Department of Surgery Baystate Health, University of Massachusetts Chan Medical School-Baystate, 759 Chestnut Street, Springfield, MA, 01199, USA.
Surg Endosc. 2023 Nov;37(11):8748-8754. doi: 10.1007/s00464-023-10321-5. Epub 2023 Aug 10.
Virtual reality (VR) simulation for laparoscopic training is available with and without haptic feedback features. Currently, there is limited data on haptic feedback's effect on skill development. Our objective is to compare expert laparoscopists' skills characteristics using VR delivered laparoscopic tasks via haptic and nonhaptic laparoscopic surgical interfaces.
Five expert laparoscopists performed seven skills tasks on two laparoscopic simulators, one with and one without haptic features. Tasks consisted of 2-handed instrument navigation, retraction and exposure, cutting, electrosurgery, and complicated object positioning. Laparoscopists alternated platforms at default difficulty settings. Metrics included time, economy of movement, completed task elements, and errors. Progressive change in performance for the final three iterations were determined by repeated measures ANOVA. Iteration quartile means were determined and compared using paired t-tests.
No change in performance was noted in the last three iterations for any metric. There were no significant differences between platforms on the final two quartiles for most metrics except avoidance of over-stretch error for retraction; and cutting task was significantly better with haptics on all iteration quartiles (p < 0.03). Economy of movement was significantly better with haptics for both hands for clip application (p < 0.01) and better for right hand on complex object positioning (p < 0.05). Accuracy was better with haptics for retraction and cutting (p < 0.05) and clip application (p < 0.05).
Results showed higher performance in accuracy, efficient instrument motion, and avoidance of excessive traction force on selected tasks performed on VR simulator with haptic feedback compared to those performed without haptics feedback. Laparoscopic surgeons interpreted machine-generated haptic cues appropriately and resulted in better performance with VR task requirements. However, our results do not demonstrate an advantage in skills acquisition, which requires additional study.
腹腔镜训练的虚拟现实 (VR) 模拟具有和不具有触觉反馈功能。目前，关于触觉反馈对技能发展的影响的数据有限。我们的目的是比较使用具有和不具有触觉功能的 VR 腹腔镜手术接口进行腹腔镜任务的专家腹腔镜医生的技能特征。
五名专家腹腔镜医生在两个腹腔镜模拟器上完成了七个技能任务，一个具有触觉功能，一个不具有触觉功能。任务包括双手器械导航、牵引和暴露、切割、电外科和复杂物体定位。腹腔镜医生在默认难度设置下交替使用平台。指标包括时间、运动经济性、完成任务元素和错误。通过重复测量方差分析确定最后三个迭代的性能变化。使用配对 t 检验确定和比较迭代四分位数均值。
对于任何指标，最后三个迭代都没有注意到性能的变化。除了避免过度拉伸的牵引错误外，在最后两个四分位数上，大多数指标在两个平台之间没有显著差异；触觉在所有迭代四分位数上的切割任务都明显更好（p < 0.03）。在夹取应用中，双手的运动经济性明显更好（p < 0.01），在复杂物体定位中右手的运动经济性更好（p < 0.05）。触觉在牵引和切割（p < 0.05）和夹取应用（p < 0.05）方面的准确性更好。
结果表明，与没有触觉反馈的情况下相比，在具有触觉反馈的 VR 模拟器上执行的选定任务的准确性、仪器运动效率更高，避免过度牵引力更好。腹腔镜外科医生适当解释了机器生成的触觉提示，从而在 VR 任务要求方面表现更好。然而，我们的结果并没有表明在技能获取方面有优势，这需要进一步研究。
