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Schrijvershof P, Rahimi AM, Leone N, Bloemendaal A, Daams F, Arezzo A, Mintz Y, Horeman T. Design and evaluation of a smart passive dynamic arm support for robotic-assisted laparoscopic surgery. J Robot Surg 2024; 18:71. [PMID: 38340240 PMCID: PMC10858817 DOI: 10.1007/s11701-024-01820-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/08/2024] [Indexed: 02/12/2024]
Abstract
Surgeons performing robotic-assisted laparoscopic surgery experience physical stress and overuse of shoulder muscles due to sub-optimal arm support during surgery. The objective is to present a novel design and prototype of a dynamic arm support for robotic laparoscopic surgery to evaluate its ergonomics and performance on the AdLap-VR simulation training device. The prototype was designed using the mechanical engineering design process: Technical requirements, concept creation, concept selection, 3D-design and built of the prototype. A crossover study was performed on a marble sorting task on the AdLap-VR. The first group performed four trials without the arm support, followed by four trials with the arm support, and the other group executed the sequence vice versa. The performance parameters used were time to complete (s), path length (mm), and the number of collisions. Afterward, the participants filled out a questionnaire on the ergonomic experience regarding both situations. 20 students executed 160 performed trials on the AdLap-VR Significant decreases in the subjective comfort parameters mental demand, physical demand, effort and frustration were observed as a result of introducing the novel arm support. Significant decreases in the objective performance parameters path length and the number of collisions were also observed during the tests. The newly developed dynamic arm support was found to improve comfort and enhance performance through increased stability on the robotic surgery skills simulator AdLap-VR.
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Affiliation(s)
- Pim Schrijvershof
- Department of Biomechanical Engineering, Technical University of Delft, Delft, The Netherlands
| | - A Masie Rahimi
- Department of Surgery, Amsterdam UMC - VU University Medical Center, Amsterdam, The Netherlands.
- Amsterdam Skills Centre for Health Sciences, Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Amsterdam, The Netherlands.
| | - Nicola Leone
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | | | - Freek Daams
- Department of Surgery, Amsterdam UMC - VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Skills Centre for Health Sciences, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Yoav Mintz
- Department of General Surgery, Hadassah Hebrew-University Medical Center, Jerusalem, Israel
| | - Tim Horeman
- Department of Biomechanical Engineering, Technical University of Delft, Delft, The Netherlands
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Hardon SF, Willuth E, Rahimi AM, Lang F, Haney CM, Felinska EA, Kowalewski KF, Müller-Stich BP, van der Peet DL, Daams F, Nickel F, Horeman T. Crossover-effects in technical skills between laparoscopy and robot-assisted surgery. Surg Endosc 2023:10.1007/s00464-023-10045-6. [PMID: 37097456 PMCID: PMC10338573 DOI: 10.1007/s00464-023-10045-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 03/25/2023] [Indexed: 04/26/2023]
Abstract
INTRODUCTION Robot-assisted surgery is often performed by experienced laparoscopic surgeons. However, this technique requires a different set of technical skills and surgeons are expected to alternate between these approaches. The aim of this study is to investigate the crossover effects when switching between laparoscopic and robot-assisted surgery. METHODS An international multicentre crossover study was conducted. Trainees with distinctly different levels of experience were divided into three groups (novice, intermediate, expert). Each trainee performed six trials of a standardized suturing task using a laparoscopic box trainer and six trials using the da Vinci surgical robot. Both systems were equipped with the ForceSense system, measuring five force-based parameters for objective assessment of tissue handling skills. Statistical comparison was done between the sixth and seventh trial to identify transition effects. Unexpected changes in parameter outcomes after the seventh trial were further investigated. RESULTS A total of 720 trials, performed by 60 participants, were analysed. The expert group increased their tissue handling forces with 46% (maximum impulse 11.5 N/s to 16.8 N/s, p = 0.05), when switching from robot-assisted surgery to laparoscopy. When switching from laparoscopy to robot-assisted surgery, intermediates and experts significantly decreased in motion efficiency (time (sec), resp. 68 vs. 100, p = 0.05, and 44 vs. 84, p = 0.05). Further investigation between the seventh and ninth trial showed that the intermediate group increased their force exertion with 78% (5.1 N vs. 9.1 N, p = 0.04), when switching to robot-assisted surgery. CONCLUSION The crossover effects in technical skills between laparoscopic and robot-assisted surgery are highly depended on the prior experience with laparoscopic surgery. Where experts can alternate between approaches without impairment of technical skills, novices and intermediates should be aware of decay in efficiency of movement and tissue handling skills that could impact patient safety. Therefore, additional simulation training is advised to prevent from undesired events.
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Affiliation(s)
- Sem F Hardon
- Department of Surgery, Amsterdam UMC - VU University Medical Center, ZH 7F 005 De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands.
| | - E Willuth
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - A Masie Rahimi
- Department of Surgery, Amsterdam UMC - VU University Medical Center, ZH 7F 005 De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Amsterdam Skills Centre for Health Sciences, Amsterdam, The Netherlands
| | - F Lang
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Caelan M Haney
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Eleni A Felinska
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Karl-Friedrich Kowalewski
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Beat P Müller-Stich
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Donald L van der Peet
- Department of Surgery, Amsterdam UMC - VU University Medical Center, ZH 7F 005 De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Freek Daams
- Department of Surgery, Amsterdam UMC - VU University Medical Center, ZH 7F 005 De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - F Nickel
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Tim Horeman
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
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Impact of educational video on performance in robotic simulation training (TAKUMI-1): a randomized controlled trial. J Robot Surg 2023:10.1007/s11701-023-01556-4. [PMID: 36905486 PMCID: PMC10374749 DOI: 10.1007/s11701-023-01556-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/01/2023] [Indexed: 03/12/2023]
Abstract
The use of virtual reality for simulations plays an important role in the initial training for robotic surgery. This randomized controlled trial aimed to investigate the impact of educational video on the performance of robotic simulation. Participants were randomized into the intervention (video) group that received an educational video and robotic simulation training or the control group that received only simulation training. The da Vinci® Skills Simulator was used for the basic course, including nine drills. The primary endpoint was the overall score of nine drills in cycles 1-10. Secondary endpoints included overall, efficiency, and penalty scores in each cycle, as well as the learning curves evaluated by the cumulative sum (CUSUM) analysis. Between September 2021 and May 2022, 20 participants were assigned to the video (n = 10) and control (n = 10) groups. The video group had significantly higher overall scores than the control group (90.8 vs. 72.4, P < 0.001). Significantly higher overall scores and lower penalty scores were confirmed, mainly in cycles 1-5. CUSUM analysis revealed a shorter learning curve in the video group. The present study demonstrated that educational video training can be effective in improving the performance of robotic simulation training and shortening the learning curve.
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Lemos M, Bell L, Deutsch S, Zieglowski L, Ernst L, Fink D, Tolba R, Bleilevens C, Steitz J. Virtual Reality in Biomedical Education in the sense of the 3Rs. Lab Anim 2022; 57:160-169. [PMID: 36221253 DOI: 10.1177/00236772221128127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Article 23(2) of EU Directive 2010/63 on the protection of animals used for scientific purposes requires staff involved in the care and use of animals to be adequately educated and trained before carrying out procedures. Therefore, the 3Rs (refinement, reduction, and replacement) and knowledge of alternative methods should be part of the education and training itself. For this purpose, the digital learning concept "Virtual Reality (VR) in Biomedical Education" evolved, which successfully combines VR components with classical learning content. Procedures, such as anesthesia induction, substance application, and blood sampling in rats, as well as aspects of the laboratory environment were recorded in 360° videos. The generated VR teaching/learning modules (VR modules) were used to better prepare participants for hands-on training (refinement) or as a complete replacement for a live demonstration; thus, reducing the number of animals used for hands-on skills training (reduction). The current study evaluated users' experience of the VR modules. Despite little previous VR experience, participants strongly appreciated the VR modules and indicated that they believed VR has the potential to enhance delivery of procedures and demonstrations. Interestingly, participants with previous experience of laboratory animal science were more convinced about VR's potential to support the 3Rs principle, and endorsed its use for further educational purposes. In conclusion, VR appeared to be highly accepted as a learning/teaching method, indicating its great potential to further replace and reduce the use of animals in experimental animal courses.
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Affiliation(s)
- Martin Lemos
- Audiovisual Media Center, Faculty of Medicine, RWTH Aachen University, Germany
| | - Laura Bell
- Audiovisual Media Center, Faculty of Medicine, RWTH Aachen University, Germany.,Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine, RWTH Aachen University, Germany
| | - Susanne Deutsch
- Institute for Laboratory Animal Science, Faculty of Medicine, RWTH Aachen University, Germany
| | - Leonie Zieglowski
- Institute for Laboratory Animal Science, Faculty of Medicine, RWTH Aachen University, Germany
| | - Lisa Ernst
- Institute for Laboratory Animal Science, Faculty of Medicine, RWTH Aachen University, Germany
| | - Daniel Fink
- Audiovisual Media Center, Faculty of Medicine, RWTH Aachen University, Germany
| | - R Tolba
- Institute for Laboratory Animal Science, Faculty of Medicine, RWTH Aachen University, Germany
| | - Christian Bleilevens
- Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, Germany
| | - Julia Steitz
- Institute for Laboratory Animal Science, Faculty of Medicine, RWTH Aachen University, Germany
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