Department of Visceral, Thoracic, and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany.
Centre for Tactile Internet With Human-in-the-Loop (CeTI), Technische Universität Dresden, Dresden, Germany.
Surg Endosc. 2024 Jul;38(7):3917-3928. doi: 10.1007/s00464-024-10919-3. Epub 2024 Jun 4.
BACKGROUND: Tissue handling is a crucial skill for surgeons and is challenging to learn. The aim of this study was to develop laparoscopic instruments with different integrated tactile vibration feedback by varying different tactile modalities and assess its effect on tissue handling skills. METHODS: Standard laparoscopic instruments were equipped with a vibration effector, which was controlled by a microcomputer attached to a force sensor platform. One of three different vibration feedbacks (F1: double vibration > 2 N; F2: increasing vibration relative to force; F3: one vibration > 1.5 N and double vibration > 2 N) was applied to the instruments. In this multicenter crossover trial, surgical novices and expert surgeons performed two laparoscopic tasks (Peg transfer, laparoscopic suture, and knot) each with all the three vibration feedback modalities and once without any feedback, in a randomized order. The primary endpoint was force exertion. RESULTS: A total of 57 subjects (15 surgeons, 42 surgical novices) were included in the trial. In the Peg transfer task, there were no differences between the tactile feedback modalities in terms of force application. However, in subgroup analysis, the use of F2 resulted in a significantly lower mean-force application (p-value = 0.02) among the student group. In the laparoscopic suture and knot task, all participants exerted significantly lower mean and peak forces using F2 (p-value < 0.01). These findings remained significant after subgroup analysis for both, the student and surgeon groups individually. The condition without tactile feedback led to the highest mean and peak force exertion compared to the three other feedback modalities. CONCLUSION: Continuous tactile vibration feedback decreases the mean and peak force applied during laparoscopic training tasks. This effect is more pronounced in demanding tasks such as laparoscopic suturing and knot tying and might be more beneficial for students. Laparoscopic tasks without feedback lead to increased force application.
背景:组织处理是外科医生的一项关键技能,学习起来具有挑战性。本研究的目的是通过改变不同的触觉模式来开发具有不同集成触觉振动反馈的腹腔镜器械,并评估其对组织处理技能的影响。
方法:标准腹腔镜器械配备了一个振动执行器,该执行器由连接到力传感器平台的微计算机控制。三种不同振动反馈中的一种(F1:两次振动>2N;F2:相对于力的振动增加;F3:一次振动>1.5N 且两次振动>2N)应用于器械。在这项多中心交叉试验中,手术新手和专家外科医生使用所有三种振动反馈模式中的两种(Peg 转移、腹腔镜缝合和打结)各进行两次,并随机进行一次没有任何反馈的操作。主要终点是力的施加。
结果:共有 57 名受试者(15 名外科医生,42 名手术新手)参与了试验。在 Peg 转移任务中,三种触觉反馈模式在力的施加方面没有差异。然而,在亚组分析中,F2 的使用导致学生组的平均力应用显著降低(p 值=0.02)。在腹腔镜缝合和打结任务中,所有参与者使用 F2 时平均力和峰值力的施加显著降低(p 值<0.01)。这些发现在校正学生和外科医生组的亚组分析后仍然具有统计学意义。与其他三种反馈模式相比,没有触觉反馈的条件导致平均和峰值力的施加最高。
结论:连续的触觉振动反馈降低了腹腔镜训练任务中平均和峰值力的施加。这种效果在腹腔镜缝合和打结等要求较高的任务中更为明显,可能对学生更有益。没有反馈的腹腔镜任务会导致力的施加增加。
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