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Learning from visual force feedback in box trainers: tissue manipulation in laparoscopic surgery.

Tim Horeman1, Freek van Delft, Mathijs D Blikkendaal

  • 1Department of Biomechanical Engineering, Faulty of Mechanical, Maritime and Materials Engineering (3mE), Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands, t.horeman@tudelft.nl.

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Summary

Visual force feedback training improves laparoscopic tissue handling skills without negatively impacting task time or instrument motion. Time feedback alone enhances instrument skills but not tissue manipulation.

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Area of Science:

  • Laparoscopic surgery training
  • Surgical skills assessment
  • Medical education technology

Background:

  • Current laparoscopic training often relies on task time and error metrics.
  • Focusing solely on time can lead to rapid, uncontrolled movements and poor tissue handling.
  • Objective assessment of surgical skill acquisition is crucial.

Purpose of the Study:

  • To compare the effectiveness of visual force feedback versus visual time feedback in laparoscopic surgical training.
  • To evaluate the impact of different feedback modalities on tissue handling and instrument motion skills.
  • To determine which feedback method best enhances overall laparoscopic technical proficiency.

Main Methods:

  • Twenty-five medical students were randomized into two groups: time feedback (n=13) and force feedback (n=12).
  • Participants performed a tissue manipulation task six times with real-time visual feedback.
  • Post-training assessment involved a different task without feedback, measuring time, force, and motion parameters.

Main Results:

  • Force feedback training demonstrated learning curves for force, task time, and instrument path length.
  • Time feedback training showed learning curves for force, task time, and instrument path length.
  • The force feedback group exhibited significantly better performance in mean absolute force, max force, and force volume during the posttest.

Conclusions:

  • Visual force feedback enhances laparoscopic tissue handling skills effectively.
  • Force feedback training does not negatively affect task time or instrument motion.
  • Traditional time feedback improves instrument motion and task completion time but not tissue manipulation proficiency.