Impact of Applied Force on Latency-Induced Errors in Endovascular Procedures: Experimental Cross-Sectional Study

Telesurgery has the potential to overcome geographical barriers in surgical care, yet data transmission latency remains a major challenge, impairing operator performance. Although haptic feedback may mitigate latency effects, optimal parameters, such as applied force, have not been well defined in the context of robotic surgical procedures. This study aimed to investigate how varying visual feedback latency and applied force levels affect task performance in an endovascular simulation and assess whether lower applied forces can mitigate performance degradation under latency.

In this prospective, experimental, cross-sectional study, healthy volunteers aged 18 to 65 years performed guidewire advancement tasks using a custom-built endovascular simulator under 12 different combinations of latency (0, 100, 200, 400 ms) and applied force (0.6, 1.2, 1.8 N). The primary outcome was the duration (ms) during which participants maintained the target force during a 10-second period.

A total of 116 participants participated in the study. The median performance time was 5,890 ms (interquartile range, 4,550 to 7,150 ms). Increased latency significantly reduced performance, with the most pronounced drop (-1,380 ms) between 100 ms and 200 ms (P < 0.05). Lower applied force (0.6 N) was associated with significantly better performance compared with higher force (1.8 N), independent of latency (-1,097.5 ms, P < 0.05). Younger participants (18 to 25 years) outperformed older participants (55 to 65 years) across all conditions (P < 0.05).

This study confirms the detrimental effect of visual feedback latency on performance in simulated robotic surgical procedures and demonstrates that reduced applied force can partially compensate for increased latency. Therefore, optimizing force parameters may improve performance and safety in telesurgical systems, particularly for older operators.