Department of BioMechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering (3mE), Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands.
Surg Endosc. 2012 Jan;26(1):242-8. doi: 10.1007/s00464-011-1861-4. Epub 2011 Aug 20.
To improve endoscopic surgical skills, an increasing number of surgical residents practice on box or virtual reality (VR) trainers. Current training is focused mainly on hand-eye coordination. Training methods that focus on applying the right amount of force are not yet available.
The aim of this project is to develop a low-cost training system that measures the interaction force between tissue and instruments and displays a visual representation of the applied forces inside the camera image. This visual representation continuously informs the subject about the magnitude and the direction of applied forces. To show the potential of the developed training system, a pilot study was conducted in which six novices performed a needle-driving task in a box trainer with visual feedback of the force, and six novices performed the same task without visual feedback of the force. All subjects performed the training task five times and were subsequently tested in a post-test without visual feedback.
The subjects who received visual feedback during training exerted on average 1.3 N (STD 0.6 N) to drive the needle through the tissue during the post-test. This value was considerably higher for the group that received no feedback (2.6 N, STD 0.9 N). The maximum interaction force during the post-test was noticeably lower for the feedback group (4.1 N, STD 1.1 N) compared with that of the control group (8.0 N, STD 3.3 N).
The force-sensing training system provides us with the unique possibility to objectively assess tissue-handling skills in a laboratory setting. The real-time visualization of applied forces during training may facilitate acquisition of tissue-handling skills in complex laparoscopic tasks and could stimulate proficiency gain curves of trainees. However, larger randomized trials that also include other tasks are necessary to determine whether training with visual feedback about forces reduces the interaction force during laparoscopic surgery.
为了提高内镜手术技能，越来越多的外科住院医师在箱式或虚拟现实（VR）训练器上进行练习。目前的培训主要集中在手眼协调上。目前还没有专门针对施加适当力量的培训方法。
本项目旨在开发一种低成本的训练系统，该系统可以测量组织与器械之间的相互作用力，并在相机图像内显示施加力的视觉表示。这种视觉表示会持续向主体传达施加力的大小和方向。为了展示所开发的训练系统的潜力，进行了一项初步研究，其中 6 名新手在具有力视觉反馈的箱式训练器中进行了针驱动任务，而另外 6 名新手则在没有力视觉反馈的情况下进行了相同的任务。所有受试者均进行了 5 次训练任务，然后在没有视觉反馈的后测中进行了测试。
接受训练时视觉反馈的受试者在针穿过组织的后测中平均施加 1.3N（STD 0.6N）的力。而没有接受反馈的组（2.6N，STD 0.9N）的数值则高很多。反馈组在后测中的最大相互作用力（4.1N，STD 1.1N）明显低于对照组（8.0N，STD 3.3N）。
力感训练系统为我们提供了在实验室环境中客观评估组织处理技能的独特可能性。在训练过程中实时显示施加的力可能有助于在复杂的腹腔镜任务中获得组织处理技能，并激发学员的熟练度提高曲线。但是，需要进行更大规模的随机试验，其中还包括其他任务，以确定是否使用有关力的视觉反馈进行培训可以减少腹腔镜手术中的相互作用力。
