Abstract

Background: We describe the development and preliminary prototype testing of ‘smart’ real-time feedback systems for four laparoscopic instruments. These provided trainees learning percutaneous needle insertion, trocar insertion, use of laparoscopic forceps, and laparoscopic suturing with increased force, haptic, and visual feedback. Each prototype was assessed to determine whether it had met the design goals of providing real-time feedback, maintaining true-to-life handling of the instruments, and offering educational benefit.

Methods: The Smart-Needle utilized a laser-diode and 3D-printed housing to transilluminate tissue, allowing for intraperitoneal visualization of an insertion site. The Smart-Trocar utilized a microcontroller to process and report applied forces, angle of advancement, and tissue impedance measured by load-cells. The Smart-Forceps utilized a microcontroller to process and report the grip force, tensile force, and transverse load applied to a laparoscopic grasper. The Suture-Assist device utilized a retractable silicone tip to provide greater haptic and visual feedback during intracorporeal suturing. Pilot studies were conducted to assess each device’s functionality, technical benefit, and training enhancement.

Results: All prototype feedback systems met the design goals of providing objective and accurate real-time feedback and maintenance of true-to-life handling of the base instrument. Preliminary evaluations of each prototype by expert educators and surgical trainees found that the feedback systems offered increased educational benefit during simulation practice.

Conclusion: We designed and developed novel surgical training tools to provide enhanced real-time feedback for surgical trainees. All four prototypes met our development goals of fidelity maintenance and continuous feedback.