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Simulators for Objective Differentiation of Force-Based Laparoscopic Skills: Towards a
Salient Haptic Skills Trainer
Dane E. Smith, Joseph Singapogu, Timothy BergGreenville Hospital System University Medical Center
Clemson University, Department of Bioengineering
Introduction
• Growing need for simulator-based training for laparoscopic surgery skills– Liability– Cost of OR time– Complexity of cases– “Milestone” assessment?
• Fundamentals of Laparoscopic Surgery (FLS) curriculum– Simulates five tasks in “low-tech” simulator– Focuses on basic, hand-eye coordination & suturing skills– Has been shown to be effective for imparting basic skills in many
studies– Not really designed to teach forces involved, the “feel”.
Introduction
• But training for advanced skills?– E.g. force-based (haptic) skills
• Is there value to teaching the subtleties of force and feel?
Salient Haptic Skills
• Which surgical maneuvers require force skill?• Richards et. al. – three salient skills
– Grasping, probing, sweeping
Purpose
• To design and validate simulators to objectively distinguish force skills of surgeons and novices.
• Can we define and simulate specific force feedback skills that we as surgeons must learn?
Materials and Methods
• We designed three custom, simple haptic simulators – Grasping– Probing– Sweeping
Probing
Sweeping
Materials and Methods
Train participants
Test participants
Compare Surgeons to Novices
Novices Exp Surg
Experiment Design
Results
• Force data and metrics differentiated surgeons from novices on all three tasks!
• Novices applied greater forces than surgeons on all three tasks
ResultsProbing Grasping Sweeping
Novice Surgeon Novice Surgeon Novice Surgeon
25 46.5**(12.8)
30.2**(15.1)
39.7*(16.2)
28.28*(9.11)
31.1(8.9)
33.2(8.5)
50 65.5**(14.4)
49.0 **(18.3)
55.5(14.3)
49.0(12.7)
57.4(14.0)
54.9(7.4)
75 85.4**(12.6)
68.7**(14.9)
74.9(15.5)
65.4(16.1)
81.6*(13.1)
74.3*(7.6)
100 95.63(6.25)
93.50(9.73)
87.1(11.8)
93.7(10.9)
102.9*(10.8)
95.6*(8.4)
125 121.1**(7.8)
113.8**(7.9)
Note: *p<0.05; **p<0.01
Conclusions
• For the specific forces of grasping, probing and sweeping these specific haptic simulators can distinguish surgeons from novices.
• Demonstrates that surgeons do possess a force skill set that is learned.
• These simulators offer a possible mechanism to specifically teach these force skills.
• Surgical tradition of “feel this” applies to laparoscopy as well as open procedures.
Next Steps..
• Combine all three skills into
one, easy-to-use trainer
• Next experiment: can the
simulator train haptic skills of
novices?
(in progress)
Clemson-GHS Haptic Skills Trainer
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