Development and validation of a surgical training simulator with haptic feedback for learning bone-sawing skill

Area of Science:

• Medical Simulation
• Surgical Training
• Maxillofacial Surgery

Background:

• Bone sawing is a critical surgical skill requiring experience and precise force control.
• Traditional surgical training for bone sawing is limited by safety, repeatability, and cost.
• Surgical training simulators with haptic feedback offer a viable alternative for skill development.

Purpose of the Study:

• To develop and validate a surgical training simulator with virtual and haptic force feedback for maxillofacial bone-sawing procedures.
• To evaluate the simulator's effectiveness in improving bone-sawing skills in both novice and experienced surgeons.
• To assess the construct, face, and transfer validity of the developed simulator.

Main Methods:

• A haptic device and 3D stereo display were integrated with a voxel-based model created from CT images.
• Multi-point collision detection was used for haptic rendering during simulated bone-sawing procedures.
• Twenty-five participants (16 novices, 9 experienced surgeons) performed six bone-sawing trials, with operative time, maximal acceleration, and haptic force exceeding thresholds recorded.

Main Results:

• Both novice and experienced surgeons significantly reduced sawing operative times and maximal acceleration with practice.
• Novices demonstrated a significant reduction in exceeding safe haptic force thresholds after four trials.
• The simulator showed higher overall performance scores for novices (8.31) compared to experienced surgeons (7.22), indicating greater benefit for less experienced individuals.
• Skill transference was evidenced by a significant reduction in maximal acceleration in the experimental group using the simulator compared to a control group.

Conclusions:

• The developed surgical simulator is valid in terms of construct, face, and transferability of skills.
• The simulator effectively facilitates the learning of bone-sawing skills, particularly for novice surgeons.
• This haptic-enabled simulator presents a promising training alternative for improving surgical proficiency in maxillofacial bone cutting.