trainee had to separate the gallbladder from its bed on the liver. The students were randomized into two groups to perform the tasks with and without HFB. We used accuracy, speed, and economy of movement as scales to compare the performance between the two groups. The participants also completed a simple questionnaire that highlighted age, sex, and experiences in videogame usage.
The two groups were comparable in age, sex, and videogame playing. No differences in the accuracy, the economy, and the speed of hand movement were noticed. In fact, adding HFB to the Lap Mentor II simulator did not contribute to any improvement in the performance of the trainees. Interestingly, we found that videogame expert players tend to have faster and more economic motion in their dominant hands. However, the performance accuracy was not significantly affected.
The presence of HFB has less effect than it thought to be on the performance of the novice trainees. This may suggest that better HFB is still needed. However, there may be visual compensation for the lack of haptics. Playing videogames has a positive impact on economy, and the speed of the dominant had motion without affecting its accuracy. Further research is needed to clarify the value of haptics to the expert surgeon and compare it to the new trainees.
腹腔镜手术已成为许多外科疾病的标准治疗方法。触觉反馈被认为是腹腔镜手术的一个重要组成部分。虚拟现实模拟是一种向实习外科医生传授手术技能的替代方法。较新的虚拟现实模拟器，如Simbionix Lap Mentor II，提供了显著改进的触觉反馈。然而，虚拟现实模拟器价格昂贵，添加触觉反馈软件估计会使商业价格增加3万美元。Lap Mentor II提供的触觉反馈尚未得到独立机构的验证。在本研究中，我们使用Simbionix Lap Mentor II来证明在虚拟现实模拟器中添加触觉反馈机制的效果。
本研究经辛辛那提大学机构审查委员会批准。招募了20名腹腔镜手术新手医学生。要求每个学生在Lap Mentor II上执行三项不同任务，并每项任务重复五次。所选任务需要大量的牵引和反牵引。第一项任务是充分拉动漏液管并夹住它们。第二项任务是充分拉伸果冻板以查看其与底部的连接并切断这些连接。在第三项任务中，学员必须将胆囊从其在肝脏上的附着处分离。学生被随机分为两组，分别在有和没有触觉反馈的情况下执行任务。我们使用准确性、速度和动作经济性作为指标来比较两组的表现。参与者还完成了一份简单问卷，突出显示了年龄、性别和电子游戏使用经历。
两组在年龄、性别和电子游戏玩法方面具有可比性。未观察到手部动作的准确性、经济性和速度存在差异。事实上，在Lap Mentor II模拟器上添加触觉反馈对学员的表现没有任何改善。有趣的是，我们发现电子游戏专家玩家优势手的动作往往更快且更经济。然而，表现准确性没有受到显著影响。
触觉反馈对新手学员表现的影响比预期的要小。这可能表明仍需要更好的触觉反馈。然而，可能存在对触觉缺失的视觉补偿。玩电子游戏对优势手动作的经济性和速度有积极影响，而不影响其准确性。需要进一步研究以阐明触觉对专家外科医生的价值，并将其与新学员进行比较。
