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Force measurement platform for training and assessment of laparoscopic skills.

Horeman T, Rodrigues SP, Jansen FW, Dankelman J, van den Dobbelsteen JJ - Surg Endosc (2010)

Bottom Line: With a maximum force of 2.6 N (SD 0.4 N) and mean nonzero force of 0.9 N (SD 0.3 N), the force exerted by the experts was significantly lower.The designed platform is easy to build, affordable, and accurate and sensitive enough to reflect the most important differences in, e.g., maximal force, mean force, and standard deviation.Furthermore, the compact design makes it possible to use the force platform in most box trainers.

View Article: PubMed Central - PubMed

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

ABSTRACT

Background: To improve endoscopic surgical skills, an increasing number of surgical residents practice on box or virtual-reality (VR) trainers. Current training is mainly focused on hand-eye coordination. Training methods that focus on applying the right amount of force are not yet available.

Methods: The aim of this project is to develop a system to measure forces and torques during laparoscopic training tasks as well as the development of force parameters that assess tissue manipulation tasks. The force and torque measurement range of the developed force platform are 0-4 N and 1 Nm (torque), respectively. To show the potential of the developed force platform, a pilot study was conducted in which five surgeons experienced in intracorporeal suturing and five novices performed a suture task in a box trainer.

Results: During the pilot study, the maximum and mean absolute nonzero force that the novice used were 4.7 N (SD 1.3 N) and 2.1 N (SD 0.6 N), respectively. With a maximum force of 2.6 N (SD 0.4 N) and mean nonzero force of 0.9 N (SD 0.3 N), the force exerted by the experts was significantly lower.

Conclusions: The designed platform is easy to build, affordable, and accurate and sensitive enough to reflect the most important differences in, e.g., maximal force, mean force, and standard deviation. Furthermore, the compact design makes it possible to use the force platform in most box trainers.

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Differences between experts and novices in performance. Each data point represents the averaged value over two measurements of one subject
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Fig10: Differences between experts and novices in performance. Each data point represents the averaged value over two measurements of one subject

Mentions: It took the surgeons 17.8 s (SD 2.1 s) and the novices 29.4 (SD 3.7 s) to complete the task. Before the surgeons and novices inserted the needle into the artificial tissue, a clear difference between orientation and position of the needle inside the needle driver was visible. After inserting the needle tip, the two types of subjects used different strategies to drive the needle through the tissue. The surgeons used mostly rotation (R) of the needle around an imaginary rotation point (Fig. 8A), whereas the novices used rotation (R) as well as translation (X, Y) (Fig. 8B). Furthermore, unlike most surgeons, all novices pressed the needle driver against the tissue during the task. A force graph and 3D force signature of the best-performing surgeon and novice are presented in Fig. 9A, B. The absolute nonzero mean force and maximal force of all subjects, measured during the needle-driving task, are presented in Fig. 10. The force graphs of the novice and surgeon who performed the needle-driving task four times are presented in Fig. 11. The maximum and mean absolute nonzero force used by the novices was on average 4.7 N (SD 1.3 N) and 2.1 N (SD 0.6 N), respectively. For surgeons, the average maximum force (2.6 N, SD 0.4 N) and the average mean force (0.9 N, SD 0.3 N) were much lower. Student t-tests showed that there was significant difference between the two groups of subjects for both depend variables (mean nonzero force: t = 4.3, p < 0.005, maximum force: t = 3.6, p < 0.017).Fig. 8


Force measurement platform for training and assessment of laparoscopic skills.

Horeman T, Rodrigues SP, Jansen FW, Dankelman J, van den Dobbelsteen JJ - Surg Endosc (2010)

Differences between experts and novices in performance. Each data point represents the averaged value over two measurements of one subject
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2982957&req=5

Fig10: Differences between experts and novices in performance. Each data point represents the averaged value over two measurements of one subject
Mentions: It took the surgeons 17.8 s (SD 2.1 s) and the novices 29.4 (SD 3.7 s) to complete the task. Before the surgeons and novices inserted the needle into the artificial tissue, a clear difference between orientation and position of the needle inside the needle driver was visible. After inserting the needle tip, the two types of subjects used different strategies to drive the needle through the tissue. The surgeons used mostly rotation (R) of the needle around an imaginary rotation point (Fig. 8A), whereas the novices used rotation (R) as well as translation (X, Y) (Fig. 8B). Furthermore, unlike most surgeons, all novices pressed the needle driver against the tissue during the task. A force graph and 3D force signature of the best-performing surgeon and novice are presented in Fig. 9A, B. The absolute nonzero mean force and maximal force of all subjects, measured during the needle-driving task, are presented in Fig. 10. The force graphs of the novice and surgeon who performed the needle-driving task four times are presented in Fig. 11. The maximum and mean absolute nonzero force used by the novices was on average 4.7 N (SD 1.3 N) and 2.1 N (SD 0.6 N), respectively. For surgeons, the average maximum force (2.6 N, SD 0.4 N) and the average mean force (0.9 N, SD 0.3 N) were much lower. Student t-tests showed that there was significant difference between the two groups of subjects for both depend variables (mean nonzero force: t = 4.3, p < 0.005, maximum force: t = 3.6, p < 0.017).Fig. 8

Bottom Line: With a maximum force of 2.6 N (SD 0.4 N) and mean nonzero force of 0.9 N (SD 0.3 N), the force exerted by the experts was significantly lower.The designed platform is easy to build, affordable, and accurate and sensitive enough to reflect the most important differences in, e.g., maximal force, mean force, and standard deviation.Furthermore, the compact design makes it possible to use the force platform in most box trainers.

View Article: PubMed Central - PubMed

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

ABSTRACT

Background: To improve endoscopic surgical skills, an increasing number of surgical residents practice on box or virtual-reality (VR) trainers. Current training is mainly focused on hand-eye coordination. Training methods that focus on applying the right amount of force are not yet available.

Methods: The aim of this project is to develop a system to measure forces and torques during laparoscopic training tasks as well as the development of force parameters that assess tissue manipulation tasks. The force and torque measurement range of the developed force platform are 0-4 N and 1 Nm (torque), respectively. To show the potential of the developed force platform, a pilot study was conducted in which five surgeons experienced in intracorporeal suturing and five novices performed a suture task in a box trainer.

Results: During the pilot study, the maximum and mean absolute nonzero force that the novice used were 4.7 N (SD 1.3 N) and 2.1 N (SD 0.6 N), respectively. With a maximum force of 2.6 N (SD 0.4 N) and mean nonzero force of 0.9 N (SD 0.3 N), the force exerted by the experts was significantly lower.

Conclusions: The designed platform is easy to build, affordable, and accurate and sensitive enough to reflect the most important differences in, e.g., maximal force, mean force, and standard deviation. Furthermore, the compact design makes it possible to use the force platform in most box trainers.

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