Elsevier

Journal of Surgical Education

Volume 76, Issue 1, January–February 2019, Pages 262-273
Journal of Surgical Education

ORIGINAL REPORTS
Is Virtual Reality Surgical Performance Influenced by Force Feedback Device Utilized?

https://doi.org/10.1016/j.jsurg.2018.06.012Get rights and content

Objective

The study objectives were to assess if surgical performance and subjective assessment of a virtual reality simulator platform was influenced by changing force feedback devices.

Design

Participants used the NeuroVR (formerly NeuroTouch) simulator to perform 5 practice scenarios and a realistic scenario involving subpial resection of a virtual reality brain tumor with simulated bleeding. The influence of force feedback was assessed by utilizing the Omni and Entact haptic systems. Tier 1, tier 2, and tier 2 advanced metrics were used to compare results. Operator subjective assessment of the haptic systems tested utilized seven Likert criteria (score 1 to 5).

Setting

The study is carried out at the McGill Neurosurgical Simulation Research and Training Centre, Montreal Neurological Institute and Hospital, Montreal, Canada.

Participants

Six expert operators in the utilization of the NeuroVR simulator platform.

Results

No significant differences in surgical performance were found between the two haptic devices. Participants significantly preferred the Entact system on all 7 Likert criteria of subjective assessment.

Conclusions

Our results show no statistical differences in virtual reality surgical performance utilizing the two bimanual haptic devices tested. Subjective assessments demonstrated that participants preferred the Entact system. Our results suggest that to maximize realism of the training experience educators employing virtual reality simulators may find it useful to assess expert opinion before choosing a force feedback device.

Introduction

Haptic feedback is defined as the combination of tactile feedback through sensory skin receptors and the kinaesthetic feedback through muscle, tendon, and joint sensory receptors.1, 2 Application of haptic feedback systems to virtual reality scenarios increases virtual tissue manipulation realism.2, 3 The utilization of specific haptic feedback systems has been shown to influence endoscopic and robot-assisted surgery training performance.4, 5, 6, 7 Haptic feedback is important for effective surgical skills training using virtual reality simulation.2, 5,6,8, 9, 10 Multiple studies have demonstrated that haptic feedback incorporation into VR training systems results in higher performance accuracy, faster skills acquisition, and expedited skills transfer.1, 2, 3,5, 6,9, 11,12 Reduced haptic feedback may result in an undesirable training effect.6, 13 Surgeons state that realistic haptic feedback is an important element of virtual reality surgical simulator performance.4, 14 Defining the role played by haptic feedback systems in virtual reality platforms is therefore critical to obtain accurate assessment and training results from these systems.

There are several commercially obtainable haptic devices for use with neurosurgical virtual reality simulators. It is not known how utilization of these different systems influences operator performance and evaluation.2 The Neurosurgical Simulation Research and Training Centre at McGill University has two haptic and interchangeable feedback devices, compatible with the NeuroVR (formerly NeuroTouch) simulation platform available. The majority of our studies have utilized the PHANTOM Omni (Sensable Technology, Wilmington, MA).15, 16, 17 The availability of a second compatible Entact system (Entact Robotics, ON, Canada) has allowed us to assess if expert operator performance was influenced by the haptic system utilized (Fig. 1). The major technical differences between the two haptic systems studied are outlined in Table 1. This study was designed to address two questions: (1) Is surgical performance on the NeuroVR simulator platform influenced by changing the force feedback device? and (2) Does expert subjective evaluation depend on the haptic device utilized?

Section snippets

Subjects

Six NeuroVR system experts participated in this study. The aim of including NeuroVR experts was to eliminate or minimize the effect of learning on performance. This increased the possibility that the critical variable factor being tested was the haptic feedback device utilized and not the experience of the operator. Participants were considered NeuroVR experts if they were using the NeuroVR system on a daily basis for their postgraduate and research studies. Five NeuroVR experts were right

Demographics

The mean age of participants was 32.2 ± 5.4. Two participants were board certified neurosurgeons and 4 were neurosurgical residents and researchers.

Learning Curve

All tier 1, tier 2, and advanced tier 2 metrics were able to be assessed. Statistical comparison of performance on the 5 practice scenarios for individual haptic devices showed no statistical difference in the metrics for both haptic devices for 10 of the 12 metrics assessed (Figure 5, Figure 6, Figure 7). When using the Omni device tumor percentage

Discussion

To assess the first study question of whether surgical performance on virtual reality simulator was affected by different force feedback devices, a number of concerns needed to be addressed. First, to deal with the possibility of a learning curve only NeuroVR platform experts participated in the trial. NeuroVR platform experts were recruited from neurosurgical researchers who were doing their virtual reality research on the NeuroVR platform. A practice scenario involving the repeated removal of

Conclusion

Our results show equivalency in expert performance utilizing the Omni and Entact haptic feedback devices utilizing the scenarios and metrics assessed. Subjective assessments demonstrated that participants preferred the Entact system. Our results suggest that to maximize realism of the training experience, educators employing virtual reality simulators may find it useful to assess expert opinion before choosing a force feedback device.

Disclosure

The authors report no conflict of interest concerning the materials and methods in this study or the funding specified in this paper.

Acknowledgments

Special thanks to Denis Laroche for his help with this manuscript. We thank all participants in the study. We would like also to thank Dr. Robert DiRaddo, Group Leader, Simulation, Life Science Division, National Research Council of Canada at Boucherville and his team, especially including Denis Laroche, Valerie Pazos, Nusrat Choudhury, Patricia Debergue, and Linda Pecora for their support in the development of the scenarios used in this study and all members of the Simulation, Life Science

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  • Funding: This work was supported by the Di Giovanni Foundation, the Montreal English School Board and the Montreal Neurological Institute and Hospital. Dr. H. Azarnoush held the Postdoctoral Neuro-Oncology Fellowship from the Montreal Neurological Institute and Hospital. Robin Sawaya held the Christian Geada Brain Tumor Research Studentship from the Montreal Neurological Institute. Dr. R. Del Maestro is the William Feindel Emeritus Professor in Neuro-Oncology at McGill University.

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