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Early exposure to haptic feedback enhances performance in surgical simulator training: a prospective randomized crossover study in surgical residents

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Abstract

Background

In the literature of skill acquisition and transfer of skills, it often is assumed that the rate of skill acquisition depends on what has been learned in a similar context (i.e., surgical simulators providing haptic feedback). This study aimed to analyze whether the addition of haptic feedback early in the training phase for image-guided surgical simulation improves performance.

Methods

A randomized crossover study design was used, in which 38 surgical residents were randomized to begin a 2-h simulator training session with either haptic or nonhaptic training followed by crossover after 1 h. The graphic context was a virtual upper abdomen. The residents performed two diathermy tasks. Two validated tests were used to control for differences in visual–spatial ability: the BasIQ general cognitive ability test and Mental Rotation Test A (MRT-A).

Results

After 2 h of training, the group that had started with haptic feedback performed the two diathermy tasks significantly better (p < 0.05, unpaired t-test). Only the group that had started with haptic training significantly improved during the last 1-h session (p < 0.01, paired t-test).

Conclusion

The findings indicate that haptic feedback could be important in the early training phase of skill acquisition in image-guided surgical simulator training.

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References

  1. Ackerman PL (1992) Predicting individual differences in complex skill acquisition: dynamics of ability determinants. J Appl Psychol 77: 598–614

    Article  PubMed  CAS  Google Scholar 

  2. Basdogan C, De S, Kim J, Muniyandi M, Kim H, Srinivasan MA (2004) Haptics in minimally invasive surgical simulation and training. IEEE Computer Graphics Applications 24: 56–64

    Article  Google Scholar 

  3. Berkley J, Turkiyyah G, Berg D, Ganter M, Weghorst S (2004) Real-time finite element modeling for surgery simulation: an application to virtual suturing. IEEE Transact Visualization Computer Graphics 10: 314–325

    Article  Google Scholar 

  4. Bethea BT, Okamura AM, Kitagawa M, Fitton TP, Cattaneo SM, Gott VL, Baumgartner WA, Yuh DD (2004) Application of haptic feedback to robotic surgery. J Laparoendosc Adv Surg Tech A 14: 191–195

    Article  PubMed  Google Scholar 

  5. Bholat OS, Haluck RS, Kutz RH, Gorman PJ, Krummel TM (1999) Defining the role of haptic feedback in minimally invasive surgery. Stud Health Technol Inform 62: 62–66

    PubMed  CAS  Google Scholar 

  6. Bholat OS, Haluck RS, Murray WB, Gorman PJ, Krummel TM (1999) Tactile feedback is present during minimally invasive surgery. J Am Coll Surg 189: 349–355

    Article  PubMed  CAS  Google Scholar 

  7. Biggs SJ, Srinivasan MA (2002) Haptic interfaces. In: Stanney KM (eds). Handbook of virtual environments: design, implementation, and applications. Lawrence Erlbaum Associates, Mahwah, NJ pp 93–115

    Google Scholar 

  8. Borg G (1998) Borg´s perceived exertion and pain scales. In: Cotton RT (ed) Human kinetics. Champaign, IL, pp 30–67

  9. Burdea CG, Coiffet P (1994) Virtual reality technology. John Wiley & Sons, New York

    Google Scholar 

  10. Csikszentmihalyi M (1990) Flow: the psychology of optimal experience. Harper/Collins, New York pp 1–49

    Google Scholar 

  11. Darzi A (2000) Hand-assisted laparoscopic colorectal surgery. Surg Endosc 14: 999–1004

    Article  PubMed  CAS  Google Scholar 

  12. Darzi A, Mackay S (2001) Assessment of surgical competence. Qual Health Care 10(Suppl 2): ii64–ii9

    PubMed  Google Scholar 

  13. Felländer-Tsai L, Kjellin A, Wredmark T, Ahlberg G, Anderberg B, Enochsson L, Hedman L, Johnson E, Mäkinen K, Ramel S, Ström P, Särnå L, Westman B (2004) Basic accreditation for invasive image-guided intervention: a shift of paradigm in high technology education, embedding performance criterion levels in advanced medical simulators in a modern educational curriculum. J Inform Technol Healthcare 3: 165–173

    Google Scholar 

  14. Gallagher AG, Richie K, McClure N, McGuigan J (2001) Objective psychomotor skills assessment of experienced, junior, and novice laparoscopists with virtual reality. World J Surg 25: 1478–1483

    Article  PubMed  CAS  Google Scholar 

  15. Ghani JA, Deshpande PD (1994) The characteristics and the experience of optimal flow in human-computer interaction. J Psychol 128: 381–391

    Google Scholar 

  16. Grantcharov TP, Kristiansen VB, Bendix J, Bardram L, Rosenberg J, Funch-Jensen P (2004) Randomized clinical trial of virtual reality simulation for laparoscopic skills training. Br J Surg 91: 146–150

    Article  PubMed  CAS  Google Scholar 

  17. Hoffman HG (1998) Physically touching virtual objects using tactile augmentation enhances the realism of virtual objects IEEE. Proceedings of the IEEE Virtual Reality Annual Symposium, Atlanta, GA

  18. Jordan JA, Gallagher AG, McGuigan J, McClure N (2001) Virtual reality training leads to faster adaptation to the novel psychomotor restrictions encountered by laparoscopic surgeons. Surg Endosc 15: 1080–1084

    Article  PubMed  CAS  Google Scholar 

  19. Kitagawa M, Dokko D, Okamura AM, Yuh DD (2005) Effect of sensory substitution on suture-manipulation forces for robotic surgical systems. J Thorac Cardiovasc Surg 129: 151–158

    Article  PubMed  Google Scholar 

  20. Lathan CE, Tracey MR, Sebrechts MM, Clawson DM, Higgins GA (2002) Using virtual environments as training simulators: measuring transfer. In: Stanney KM (eds). Handbook of virtual environments: design, implementation, and applications. Lawrence Erlbaum Associates, Mahwah, NJ pp 414–434

    Google Scholar 

  21. Louis TA, Lavori PW, Bailar JC, Polansky M (1984) Crossover and self-controlled designs in clinical research. N Engl J Med 5: 24–31

    Article  Google Scholar 

  22. Mårdberg B, Sjöberg A, Henrysson-Eidvall S (2000) BasIQ begåvningstest: manual. Psykologiförlaget AB, Stockholm, Sweden, pp 47–55

    Google Scholar 

  23. Moody L, Baber C, Arvanitis TN (2002) Objective surgical performance evaluation based on haptic feedback. Stud Health Technol Inform 85: 304–310

    PubMed  Google Scholar 

  24. Moorthy K, Munz Y, Sarker SK, Darzi A (2003) Objective assessment of technical skills in surgery. BMJ 327: 1032–1037

    Article  PubMed  Google Scholar 

  25. Nakao M, Imanishi K, Kuroda T, Oyama H (2004) Practical haptic navigation with clickable 3D region input interface for supporting master-slave type robotic surgery. Stud Health Technol Inform 98: 265–271

    PubMed  Google Scholar 

  26. Nelson TW, Bolia RS (2002) Technological considerations in the design of multisensory virtual environments: the virtual field of dreams will have to wait. In: Stanney KM (eds). Handbook of virtual environments: design, implementation, and applications. Lawrence Erlbaum Associates: Mahwah, NJ pp 301–311

    Google Scholar 

  27. Peters M, Laeng B, Latham K, Jackson M, Zaitouna R, Richardson C (2000) A redrawn Vanderberg and Kuse mental rotation test: different versions and factors that affect performance. Brain Cogn 28: 39–58

    Article  Google Scholar 

  28. Popescu GV, Burdea CG, Treffitz H (2002) Multimodal interaction modelling. In: Stanney KM (eds). Handbook of virtual environments: design, implementation, and applications. Lawrence Erlbaum Associates: Mahwah, NJ pp 435–454

    Google Scholar 

  29. Prystowsky JB, Regehr G, Rogers DA, Loan JP, Hiemenz LL, Smith KM (1999) A virtual reality module for intravenous catheter placement. Am J Surg 177: 171–175

    Article  PubMed  CAS  Google Scholar 

  30. Salas E, Cannon-Bowers JA (2001) The science of training: a decade of progress. Annu Rev Psychol 52: 471–479

    Article  PubMed  CAS  Google Scholar 

  31. Seymour NE, Gallagher AG, Roman SA, O’Brien MK, Bansal VK, Andersen DK, Satava RM (2002) Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Ann Surg 236: 458–463, discussion 463–464

    Article  PubMed  Google Scholar 

  32. Stanney KM, Zyda M (2002) Environments in the 21st century: introductory chapter. In: Stanney KM (eds). Handbook of virtual environments: design, implementation, and applications. Lawrence Erlbaum Associates: Mahwah, NJ pp 1–14

    Google Scholar 

  33. Strom P, Kjellin A, Hedman L, Johnson E, Wredmark T, Fellander-Tsai L (2003) Validation and learning in the Procedicus KSA virtual reality surgical simulator. Surg Endosc 17: 227–231

    Article  PubMed  CAS  Google Scholar 

  34. Strom P, Kjellin A, Hedman L, Wredmark T, Fellander-Tsai L (2004) Training in tasks with different visual-spatial components does not improve virtual arthroscopy performance. Surg Endosc 18: 115–120

    Article  PubMed  CAS  Google Scholar 

  35. Wagner CR, Stylopoulos N, Howe RD (2002) The role of haptic feedback in surgery: analysis of blunt dissection. Proceedings of the 10th Symposium on Haptic Interfaces for Virtual Environment and Teleoperator Systems (HAPTICS) 39: 68–74

    Google Scholar 

  36. Wanzel KR, Hamstra SJ, Anastakis DJ, Matsumoto ED, Cusimano MD (2002) Effect of visual–spatial ability on learning of spatially complex surgical skills. Lancet 359: 230–231

    Article  PubMed  Google Scholar 

  37. Wickens CD, Lee JD, Liu Y, Gordon Becker SE (2004) An introduction to human factors engineering. Pearson, Prentice Hall, NJ

    Google Scholar 

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Acknowledgments

This study was supported by research grants from Karolinska Institutet, Huddinge University Hospital AB, and the European Commission Goal 1: North of Sweden.

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Correspondence to P. Ström.

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Ström, P., Hedman, L., Särnå, L. et al. Early exposure to haptic feedback enhances performance in surgical simulator training: a prospective randomized crossover study in surgical residents. Surg Endosc 20, 1383–1388 (2006). https://doi.org/10.1007/s00464-005-0545-3

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  • DOI: https://doi.org/10.1007/s00464-005-0545-3

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