Psychology of Learning and Instruction, Department of Psychology, School of Science, Technische Universität Dresden, Zellescher Weg 17, 01069, Dresden, Germany.
Centre for Tactile Internet with Human-in-the-Loop (CeTI), Technische Universität Dresden, Dresden, Germany.
Surg Endosc. 2023 Apr;37(4):2439-2452. doi: 10.1007/s00464-022-09740-7. Epub 2022 Oct 27.
Force feedback is a critical element for performing and learning surgical suturing skill. Force feedback is impoverished or not present at all in non-open surgery (i.e., in simulation, laparoscopic, and robotic-assisted surgery), but it can be augmented using different modalities. This rapid, systematic review examines how the modality of delivering force feedback influences the performance and learning of surgical suturing skills.
An electronic search was performed on PubMed/MEDLINE, Web of Science, and Embase databases to identify relevant articles. The results were synthesized using vote counting based on direction of effect.
A total of nine studies of medium-to-low quality were included. The synthesis of results suggests that the visual modality could be more beneficial than the tactile and auditory modalities in improving force control and that auditory and tactile modalities could be more beneficial than the visual modality in improving suturing performance. Results are mixed and unclear with regards to how modality affects the reduction of force magnitude and unclear when unimodal was compared to multimodal feedback. The studies have a general low level of evidence.
The low number of studies with low methodological quality and low level of evidence (most were proof of concept) prevents us from drawing any meaningful conclusion and as such it is currently unknown whether and how force feedback modality influences surgical suturing skill. Speculatively, the visual modality may be more beneficial for improving the control of exerted force, while auditory and tactile modalities may be more effective in improving the overall suturing performance. We consider the issue of feedback modality to be highly relevant in this field, and we encourage future research to conduct further investigation integrating principles from learning psychology and neuroscience: identify feedback goal, context, and skill level and then design and compare feedback modalities accordingly.
力反馈对于执行和学习手术缝合技能至关重要。在非开放式手术（即模拟、腹腔镜和机器人辅助手术）中，力反馈匮乏或根本不存在，但可以通过不同的方式进行增强。本快速系统综述检查了提供力反馈的方式如何影响手术缝合技能的表现和学习。
在 PubMed/MEDLINE、Web of Science 和 Embase 数据库中进行电子检索，以确定相关文章。使用基于效应方向的投票计数法对结果进行综合。
共纳入九项中低质量研究。结果综合表明，在改善力控制方面，视觉模式可能比触觉和听觉模式更有益，而在改善缝合性能方面，听觉和触觉模式可能比视觉模式更有益。当比较单模态与多模态反馈时，结果在力幅度降低方面存在差异且不明确，在如何影响力反馈模式方面的结果也不明确。研究的证据水平普遍较低。
研究数量少，方法学质量低，证据水平低（大多数为概念验证），这使得我们无法得出任何有意义的结论，因此目前尚不清楚力反馈模式是否以及如何影响手术缝合技能。推测而言，视觉模式可能更有利于改善施加力的控制，而听觉和触觉模式可能更有效地提高整体缝合性能。我们认为反馈模式问题在该领域非常重要，并鼓励未来的研究结合学习心理学和神经科学的原则进行进一步调查：确定反馈目标、上下文和技能水平，然后相应地设计和比较反馈模式。
