Abstract
PurposeVeress needle (VN) insertion, if not correctly performed, could cause severe injuries to intra-abdominal organs and vessels. Therefore, cognitive and psychomotor skills training is needed. Virtual reality (VR) and haptic technologies have the potential to offer realistic simulations.MethodsWe developed a novel VR and haptic surgical simulator for VN insertion to teach trainees how to correctly puncture the abdominal wall, experiencing realistic tactile sensations throughout the simulation. The simulator allows for both procedural and realistic training. We released two different versions: the first using the OpenHaptics^{text {TM}} (OH) Toolkit and the second exploiting CHAI3D. We evaluated the learning effect using different performance indexes (time to perform the procedure, error in insertion angle, number of undesired contacts with organs) in an insertion task for both experienced urologists and students.ResultsA general improvement of the chosen performance indexes was registered in the second repetition of the task for both groups. From the questionnaires, the simulator leveraging OH provides the trainee with a more precise haptic feedback, whereas the one exploiting CHAI3D allows them to perform the procedure more easily thanks to the better visualization of the virtual environment. The results proved that the participants appreciated both implementations, and the System Usability Scale (SUS) test resulted in a “good” usability.ConclusionThe haptics-based and VR simulator has shown the potential to be an important resource for the basic urological training in obtaining the pneumoperitoneum and improving the acquisition of the necessary psychomotor skills, allowing for extended and more effective training without compromising patient safety.
Highlights
Improper access to the abdomen through Veress needle (VN) insertion is the cause of unique and life-threatening complications like injuries to intra-abdominal organs and vessels [1,2].The blind insertion and the firm reliance on the tactile sensation when inserting the VN through the different layers of the abdominal wall make this procedure risky for non-trained surgeons
Since the operating room (OR) is not an ideal environment to practice and learn VN insertion due to recognized potential for injury, we evaluated the benefits of including Virtual reality (VR) and haptics to teach how to correctly puncture the abdominal wall without damaging the internal organs
It should ensure the following specifications to meet the disadvantages of current training models and address the physicians’ needs: (i) anatomical realism, (ii) realistic haptic feedback, (iii) intuitive use for trainees, (iv) accurate measurements of the training outcomes, and (v) commercial viability and relevancy since this tool should be economically accessible for medical schools and convey the visual and tactile stimuli of a real operation
Summary
Improper access to the abdomen through Veress needle (VN) insertion is the cause of unique and life-threatening complications like injuries to intra-abdominal organs and vessels [1,2]. The blind insertion and the firm reliance on the tactile sensation when inserting the VN through the different layers of the abdominal wall make this procedure risky for non-trained surgeons. When the surgeon introduces the needle, the crucial step is the sensation of two distinct “pops” signaling that the tip is passing through the abdominal wall [4]. Since the surgeon needs to perform complex technical and cognitive tasks with tiny margin for error, it is difficult to acquire the required psychomotor skills through cognitive training only. Studies have pointed out that practice is the actual key for psychomotor skills acquisition [8] providing
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