Gomez Ernest D, Husin Haliza Mat, Dumon Kristoffel R, Williams Noel N, Kuchenbecker Katherine J
Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, USA.
Department of Mechanical Engineering and Applied Mechanics, University of Pennsylvania, Philadelphia, USA.
Surg Endosc. 2025 Mar;39(3):1523-1535. doi: 10.1007/s00464-024-11459-6. Epub 2024 Dec 31.
New surgeons experience heavy workload during robot-assisted surgery partially because they must use vision to compensate for the lack of haptic feedback. We hypothesize that providing realistic haptic feedback during dry-lab simulation training may accelerate learning and reduce workload during subsequent surgery on patients.
We conducted a single-blinded study with 12 general surgery residents (third and seventh post-graduate year, PGY) randomized into haptic and control groups. Participants performed five simulated bariatric surgeries on a custom inanimate simulator followed by live robot-assisted sleeve gastrectomies (RASGs) using da Vinci robots. The haptic group received naturalistic haptic feedback of instrument vibrations during their first four simulated procedures. Participants completed pre-/post-procedure STAI and post-procedure NASA-TLX questionnaires in both simulation and the operating room (OR).
Higher PGY level (simulation: p < 0.001, OR p = 0.004), shorter operative time (simulation: p < 0.001, OR p = 0.003), and lower pre-procedure STAI (simulation: p = 0.003, OR p < 0.001) were significantly associated with lower self-reported overall workload in both operative settings; PGY-7 s reported about 10% lower workload than PGY-3 s. The haptic group had significantly lower overall covariate-adjusted NASA-TLX during the fourth (p = 0.03) and fifth (p = 0.04) simulated procedures and across all OR procedures (p = 0.047), though not for only the first three OR procedures. Haptic feedback reduced physical demand (simulation: p < 0.001, OR p = 0.001) and increased perceived performance (simulation: p = 0.031, OR p < 0.001) in both settings.
Haptic feedback of instrument vibrations provided during robotic surgical simulation reduces trainee workload during both simulation and live OR cases. The implications of workload reduction and its potential effects on patient safety warrant further investigation.
新外科医生在机器人辅助手术期间工作量繁重，部分原因是他们必须依靠视觉来弥补触觉反馈的缺失。我们假设在干式实验室模拟训练期间提供逼真的触觉反馈可能会加速学习，并减少后续患者手术期间的工作量。
我们进行了一项单盲研究，将12名普通外科住院医师（研究生三年级和七年级）随机分为触觉组和对照组。参与者在定制的无生命模拟器上进行了五次模拟减肥手术，随后使用达芬奇机器人进行了现场机器人辅助袖状胃切除术（RASG）。触觉组在其前四次模拟手术过程中接受了器械振动的自然触觉反馈。参与者在模拟和手术室（OR）中完成了术前/术后状态特质焦虑量表（STAI）和术后NASA任务负荷指数（NASA-TLX）问卷。
较高的研究生年级水平（模拟：p<0.001，手术室：p = 0.004）、较短的手术时间（模拟：p<0.001，手术室：p = 0.003）以及较低的术前STAI（模拟：p = 0.003，手术室：p<0.001）与两种手术环境中自我报告的总体工作量较低显著相关；研究生七年级报告的工作量比研究生三年级低约10%。在第四次（p = 0.03）和第五次（p = 0.04）模拟手术以及所有手术室手术中（p = 0.047），触觉组经协变量调整后的总体NASA-TLX显著较低，不过仅前三次手术室手术时并非如此。触觉反馈在两种环境中均降低了体力需求（模拟：p<0.001，手术室：p = 0.001）并提高了自我感知表现（模拟：p = 0.031，手术室：p<0.001）。
机器人手术模拟期间提供的器械振动触觉反馈可降低模拟和实际手术室病例中受训人员的工作量。工作量减少的影响及其对患者安全的潜在作用值得进一步研究。
