Salient haptic skills trainer: Initial validation of a novel simulator for training force-based laparoscopic surgical skills

Background: There is an increasing need for efficient training simulators to teach advanced laparoscopic skills beyond those imparted by a box trainer. In particular, force-based or haptic skills must be addressed in simulators, especially because a large percentage of surgical errors are caused by the over-application of force. In this work, the efficacy of a novel, salient haptic skills simulator is tested as a training tool for force-based laparoscopic skills. Methods: Thirty novices with no previous laparoscopic experience trained on the simulator using a pre-test-feedback-post-test experiment model. Ten participants were randomly assigned to each of the three salient haptic skills - grasping, probing, and sweeping - on the simulator. Performance was assessed by comparing force performance metrics before and after training on the simulator. Results: Data analysis indicated that absolute error decreased significantly for all three salient skills after training. Participants also generally decreased applied forces after training, especially at lower force levels. Overall, standard deviations also decreased after training, suggesting that participants improved their variability of applied forces. Conclusions: The novel, salient haptic skills simulator improved the precision and accuracy of participants when applying forces with the simulator. These results suggest that the simulator may be a viable tool for laparoscopic force skill training. However, further work must be undertaken to establish full validity. Nevertheless, this work presents important results toward addressing simulator-based force-skills training specifically and surgical skills training in general.