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