Effect of mental training on short-term psychomotor skill acquisition in laparoscopic surgery -a pilot study (original) (raw)
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Effect of haptic feedback in laparoscopic surgery skill acquisition
Surgical Endoscopy, 2011
Background-The benefits of haptic feedback in laparoscopic surgery training simulators is a topic of debate in the literature. It is hypothesized that novice surgeons may not benefit from the haptic information, especially during the initial phase of learning a new task. Therefore, providing haptic feedback to novice trainees in the early stage of training may be distracting and detrimental to learning. Objective-A controlled experiment was conducted to examine the effect of haptic feedback on the learning curve of a complex laparoscopic suturing and knot-tying task. Method-The ProMIS and the MIST-VR surgical simulators were used to represent conditions with and without haptic feedback, respectively. Twenty novice subjects (10 per simulator) were trained to perform suturing and knot-tying and practiced the tasks over eighteen one-hour sessions. Results-At the end of the 3-week training period, subjects performed equally fast but more consistently with haptics (ProMIS) than without (MIST-VR). Subjects showed slightly higher learning rate and reached the first plateau of the learning curve earlier with haptic feedback. Conclusion-In general, learning with haptic feedback was significantly better than without haptic feedback for a laparoscopic suturing and knot-tying task, but only in the first 5 hours of training. Application-Haptic feedback may not be warranted in laparoscopic surgical trainers. The benefits of a shorter time to the first performance plateau and more consistent initial performance should be balanced with the cost of implementing haptic feedback in surgical simulators.
Role of Haptic Feedback and Cognitive Load in Surgical Skill Acquisition
PsycEXTRA Dataset
Teaching novice surgeons to attend to subtle and often misleading haptic cues in minimally invasive surgery can be challenging. Haptic cues may even be distracting during initial skill acquisition stage. A controlled experiment with thirty surgical residents and attendings was conducted to test the hypothesis that haptic feedback is more useful to the expert than novice surgeon because of the difference in spare cognitive capacity resulting from experience. In general, surgeons cannot perform a cognitively demanding task and laparoscopic surgery at the same time. Haptic feedback not only enhances performance, but counters the effect of cognitive loading, especially in accuracy of task performance. Performance is faster with more experience. With more spare cognitive capacity available, experienced surgeons can better take advantage of haptic feedback to aid their performance.
Surgical endoscopy, 2016
Visual force feedback allows trainees to learn laparoscopic tissue manipulation skills. The aim of this experimental study was to find the most efficient visual force feedback method to acquire these skills. Retention and transfer validity to an untrained task were assessed. Medical students without prior experience in laparoscopy were randomized in three groups: Constant Force Feedback (CFF) (N = 17), Bandwidth Force Feedback (BFF) (N = 16) and Fade-in Force Feedback (N = 18). All participants performed a pretest, training, post-test and follow-up test. The study involved two dissimilar tissue manipulation tasks, one for training and one to assess transferability. Participants performed six trials of the training task. A force platform was used to record several force parameters. A paired-sample t test showed overall lower force parameter outcomes in the post-test compared to the pretest (p < .001). A week later, the force parameter outcomes were still significantly lower than f...
Gynecological Surgery, 2010
The effect of different structured training programs on basic laparoscopic psychomotor skills (LPS), as assessed by hand-eye coordination (HEC), and on advanced LPS, as assessed by laparoscopic intracorporeal knot tying (LICK), was evaluated. Sixty gynecologists without laparoscopic experience were randomly allocated to three groups for different HEC training and similar LICK training. During HEC training, group 1 (G1) trained the dominant hand (DH) and the nondominant hand, G2 trained the DH only, and G3 did not train at all. All groups then underwent LICK training. HEC and LICK training consisted of 60 repetitions of the relevant task. All participants were tested at the beginning of the study (T1), before LICK training (T2), and after LICK training (T3). The time to correctly performed exercise was scored. The groups had comparable scores at T1. At T2, G1 and G2 improved their relevant HEC scores (both hands in G1, DH in G2), and LICK scores improved according to the previous HEC training (G1 > G2 or G3 and G2 > G3). At T3, all groups further improved their LICK scores up to the same level. The LICK training did not provide any additional improvement in HEC for G1 and G2, but it further improved HEC for G3, though not up to the same level of the other groups. This study confirms that training improves laparo-scopic skills and indicates that many repetitions are required for reaching proficiency. Full acquisition of LPS (e.g., HEC) facilitates the acquisition of more complex laparoscopic tasks (e.g., LICK). Mastering LICK is not sufficient for acquiring HEC skills, the clinical relevance of which still needs to be evaluated. Mastering both skills before starting a training program in the operating theater is advisable.
Gynecological surgery, 2016
This follow-up RCT was conducted to evaluate laparoscopic psychomotor skills retention after finishing a structured training program. In a first study, 80 gynecologists were randomly allocated to four groups to follow different training programs for hand-eye coordination (task 1) with the dominant hand (task 1-a) and the non-dominant hand (task 1-b) and laparoscopic intra-corporeal knot tying (task 2) in the Laparoscopic Skills Testing and Training (LASTT) model. First, baseline skills were tested (T1). Then, participants trained task 1 (G1: 1-a and 1-b, G2: 1-a only, G3 and G4: none) and then task 2 (all groups but G4). After training all groups were tested again to evaluate skills acquisition (T2). For this study, 2 years after a resting period, 73 participants were recruited and tested again to evaluate skills retention (T3). All groups had comparable skills at T1 for all tasks. At T2, G1, G2, and G3 improved their skills, but the level of improvement was different (G1 = G2 > ...
The Effect of Augmented Feedback on Grasp Force in Laparoscopic Grasp Control
IEEE Transactions on Haptics, 2010
Little is known about the influence of augmented feedback, on laparoscopic grasp control. To gain more knowledge on the influence of this on the learning curve, two experiments were conducted. In the first experiment, four groups learned a single-handed laparoscopic lifting task. Three groups received augmented feedback (visual, haptic, or a combination of feedback modes) on slip and excessive pinch force. In the second experiment, a two-handed task had to be accomplished to investigate whether paying reduced attention would influence grasp-force control. The surgeons and novices either received tactile feedback or no augmented feedback on grasp forces. In both experiments, learning sessions and a retention test followed a pretest. In the two-handed task, novices who received tactile feedback could control their pinch force in order to remain within the required limits unlike participants who did not receive augmented feedback. Approximately, one-third of the participants who received augmented feedback became dependent on the signal. Regardless of their level of experience, participants benefited from augmented feedback. This research supports the claim that there is a need for augmented tactile feedback when learning laparoscopic grasp control. It enhances learning and goes beyond what could be achieved without.
Force feedback and basic laparoscopic skills
Surgical Endoscopy, 2008
Background Not much is known about the exact role of force feedback in laparoscopy. This study aimed to determine whether force feedback influences movements of instruments during training in laparoscopic tasks and whether force feedback is required for training in basic laparoscopic force application tasks. Methods A group of 19 gynecologic residents, randomly divided into two groups, performed three laparoscopic tasks in both the box trainer and the virtual reality (VR) trainer. The box-VR group began with the box trainer, whereas the VR-box group began with the VR trainer. The three selected tasks included different levels of force application. The box trainer provides natural force feedback, whereas the VR trainer does not provide force feedback. The performance of the two groups was compared with regard to time, path length, and depth perception.
Periodic Kinesthetic Guidance Cannot Expedite Learning Surgical Skills
Surgical Innovation, 2020
Introduction. Connecting multiple haptic devices in a master-slave fashion enables us to deliver kinesthetic (haptic) feedback from 1 person to another. This study examined whether inter-user feedback delivered from an expert to a novice would facilitate skill acquisition of the novice in learning laparoscopic surgery and expedite it compared to traditional methods. Methods. We recruited fourteen novices and divided them into 1 of 2 training groups with 6 halfhour training sessions. The task was precision cutting adopted from one of the tasks listed in Fundamentals of Laparoscopic Surgery using laparoscopic instruments. In the haptic feedback group (haptic), 8 subjects had the chance to passively feel an expert's performance before they started to practice in each training session. In the self-learning group (control), 6 subjects watched a video before practicing. Each session was video recorded, and task performance was measured by task completion time, number of grasper adjustments, and instrument crossings. Cutting accuracy, defined as the percentage of deviation of the cutting line from the predefined line, was analyzed via computer analysis. Results. Results show no significant difference among performance measures between the 2 groups. Participants performed similarly when practicing alone or with periodic haptic feedback. Discussion. Further research will be needed for improving our way of integrating between-person haptic feedback with skills training protocol.
Surgery, 2006
Proficiency-based curricula maximize efficiency by tailoring training to meet the needs of each individual; however, because rates of skill acquisition vary widely, such curricula may be difficult to implement. We hypothesized that psychomotor testing would predict baseline performance and training duration in a proficiency-based laparoscopic simulator curriculum. Methods. Residents (R1, n ϭ 20) were enrolled in an IRB-approved prospective study at the beginning of the academic year. All completed the following: a background information survey, a battery of 12 innate ability measures (5 motor, and 7 visual-spatial), and baseline testing on 3 validated simulators [VT] tasks, 12 virtual reality [minimally invasive surgical trainervirtual reality, MIST-VR] tasks, and 2 laparoscopic camera navigation [LCN] tasks). Participants trained to proficiency, and training duration and number of repetitions were recorded. Baseline test scores were correlated to skill acquisition rate. Cutoff scores for each predictive test were calculated based on a receiver operator curve, and their sensitivity and specificity were determined in identifying slow learners. Results: Only the Cards Rotation test correlated with baseline simulator ability on VT and LCN. Curriculum implementation required 347 man-hours (6-person team) and $795,000 of capital equipment. With an attendance rate of 75%, 19 of 20 residents (95%) completed the curriculum by the end of the academic year. To complete training, a median of 12 hours (range, 5.5-21), and 325 repetitions (range, 171-782) were required. Simulator score improvement was 50%. Training duration and repetitions correlated with prior video game and billiard exposure, grooved pegboard, finger tap, map planning, Rey Recall score, and baseline performance on VT and LCN. The map planning cutoff score proved most specific in identifying slow learners. Conclusions: Proficiency-based laparoscopic simulator training provides improvement in performance and can be effectively implemented as a routine part of resident education, but may require significant resources. Although psychomotor testing may be of limited value in the prediction of baseline laparoscopic performance, its importance may lie in the prediction of the rapidity of skill acquisition. These tests may be useful in optimizing curricular design by allowing the tailoring of training to individual needs. (Surgery 2006;140:252-62.)