Wilmer Eye Institute, Johns Hopkins School of Medicine, 400 N. Broadway, Baltimore, MD 21287-9277, USA.
Invest Ophthalmol Vis Sci. 2013 Feb 15;54(2):1316-24. doi: 10.1167/iovs.12-11136.
To determine the extent that auditory force feedback (AFF) substitution improves performance during a simulated ophthalmic peeling procedure.
A 25-gauge force-sensing microforceps was linked to two AFF modes. The "alarm" AFF mode sounded when the force reached 9 mN. The "warning" AFF mode made beeps with a frequency proportional to the generated force. Participants with different surgical experience levels were asked to peel a series of bandage strips off a platform as quickly as possible without exceeding 9 mN of force. In study arm A, participants peeled with alarm and warning AFF modes, the order randomized within the experience level. In study arm B, participants first peeled without AFF, then alarm or warning AFF (order randomized within the experience level), and finally without AFF.
Of the 28 "surgeon" participants, AFF improved membrane peeling performance, reducing average force generated (P < 0.01), SD of forces (P < 0.05), and force × time above 9 mN (P < 0.01). Short training periods with AFF improved subsequent peeling performance when AFF was turned off, with reductions in average force, SD of force, maximum force, time spent above 9 mN, and force × time above 9 mN (all P < 0.001). Except for maximum force, peeling with AFF reduced all force parameters (P < 0.05) more than peeling without AFF after completing a training session.
AFF enables the surgeon to reduce the forces generated with improved precision during phantom membrane peeling, regardless of surgical experience. New force-sensing surgical tools combined with AFF offer the potential to enhance surgical training and improve surgical performance.
确定听觉力反馈（AFF）替代在模拟眼科剥离过程中提高性能的程度。
将 25G 力感微夹连接到两种 AFF 模式。当力达到 9 mN 时，“警报”AFF 模式会发出声音。“警告”AFF 模式会根据产生的力发出频率成正比的蜂鸣声。要求具有不同手术经验水平的参与者尽可能快地从平台上剥离一系列绷带条，而不超过 9 mN 的力。在研究臂 A 中，参与者使用警报和警告 AFF 模式进行剥离，经验水平内的顺序随机化。在研究臂 B 中，参与者首先在没有 AFF 的情况下进行剥离，然后是没有 AFF 的情况下进行报警或警告 AFF（经验水平内的顺序随机化），最后是没有 AFF 的情况下进行剥离。
在 28 名“外科医生”参与者中，AFF 改善了膜剥离性能，减少了平均产生的力（P <0.01），力的标准差（P <0.05），以及力×时间超过 9 mN（P <0.01）。在关闭 AFF 时，使用 AFF 进行短期培训可以提高随后的剥离性能，减少平均力、力的标准差、最大力、9 mN 以上的时间和力×时间超过 9 mN（均 P <0.001）。除最大力外，使用 AFF 进行剥离比不使用 AFF 进行剥离后降低了所有力参数（P <0.05）。
AFF 使外科医生能够在进行模拟膜剥离时以更高的精度减少产生的力，而与手术经验无关。新的力感手术工具与 AFF 相结合，具有提高手术培训和改善手术性能的潜力。
