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Haptic simulators accelerate laparoscopic simulator training, but skills are not transferable to a non-haptic simulator: a randomized trial

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Abstract

Background

Laparoscopy requires specific psychomotor skills and can be challenging to learn. Most proficiency-based laparoscopic training programs have used non-haptic virtual reality simulators; however, haptic simulators can provide the tactile sensations that the surgeon would experience in the operating room. The objective was to investigate the effect of adding haptic simulators to a proficiency-based laparoscopy training program.

Methods

A randomized controlled trial was designed where residents (n = 36) were randomized to proficiency-based laparoscopic simulator training using haptic or non-haptic simulators. Subsequently, participants from the haptic group completed a follow-up test, where they had to reach proficiency again using the non-haptic simulator. Participants from the non-haptic group returned to train until reaching proficiency again using the non-haptic simulator.

Results

Mean completion times during the intervention were 120 min (SD 38.7 min) and 183 min (SD 66.3 min) for the haptic group and the non-haptic group, respectively (p = 0.001). The mean times to proficiency during the follow-up test were 107 min (SD 41.0 min) and 58 min (SD 23.7 min) for the haptic and the non-haptic group, respectively (p < 0.001). The haptic group was not faster to reach proficiency in the follow-up test than during the intervention (p = 0.22). In contrast, the non-haptic group reached the required proficiency level significantly faster in the follow-up test (p < 0.001).

Conclusion

Haptic virtual reality simulators reduce the time to reach proficiency compared to non-haptic simulators. However, the acquired skills are not transferable to the conventional non-haptic setting.

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Author information

Authors and Affiliations

  1. Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, The Capital Region, Copenhagen, Denmark

    Anishan Vamadevan, Lars Konge, Morten Stadeager & Flemming Bjerrum

  2. Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    Lars Konge

  3. Department of Surgery, Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark

    Morten Stadeager

  4. Department of Surgery, Zealand University Hospital, Køge, Denmark

    Flemming Bjerrum

Authors
  1. Anishan Vamadevan
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  2. Lars Konge
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  3. Morten Stadeager
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  4. Flemming Bjerrum
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Corresponding author

Correspondence to Anishan Vamadevan.

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Disclosures

Anishan Vamadevan, Morten Stadeager, Lars Konge, Flemming Bjerrum have no conflicts of interest or financial ties to disclose.

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Appendix

Appendix

Basic skill 1: Instrument navigation.

Parameter

Requirement for proficiency level

Left instrument time (s)

 < 25

Left instrument misses

 < 2

Left instrument path length (m)

 < 1.4

Left instrument angular path (degrees)

 < 250

Right instrument time (s)

 < 25

Right instrument misses

 < 2

Right instrument path length (m)

 < 1.4

Right instrument angular path (degrees)

 < 250

Tissue Damage

 < 5

Maximum Damage (mm)

 < 10

Basic skill 2: Grasping.

Parameter

Requirements for proficiency level

Left instrument time (s)

 < 45

Left instrument path length (m)

 < 2

Left instrument angular path (degrees)

 < 300

Right instrument time (s)

 < 45

Right instrument path length (m)

 < 2

Right instrument angular path (degrees)

 < 300

Tissue damage (frequency)

 < 3

Basic skill 3: Lifting and grasping.

Parameter requirements for proficiency level

Requirements for proficiency level

Total time (s)

 < 120

Left instrument misses (%)

 < 60

Left instrument path length (m)

 < 3.2

Left instrument angular path (degrees)

 < 600

Right instrument misses (%)

 < 60

Right instrument path length (m)

 < 3.2

Right instrument angular path (degrees)

 < 600

Tissue damage (frequency)

 < 5

Maximum damage (mm)

 < 15

Grasper collided with left box (frequency)

 < 10

Left box lifted (frequency)

 < 15

Grasper collided with right box (frequency)

 < 10

Basic skills 4: Fine dissection.

Parameters

Requirements for proficiency level

Total time (s)

 < 150

Ripped or burned blood vessels

 < 0

Energy damaged on blood vessels (%)

 < 20

Ripped small vessels (%)

 < 25

Burned small vessels with or without stretch (%)

 < 25

Grasper path length (m)

 < 0.5

Grasper angular path (degrees)

 < 120

Grasper outside view (frequency)

 < 2

Grasper outside view (s)

 < 4

Cutter path length (m)

 < 0.9

Cutter path length (m)

 < 0.8

Cutter angular path (degrees)

 < 200

Cutter outside view (frequency)

 < 2

Cutter outside view (s)

 < 4

Procedural modul: Ectopic Pregnancy.

Parameters for the procedure: salpingectomy on the Lapsim® virtual reality simulator. To reach the proficiency level all the requirements for the proficiency level must be fulfilled using correct operation technique.

Parameters

Requirements for proficiency level

Total time (s)

 < 280

Left instrument path length (m)

 < 2

Left instrument angular path (degrees) 

 < 350

Right instrument path length (m)

 < 3

Right instrument angular path (degrees)

 < 450

Blood loss (ml)

 < 180

Pool of blood (ml)

 < 10

Ovary Diathermy damage (s)

 < 3

Tube Cut: Uterus distance (mm)

 < 10

Removed dissected tissue (Yes/No)

Yes

Bleeding vessel cut (Yes/No)

No

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Vamadevan, A., Konge, L., Stadeager, M. et al. Haptic simulators accelerate laparoscopic simulator training, but skills are not transferable to a non-haptic simulator: a randomized trial. Surg Endosc 37, 200–208 (2023). https://doi.org/10.1007/s00464-022-09422-4

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  • DOI: https://doi.org/10.1007/s00464-022-09422-4

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