Authors: O A J van der Meijden M P Schijven
Publish Date: 2009/01/01
Volume: 23, Issue: 6, Pages: 1180-1190
Abstract
Virtual reality VR as surgical training tool has become a stateoftheart technique in training and teaching skills for minimally invasive surgery MIS Although intuitively appealing the true benefits of haptic VR training platforms are unknown Many questions about haptic feedback in the different areas of surgical skills training need to be answered before adding costly haptic feedback in VR simulation for MIS training This study was designed to review the current status and value of haptic feedback in conventional and robotassisted MIS and training by using virtual reality simulationA systematic review of the literature was undertaken using PubMed and MEDLINE The following search terms were used Haptic feedback OR Haptics OR Force feedback AND/OR Minimal Invasive Surgery AND/OR Minimal Access Surgery AND/OR Robotics AND/OR Robotic Surgery AND/OR Endoscopic Surgery AND/OR Virtual Reality AND/OR Simulation OR Surgical Training/EducationIn the current literature no firm consensus exists on the importance of haptic feedback in performing minimally invasive surgery Although the majority of the results show positive assessment of the benefits of force feedback results are ambivalent and not unanimous on the subject Benefits are least disputed when related to surgery using robotics because there is no haptic feedback in currently used robotics The addition of haptics is believed to reduce surgical errors resulting from a lack of it especially in knot tying Little research has been performed in the area of robotassisted endoscopic surgical training but results seem promising Concerning VR training results indicate that haptic feedback is important during the early phase of psychomotor skill acquisitionIn every day life the importance of the sense of touch is eminent Recent studies have shown that loss of sense of touch can be catastrophic Skilled actions such as using tools holding objects or even plain walking may become almost impossible upon losing the sense of touch 1 Touch is the earliest sense developed in human embryology and is believed to be essential for good clinical practice 2 3 Therefore the potential of haptic technology may not be underestimated for clinical specialities that rely on sensory input such as minimally invasive surgery MISIn surgery haptic or force feedback refers to the sense of touch that a surgeon experiences—both consciously and unconsciously—while performing surgery It is known that in MIS haptics are deprived compared with open surgery 4 5 6 7 Haptics provide sensation to numerous surgical procedures varying from structure to structure and depending on type of force applied and relates to tissue damage straightness of suturing and task completion time 3 8Within the various applications of MIS a distinction can be made between conventional endoscopic surgery CES and robotassisted endoscopic surgery RAS For CES the surgeon operates directly on the patient by using an endoscopic interface whereas for RAS a computerinstrumented interface surgical robot is positioned between the surgeon and patient Deprived haptic feedback as experienced while performing CES or a total lack of it as experienced while performing RAS may be a missing feature for the endoscopic surgeon 2 9 10 11Next to ongoing developments in MIS such as RAS surgical training in MIS also has experienced rapid change Virtual reality VR simulation is a computerbased application for MIS training Beyond its infancy VR simulation is integrated in many MIS training curricula throughout the world 9 10 12 13 14 15 16
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