1. Simulators for Objective Differentiation of Force-Based Laparoscopic Skills: Towards a Salient Haptic Skills Trainer Dane E. Smith, Joseph Singapogu, Timothy Berg Greenville Hospital System University Medical Center Clemson University, Department of Bioengineering

3. Introduction Growing need for simulator-based training for laparoscopic surgery skills –Liability –Cost of OR time –Complexity of cases –“Milestone” assessment? Fundamentals of Laparoscopic Surgery (FLS) curriculum –Simulates five tasks in “low-tech” simulator –Focuses on basic, hand-eye coordination & suturing skills –Has been shown to be effective for imparting basic skills in many studies –Not really designed to teach forces involved, the “feel”.

4. Introduction But training for advanced skills? –E.g. force-based (haptic) skills Is there value to teaching the subtleties of force and feel?

5. Salient Haptic Skills Which surgical maneuvers require force skill? Richards et. al. – three salient skills –Grasping, probing, sweeping

6. Purpose To design and validate simulators to objectively distinguish force skills of surgeons and novices. Can we define and simulate specific force feedback skills that we as surgeons must learn?

7. Materials and Methods We designed three custom, simple haptic simulators –Grasping –Probing –Sweeping

8. Probing

9. Sweeping

10. Materials and Methods Train participants Test participants Compare Surgeons to Novices NovicesExp Surg

11. Experiment Design

12. Results Force data and metrics differentiated surgeons from novices on all three tasks! Novices applied greater forces than surgeons on all three tasks

13. Results ProbingGraspingSweeping NoviceSurgeonNoviceSurgeonNoviceSurgeon 2546.5** (12.8) 30.2** (15.1) 39.7* (16.2) 28.28* (9.11) 31.1 (8.9) 33.2 (8.5) 5065.5** (14.4) 49.0 ** (18.3) 55.5 (14.3) 49.0 (12.7) 57.4 (14.0) 54.9 (7.4) 7585.4** (12.6) 68.7** (14.9) 74.9 (15.5) 65.4 (16.1) 81.6* (13.1) 74.3* (7.6) 10095.63 (6.25) 93.50 (9.73) 87.1 (11.8) 93.7 (10.9) 102.9* (10.8) 95.6* (8.4) 125121.1** (7.8) 113.8** (7.9) Note: *p<0.05; **p<0.01

14. Conclusions For the specific forces of grasping, probing and sweeping these specific haptic simulators can distinguish surgeons from novices. Demonstrates that surgeons do possess a force skill set that is learned. These simulators offer a possible mechanism to specifically teach these force skills. Surgical tradition of “feel this” applies to laparoscopy as well as open procedures.

15. Next Steps.. Combine all three skills into one, easy-to-use trainer Next experiment: can the simulator train haptic skills of novices? (in progress) Clemson-GHS Haptic Skills Trainer