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

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Abstract

Background

Currently, task time and errors are often used as performance parameters in laparoscopic training. Training with the focus on task time improvement alone results in fast, but possibly less controlled, instrument movements and therefore suboptimal tissue handling skills.

Methods

Twenty-five medical students were randomly assigned in two groups. Both groups performed a tissue manipulation task six times. During this training session, the time feedback group (n = 13) received real-time visual feedback of the task time. The force feedback group (n = 12) received real-time visual feedback of the tissue manipulation force. After the training sessions, participants in both groups performed an entirely different task without visual feedback. Task time, force, and motion parameters of this posttest were used to compare the technical skills of the medical students.

Results

The training data of the group that received force feedback showed a learning curve for the mean and max absolute force, max force area, force volume, task time, and path length of both instruments. The data from the group that received time feedback showed a learning curve for the max force, task time, and path length of both instruments. In the posttest, the parameters of mean absolute force (p = 0.039), max force (p = 0.041), and force volume (p = 0.009) showed a significant difference in favor of the group that received force feedback.

Conclusions

The learning curves and the posttest indicate that training with visual force feedback improves tissue handling skills with no negative effect on the task time and instrument motions. Conventional laparoscopic training with visual time feedback improves instrument motion and task time, but it does not improve tissue manipulation skills.

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Acknowledgments

The authors would like to thank biomechanical engineering technicians Arjan van Dijke and Hans Drop, Delft University of Technology, for their help in connecting all the electrical components. They thank all surgeons and gynecologists for taking an interest in our study and providing practical information about the learning effects in training. Finally, the authors express special thanks to Gert-Jan Hultzer and René Rodenburg from the skills lab at Leiden University Medical Center for providing us with the necessary instruments, materials, and facilities.

Disclosures

Tim Horeman, Freek van Delft, Mathijs D. Blikkendaal, Jenny Dankelman, John J. van den Dobbelsteen, and Frank-Willem Jansen have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

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

    Tim Horeman, Freek van Delft, Jenny Dankelman & John J. van den Dobbelsteen

  2. Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands

    Tim Horeman, Freek van Delft, Mathijs D. Blikkendaal & Frank-Willem Jansen

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  1. Tim Horeman
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  2. Freek van Delft
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  3. Mathijs D. Blikkendaal
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  4. Jenny Dankelman
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  5. John J. van den Dobbelsteen
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  6. Frank-Willem Jansen
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Correspondence to Tim Horeman.

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Horeman, T., van Delft, F., Blikkendaal, M.D. et al. Learning from visual force feedback in box trainers: tissue manipulation in laparoscopic surgery. Surg Endosc 28, 1961–1970 (2014). https://doi.org/10.1007/s00464-014-3425-x

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  • DOI: https://doi.org/10.1007/s00464-014-3425-x

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