Enhanced Robotic Surgical Training Using Augmented Visual Feedback

Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
Surgical Innovation (Impact Factor: 1.46). 04/2008; 15(1):59-68. DOI: 10.1177/1553350608315953
Source: PubMed


The goal of this study was to enhance robotic surgical training via real-time augmented visual feedback. Thirty novices (medical students) were divided into 5 feedback groups (speed, relative phase, grip force, video, and control) and trained during 1 session in 3 inanimate surgical tasks with the da Vinci Surgical System. Task completion time, distance traveled, speed, curvature, relative phase, and grip force were measured immediately before and after training and during a retention test 2 weeks after training. All performance measures except relative phase improved after training and were retained after 2 weeks. Feedback-specific effects showed that the speed group was faster than other groups after training, and the grip force group applied less grip force. This study showed that the real-time augmented feedback during training can enhance the surgical performance and can potentially be beneficial for both training and surgery.

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Available from: Timothy N Judkins
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    • "In a separate study, we provide evidence that untrained surgeons performing robotic in vitro training tasks (peg transfer and suturing) cause instrument vibrations that are significantly larger than those created by experienced robotic surgeons doing the same tasks [28]. Based on other research where feedback of instrument tip speed and grip force during robotic surgical training improved performance [29], we hypothesize that providing feedback of instrument vibrations to novices can help accelerate their learning of instrument handling skills. We are in the process of running studies to test this hypothesis with medical students and surgical residents at our institution. "
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    ABSTRACT: Background: Robotic minimally invasive surgery (RMIS) lacks the haptic (kinesthetic and tactile) cues that surgeons are accustomed to receiving in open and laparoscopic surgery. We previously introduced a method for adding tactile and audio feedback of tool vibrations to RMIS systems, creating sensations similar to what one feels and hears when using a laparoscopic tool. Our prior work showed that surgeons performing box-trainer tasks significantly preferred having this feedback and believed that it helped them concentrate on the task, but we did not know how well our approach would work in a clinically relevant setting. This study constituted the first in vivo test of our system. Methods: Accelerometers that measure tool vibrations were mounted to the patient-side manipulators of a da Vinci S surgical system. The measured vibrations were recorded and presented to the surgeon through vibrotactile and audio channels while two transperitoneal nephrectomies and two mid-ureteral dissections with uretero-ureterostomy were completed on a porcine model. We examined 30 minutes of resulting video to identify and tag manipulation events, aiming to determine whether our system can measure significant and meaningful tool vibrations during in vivo procedures. Results: A total of 1,404 manipulation events were identified. Analysis of each event's accelerations indicated that 82 % of these events resulted in significant vibrations. The magnitude of the accelerations measured for different manipulation events varied widely, with hard contact causing the largest cues. Conclusions: This study demonstrates the feasibility of providing tool vibration feedback during in vivo RMIS. Significant tool vibrations were reliably measured for the majority of events during standard urological procedures on a porcine model, while real-time, naturalistic tactile and audio tool vibration feedback was provided to the surgeon. The feedback system's modules were easily implemented outside the sterile field of the da Vinci S and did not interfere with the surgical procedure.
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