Haptic based fundamentals of laparoscopic surgery simulation for training with objective assessments

P Abinaya; M Manivannan

doi:10.3389/frobt.2024.1363952

Haptic based fundamentals of laparoscopic surgery simulation for training with objective assessments

Front Robot AI. 2024 May 30:11:1363952. doi: 10.3389/frobt.2024.1363952. eCollection 2024.

Authors

P Abinaya¹, M Manivannan¹

Affiliation

¹ Haptics Laboratory, Department of Applied Mechanics and Biomedical Engineering, Indian Institute of Technology Madras, Tamil Nadu, India.

Abstract

Force is crucial for learning psychomotor skills in laparoscopic tissue manipulation. Fundamental laparoscopic surgery (FLS), on the other hand, only measures time and position accuracy. FLS is a commonly used training program for basic laparoscopic training through part tasks. The FLS is employed in most of the laparoscopic training systems, including box trainers and virtual reality (VR) simulators. However, many laparoscopic VR simulators lack force feedback and measure tissue damage solely through visual feedback based on virtual collisions. Few VR simulators that provide force feedback have subjective force metrics. To provide an objective force assessment for haptic skills training in the VR simulators, we extend the FLS part tasks to haptic-based FLS (HFLS), focusing on controlled force exertion. We interface the simulated HFLS part tasks with a customized bi-manual haptic simulator that offers five degrees of freedom (DOF) for force feedback. The proposed tasks are evaluated through face and content validity among laparoscopic surgeons of varying experience levels. The results show that trainees perform better in HFLS tasks. The average Likert score observed for face and content validity is greater than 4.6 ± 0.3 and 4 ± 0.5 for all the part tasks, which indicates the acceptance of the simulator among subjects for its appearance and functionality. Face and content validations show the need to improve haptic realism, which is also observed in existing simulators. To enhance the accuracy of force rendering, we incorporated a laparoscopic tool force model into the simulation. We study the effectiveness of the model through a psychophysical study that measures just noticeable difference (JND) for the laparoscopic gripping task. The study reveals an insignificant decrease in gripping-force JND. A simple linear model could be sufficient for gripper force feedback, and a non-linear LapTool force model does not affect the force perception for the force range of 0.5-2.5 N. Further study is required to understand the usability of the force model in laparoscopic training at a higher force range. Additionally, the construct validity of HFLS will confirm the applicability of the developed simulator to train surgeons with different levels of experience.

Keywords: FLS task; and psychophysics; haptics; laparoscopic tool force model; laparoscopic training simulator; virtual reality.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The haptic device in the study was funded by DIT, Govt. of India, and Biotechnology Industry Research Assistance Council (BIRAC-BT/IIPME/0069/01/15). The research is supported by the Science and Engineering Research Board, Department of Science and Technology, Government of India, and Merkel Haptic Systems Pvt. Ltd. through the Prime Minister’s Fellowship for Doctoral Research, which is coordinated by the Federation of Indian Chambers of Commerce and Industry (FICCI). Merkel Haptic Systems Pvt. Ltd. was not involved in the study design, collection, analysis, interpretation of data, the writing of this article, or the decision to submit it for publication.