Introduction
Laparoscopic virtual reality simulators are becoming a ubiquitous tool in resident
training and assessment. These devices provide the operator with various levels of
realism, including haptic (or force) feedback. However, this feature adds significantly
to the cost of the devices, and limited data exist assessing the value of haptics
in skill acquisition and development. Utilizing the Laparoscopy VR (Immersion Medical,
Gaithersburg, MD), we hypothesized that the incorporation of force feedback in the
simulated operative environment would allow superior trainee performance compared
with performance of the same basic skills tasks in a non-haptic model.
Methods
Ten medical students with minimal laparoscopic experience and similar baseline skill
levels as proven by performance of two fundamentals of laparoscopic surgery (FLS)
tasks (peg transfer and cutting drills) voluntarily participated in the study. Each
performed two tasks, analogous to the FLS drills, on the Laparoscopy VR at 3 levels
of difficulty, based on the established settings of the manufacturer. After achieving
familiarity with the device and tasks, the students completed the drills both with
and without force feedback. Data on completion time, instrument path length, right
and left hand errors, and grasping tension were analyzed. The scores in the haptic-enhanced
simulation environment were compared with the scores in the non-haptic model and analyzed
utilizing Student's t-test.
Results
The peg transfer drill showed no difference in performance between the haptic and
non-haptic simulations for all metrics at all three levels of difficulty. For the
more complex cutting exercise, the time to complete the tasks was significantly shorter
when force feedback was provided, at all levels of difficulty (158±56 versus 187±51 s, 176±49 versus 222±68 s, and 275±76 versus 422±220 s, at levels 1, 2, and 3, respectively, P<0.05). Data on instrument path length, grasping tension, and errors showed a trend
toward a benefit from haptics at all difficulty levels, but this difference did not
achieve statistical significance.
Conclusions
In the more advanced tasks, haptics allowed superior precision, resulting in faster
completion of tasks and a trend toward fewer technical errors. In the more basic tasks,
haptic-enhanced simulation did not demonstrate an appreciable performance improvement
among our trainees. These data suggest that the additional expense of haptic-enhanced
laparoscopic simulators may be justified for advanced skill development in surgical
trainees as simulator technology continues to improve.
Key Words
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References
Panait L, Bell RL, Roberts KE, et al. Laparoscopic Operative Skills are Predicted by Virtual Reality Simulator Performance. Paper presented at: Proceedings of the 89th Annual Meeting of the New England Surgical Society, September 2008; Boston, MA.
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Article Info
Publication History
Published online: May 15, 2009
Received:
January 9,
2009
Identification
Copyright
© 2009 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
