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Surgical simulator design and development.

Dankelman J - World J Surg (2008)

Bottom Line: Several training simulators have become commercially available, but fundamental research into the requirements for effective and efficient training in MIS is still lacking.During MIS, force feedback is reduced owing to friction in the laparoscopic instruments and within the trocar.Although force feedback is reduced during MIS, it is needed for tissue manipulation, and therefore force application should be trained as well.

View Article: PubMed Central - PubMed

Affiliation: Department of BioMechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering (3mE), Delft University of Technology, Mekelweg 2, Delft, 2628, CD, The Netherlands. j.dankelman@tudelft.nl

ABSTRACT
With the introduction of minimally invasive surgery (MIS), it became necessary to develop training methods to learn skills outside the operating room. Several training simulators have become commercially available, but fundamental research into the requirements for effective and efficient training in MIS is still lacking. Three aspects of developing a training program are investigated here: what should be trained, how it should be trained, and how to assess the results of training. In addition, studies are presented that have investigated the role of force feedback in surgical simulators. Training should be adapted to the level of behavior: skill-based, rule-based, or knowledge-based. These levels can be used to design and structure a training program. Extra motivation for training can be created by assessment. During MIS, force feedback is reduced owing to friction in the laparoscopic instruments and within the trocar. The friction characteristics vary largely among instruments and trocars. When force feedback is incorporated into training, it should include the large variation in force feedback properties as well. Training different levels of behavior requires different training methods. Although force feedback is reduced during MIS, it is needed for tissue manipulation, and therefore force application should be trained as well.

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TrEndo tracking system to measure laparoscopic instrument movements in a box trainer
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Fig2: TrEndo tracking system to measure laparoscopic instrument movements in a box trainer

Mentions: There are various reliable and valid assessment tools available for measuring the various components of surgical competence. They can be divided into cognitive, clinical, and technical assessment tools [21]. Different assessment methods are required for the different levels of human behavior. At the SBB level, a simulator is an example of a technical assessment tool. The performance feedback properties of VR simulators are stimulating their use, and automatic supervision of training sessions is easily implemented. Performance in the pelvi-trainer has been assessed using an electromagnetic hand-motion tracking device [22]. At the Delft University of Technology we developed the TrEndo, a tracking system based on optical sensors able to track instruments’ movements (Fig. 2) [23, 24]. Translating instrument movements into effective feedback, however, is not a easy task. A number of measurements are needed to get a fundamental grip on which parameters are important for assessing task performance. Position sensors to track instruments return information on, for example, the number of actions, time per action, and total trajectory length. Currently, we are investigating whether an often used concept, the shortest path length concept, is valid [25].Fig. 2


Surgical simulator design and development.

Dankelman J - World J Surg (2008)

TrEndo tracking system to measure laparoscopic instrument movements in a box trainer
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2211365&req=5

Fig2: TrEndo tracking system to measure laparoscopic instrument movements in a box trainer
Mentions: There are various reliable and valid assessment tools available for measuring the various components of surgical competence. They can be divided into cognitive, clinical, and technical assessment tools [21]. Different assessment methods are required for the different levels of human behavior. At the SBB level, a simulator is an example of a technical assessment tool. The performance feedback properties of VR simulators are stimulating their use, and automatic supervision of training sessions is easily implemented. Performance in the pelvi-trainer has been assessed using an electromagnetic hand-motion tracking device [22]. At the Delft University of Technology we developed the TrEndo, a tracking system based on optical sensors able to track instruments’ movements (Fig. 2) [23, 24]. Translating instrument movements into effective feedback, however, is not a easy task. A number of measurements are needed to get a fundamental grip on which parameters are important for assessing task performance. Position sensors to track instruments return information on, for example, the number of actions, time per action, and total trajectory length. Currently, we are investigating whether an often used concept, the shortest path length concept, is valid [25].Fig. 2

Bottom Line: Several training simulators have become commercially available, but fundamental research into the requirements for effective and efficient training in MIS is still lacking.During MIS, force feedback is reduced owing to friction in the laparoscopic instruments and within the trocar.Although force feedback is reduced during MIS, it is needed for tissue manipulation, and therefore force application should be trained as well.

View Article: PubMed Central - PubMed

Affiliation: Department of BioMechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering (3mE), Delft University of Technology, Mekelweg 2, Delft, 2628, CD, The Netherlands. j.dankelman@tudelft.nl

ABSTRACT
With the introduction of minimally invasive surgery (MIS), it became necessary to develop training methods to learn skills outside the operating room. Several training simulators have become commercially available, but fundamental research into the requirements for effective and efficient training in MIS is still lacking. Three aspects of developing a training program are investigated here: what should be trained, how it should be trained, and how to assess the results of training. In addition, studies are presented that have investigated the role of force feedback in surgical simulators. Training should be adapted to the level of behavior: skill-based, rule-based, or knowledge-based. These levels can be used to design and structure a training program. Extra motivation for training can be created by assessment. During MIS, force feedback is reduced owing to friction in the laparoscopic instruments and within the trocar. The friction characteristics vary largely among instruments and trocars. When force feedback is incorporated into training, it should include the large variation in force feedback properties as well. Training different levels of behavior requires different training methods. Although force feedback is reduced during MIS, it is needed for tissue manipulation, and therefore force application should be trained as well.

Show MeSH