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Effects of laparoscopic instrument and finger on force perception: a first step towards laparoscopic force-skills training

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Abstract

Background

In laparoscopic surgery, no external feedback on the magnitude of the force exerted is available. Hence, surgeons and residents tend to exert excessive force, which leads to tissue trauma. Ability of surgeons and residents to perceive their own force output without external feedback is a critical factor in laparoscopic force-skills training. Additionally, existing methods of laparoscopic training do not effectively train residents and novices on force-skills. Hence, there is growing need for the development of force-based training curriculum.

Objective

As a first step towards force-based laparoscopic skills training, this study analysed force perception difference between laparoscopic instrument and finger in contralateral bimanual passive probing task.

Methods

The study compared the isometric force matching performance of novices, residents and surgeons with finger and laparoscopic instrument. Contralateral force matching paradigm was employed to analyse the force perception capability in terms of relative (accuracy), and constant errors in force matching.

Results

Force perception of experts was found to be better than novices and residents. Interestingly, laparoscopic instrument was more accurate in discriminating the forces than finger. The dominant hand attempted to match the forces accurately, whereas non-dominant hand (NH) overestimated the forces. Further, the NH of experts was found to be most accurate. Furthermore, excessive forces were applied at lower force levels and at very high force levels.

Conclusions

Due to misperception of force, novices and residents applied excessive forces. However, experts had good control over force with both dominant and NHs. These findings suggest that force-based training curricula should not only have proprioception tasks, but should also include bimanual force-skills training exercises in order to improve force perception ability and hand skills of novices and residents. The results can be used as a performance metric in both box and virtual reality based force-skills training.

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Acknowledgments

The authors thank all the surgical residents and expert surgeons of surgical gastroenterology department, Rajiv Gandhi Government General Hospital, Chennai, India, who willingly participated in the experiments. The authors acknowledge the support of Dr. Sandeep in coordinating with the subjects for the experiments. The authors also extend thanks to the editor(s) and anonymous reviewers for their insightful comments towards improving the quality of the manuscript.

Disclosures

M.S.Raghu Prasad, M.Manivanan and S.M Chandramohan have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Haptics Lab, Biomedical Engineering Group, Department of Applied Mechanics, Indian Institute of Technology Madras, Chennai, 600036, Tamil Nadu, India

    M. S. Raghu Prasad & M. Manivannan

  2. Department of Surgical Gastroenterology, Rajiv Gandhi Government General Hospital and Madras Medical College, Chennai, 600036, Tamil Nadu, India

    S. M. Chandramohan

  3. MSB 207A, Biomedical Engineering Group, Department of Applied Mechanics, Indian Institute of Technology Madras, Chennai, 600036, Tamil Nadu, India

    M. Manivannan

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  1. M. S. Raghu Prasad
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Correspondence to M. Manivannan.

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Raghu Prasad, M.S., Manivannan, M. & Chandramohan, S.M. Effects of laparoscopic instrument and finger on force perception: a first step towards laparoscopic force-skills training. Surg Endosc 29, 1927–1943 (2015). https://doi.org/10.1007/s00464-014-3887-x

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  • DOI: https://doi.org/10.1007/s00464-014-3887-x

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