Limited Value of Haptics in Virtual Reality Laparoscopic Cholecystectomy Training

INTRODUCTION: Haptics is an expensive addition to virtual reality simulators, and the added value to training has not been proven. This study evaluated the benefit of haptics in virtual reality laparoscopic surgery training of novices.
METHODS AND PROCEDURES: The Lap Mentor II (Simbionix, Cleveland, OH) haptic virtual reality simulator was used in the study. Laparoscopic novice students were randomly placed in three groups: control (n=10), haptics trained (n=6) and non-haptics trained (n=4). The control group performed the nine basic laparoscopy tasks and four cholecystectomy procedural tasks one time with haptics engaged at the default setting. The haptics trained group was sequentially trained to proficiency in the basic tasks and then performed each of the procedural tasks one time with haptics engaged. The non-haptics group used the same training protocol except haptics was disengaged. Proficiency was to previously published expert values. Each group was assessed in the performance of ten laparoscopic cholecystectomies (alternating with and without haptics). Performance was measured via automatically collected simulator data. Unpaired student t-test was used to compare the groups. A p value <0.05 was considered significant.
RESULTS: There were no statistical differences between training and control groups with regard to gender, age, hand dominance, video game experience, musical instrument experience, surgical experience, or simulator experience.
In basic task training, the number of attempts to achieve expert proficiency did not differ between haptics and non-haptics groups.
In simulated laparoscopic cholecystectomy, the average performance of the non-haptics group on ten cholecystectomies was superior to the haptics group in total time, time to extract gallbladder, time cautery is applied without appropriate contact with adhesions, total cautery time, efficiency of cautery, safe cautery, number of movements of the right instrument, and total path length of the right instrument. The haptics and non-haptics groups both outperformed the control group in total time, time to extract gallbladder, time cautery is applied without appropriate contact with adhesions, total cautery time, efficiency of cautery, number of non-cauterized bleeding, number of movements of the left instrument, total path length of left instrument, and average speed of left instrument. In addition, the non-haptics group outperformed the control group on safe clipping, safe cutting, number of perforations, number of movements of right instrument, total path length of right instrument, and average speed of right instrument.
CONCLUSIONS: Haptics does not improve the efficiency or effectiveness of LapMentor II virtual reality laparoscopic surgery training. Subjects trained to the same metrics without haptics performed simulated laparoscopic cholecystectomies better than subjects trained with haptics. Limited benefit and significant cost of haptics suggests haptics should not routinely be included in virtual reality laparoscopic surgery training. Further research is recommended to determine the value of haptics in virtual reality training of specific procedures primarily performed using the sense of touch.


Session: Podium Presentation

Program Number: S003

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