The influence of simulating cyclic diaphragm movement training on acquisition of basic laparoscopic skills with an actuated training platform
EAES Academy. Klok J. 07/05/22; 366560; P303
Jan-Willem Klok
Contributions
Contributions
Abstract
Aims
Laparoscopic surgery has many advantages but comes with its own challenges. For example, the working space and field of view of the abdominal cavity is limited and often obstructed by organs. The abdominal cavity is flexible, dynamic and interactive with the rest of the patient’s body, causing the manipulated tissue to move. A contributor to abdominal tissue movement is respiration, transferred by the diaphragm. These are not introduced during basic laparoscopic skills training. The acquisition of sensory and motoric skills is crucial for safe surgery. Currently, little is known about the influence of simulated movement on training. Therefore, it was investigated if basic laparoscopic skills training with task movement has an influence on the acquisition of laparoscopic skills.
Methods
An actuated platform (DyLaP), compatible with a ForceSense laparoscopic box trainer was designed (Figure 1), capable of simulating diaphragm movements. The movement fidelity was approved by a laparoscopic surgeon, characterized by an asymmetric sinusoidal with an amplitude of 12mm, simulating 1.5s of inhalation and 3s of exhalation. During a pilot study, eight students divided into two groups were asked to perform a precision peg transfer task on a box trainer. One group performed six trails of the task without movement followed by an exam trail with movements (static group). The other group performed six trails with movement followed by an exam trail with movements (dynamic group). During all trails, time to task completion and forces in three directions exerted on the DyLaP were measured.
Results
Time to completion for the dynamic group exam was significantly lower than the static group exam (mean t=208s SD40s versus mean t=142s SD26s, respectively with p=<0.05). The time to completion learning curve (Figure 2) showed that the dynamic group performed worse in the first trail compared to the static group. After the first trail, performance of both groups converged, with the exception of the exams. There was no significant difference in the forces exerted on the platform.
Conclusions
The DyLaP proved to be a useful tool to investigate the role of simulated organ movement in basic laparoscopic skills training. The pilot study showed that introducing simulated movement during laparoscopic training does have an influence on skill acquisition. It was observed that participants used stationary moments of the cyclic motion as windows of opportunity to place the rings. Regarding position-based tasks, predictable organ movement might be less relevant for skills acquisition. Therefore, it will be investigated if there is a relevant skill acquisition difference with a force-based task that requires full time contact. Also, training with disturbances of the diaphragm would be clinically relevant. Further research is needed to investigate whether force-based tasks and sudden movements have a relevant influence on laparoscopic skills training.
Laparoscopic surgery has many advantages but comes with its own challenges. For example, the working space and field of view of the abdominal cavity is limited and often obstructed by organs. The abdominal cavity is flexible, dynamic and interactive with the rest of the patient’s body, causing the manipulated tissue to move. A contributor to abdominal tissue movement is respiration, transferred by the diaphragm. These are not introduced during basic laparoscopic skills training. The acquisition of sensory and motoric skills is crucial for safe surgery. Currently, little is known about the influence of simulated movement on training. Therefore, it was investigated if basic laparoscopic skills training with task movement has an influence on the acquisition of laparoscopic skills.
Methods
An actuated platform (DyLaP), compatible with a ForceSense laparoscopic box trainer was designed (Figure 1), capable of simulating diaphragm movements. The movement fidelity was approved by a laparoscopic surgeon, characterized by an asymmetric sinusoidal with an amplitude of 12mm, simulating 1.5s of inhalation and 3s of exhalation. During a pilot study, eight students divided into two groups were asked to perform a precision peg transfer task on a box trainer. One group performed six trails of the task without movement followed by an exam trail with movements (static group). The other group performed six trails with movement followed by an exam trail with movements (dynamic group). During all trails, time to task completion and forces in three directions exerted on the DyLaP were measured.
Results
Time to completion for the dynamic group exam was significantly lower than the static group exam (mean t=208s SD40s versus mean t=142s SD26s, respectively with p=<0.05). The time to completion learning curve (Figure 2) showed that the dynamic group performed worse in the first trail compared to the static group. After the first trail, performance of both groups converged, with the exception of the exams. There was no significant difference in the forces exerted on the platform.
Conclusions
The DyLaP proved to be a useful tool to investigate the role of simulated organ movement in basic laparoscopic skills training. The pilot study showed that introducing simulated movement during laparoscopic training does have an influence on skill acquisition. It was observed that participants used stationary moments of the cyclic motion as windows of opportunity to place the rings. Regarding position-based tasks, predictable organ movement might be less relevant for skills acquisition. Therefore, it will be investigated if there is a relevant skill acquisition difference with a force-based task that requires full time contact. Also, training with disturbances of the diaphragm would be clinically relevant. Further research is needed to investigate whether force-based tasks and sudden movements have a relevant influence on laparoscopic skills training.
Aims
Laparoscopic surgery has many advantages but comes with its own challenges. For example, the working space and field of view of the abdominal cavity is limited and often obstructed by organs. The abdominal cavity is flexible, dynamic and interactive with the rest of the patient’s body, causing the manipulated tissue to move. A contributor to abdominal tissue movement is respiration, transferred by the diaphragm. These are not introduced during basic laparoscopic skills training. The acquisition of sensory and motoric skills is crucial for safe surgery. Currently, little is known about the influence of simulated movement on training. Therefore, it was investigated if basic laparoscopic skills training with task movement has an influence on the acquisition of laparoscopic skills.
Methods
An actuated platform (DyLaP), compatible with a ForceSense laparoscopic box trainer was designed (Figure 1), capable of simulating diaphragm movements. The movement fidelity was approved by a laparoscopic surgeon, characterized by an asymmetric sinusoidal with an amplitude of 12mm, simulating 1.5s of inhalation and 3s of exhalation. During a pilot study, eight students divided into two groups were asked to perform a precision peg transfer task on a box trainer. One group performed six trails of the task without movement followed by an exam trail with movements (static group). The other group performed six trails with movement followed by an exam trail with movements (dynamic group). During all trails, time to task completion and forces in three directions exerted on the DyLaP were measured.
Results
Time to completion for the dynamic group exam was significantly lower than the static group exam (mean t=208s SD40s versus mean t=142s SD26s, respectively with p=<0.05). The time to completion learning curve (Figure 2) showed that the dynamic group performed worse in the first trail compared to the static group. After the first trail, performance of both groups converged, with the exception of the exams. There was no significant difference in the forces exerted on the platform.
Conclusions
The DyLaP proved to be a useful tool to investigate the role of simulated organ movement in basic laparoscopic skills training. The pilot study showed that introducing simulated movement during laparoscopic training does have an influence on skill acquisition. It was observed that participants used stationary moments of the cyclic motion as windows of opportunity to place the rings. Regarding position-based tasks, predictable organ movement might be less relevant for skills acquisition. Therefore, it will be investigated if there is a relevant skill acquisition difference with a force-based task that requires full time contact. Also, training with disturbances of the diaphragm would be clinically relevant. Further research is needed to investigate whether force-based tasks and sudden movements have a relevant influence on laparoscopic skills training.
Laparoscopic surgery has many advantages but comes with its own challenges. For example, the working space and field of view of the abdominal cavity is limited and often obstructed by organs. The abdominal cavity is flexible, dynamic and interactive with the rest of the patient’s body, causing the manipulated tissue to move. A contributor to abdominal tissue movement is respiration, transferred by the diaphragm. These are not introduced during basic laparoscopic skills training. The acquisition of sensory and motoric skills is crucial for safe surgery. Currently, little is known about the influence of simulated movement on training. Therefore, it was investigated if basic laparoscopic skills training with task movement has an influence on the acquisition of laparoscopic skills.
Methods
An actuated platform (DyLaP), compatible with a ForceSense laparoscopic box trainer was designed (Figure 1), capable of simulating diaphragm movements. The movement fidelity was approved by a laparoscopic surgeon, characterized by an asymmetric sinusoidal with an amplitude of 12mm, simulating 1.5s of inhalation and 3s of exhalation. During a pilot study, eight students divided into two groups were asked to perform a precision peg transfer task on a box trainer. One group performed six trails of the task without movement followed by an exam trail with movements (static group). The other group performed six trails with movement followed by an exam trail with movements (dynamic group). During all trails, time to task completion and forces in three directions exerted on the DyLaP were measured.
Results
Time to completion for the dynamic group exam was significantly lower than the static group exam (mean t=208s SD40s versus mean t=142s SD26s, respectively with p=<0.05). The time to completion learning curve (Figure 2) showed that the dynamic group performed worse in the first trail compared to the static group. After the first trail, performance of both groups converged, with the exception of the exams. There was no significant difference in the forces exerted on the platform.
Conclusions
The DyLaP proved to be a useful tool to investigate the role of simulated organ movement in basic laparoscopic skills training. The pilot study showed that introducing simulated movement during laparoscopic training does have an influence on skill acquisition. It was observed that participants used stationary moments of the cyclic motion as windows of opportunity to place the rings. Regarding position-based tasks, predictable organ movement might be less relevant for skills acquisition. Therefore, it will be investigated if there is a relevant skill acquisition difference with a force-based task that requires full time contact. Also, training with disturbances of the diaphragm would be clinically relevant. Further research is needed to investigate whether force-based tasks and sudden movements have a relevant influence on laparoscopic skills training.
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