Specificity of motor learning in simulator training of endoscopic-surgery skills

Abstract

The introduction of simulators for the practice of endoscopic-surgery sensori-motor skills opens a wide range of design options. An obvious one is augmented visual information early in practice, in particular a direct view of the site instead of the endoscopic view. We studied the effects of such augmented visual information on the simulated ablation of tissue with straight, horizontal and parallel cuts. Direct view had an immediate beneficial effect on performance as compared with endoscopic-view practice. However, in subsequent tests with endoscopic view the benefits disappeared and turned into costs for some aspects of performance, e.g., duration. This finding highlights for a simulated surgical task that optimisation of practice by a performance criterion may not result in optimisation by a transfer criterion.

Practitioner Summary: Endoscopic surgery represents a challenge for human sensori-motor skills, but new simulator-based training methods give leeway for optimisation. A candidate is augmented visual feedback, in particular a direct rather than endoscopic view of the site. However, performance becomes dependent on the augmented feedback so that the costs outweigh the benefits.

Keywords:

• simulation
• augmented feedback
• resection
• transfer

Acknowledgement

We thank Nicolas Ludolph, Andreas Volgmann, and Petra Wallmeyer for their support in development of the simulator setup and data acquisition. Ullrich Bolbach is now at Krankenhaus Barmherzige Brüder, Regensburg.