How does the modality of delivering force feedback influence the performance and learning of surgical suturing skills? We don't know, but we better find out! A review

Luca Oppici; Kim Grütters; Felix Bechtolsheim; Stefanie Speidel

doi:10.1007/s00464-022-09740-7

How does the modality of delivering force feedback influence the performance and learning of surgical suturing skills? We don't know, but we better find out! A review

Surg Endosc. 2023 Apr;37(4):2439-2452. doi: 10.1007/s00464-022-09740-7. Epub 2022 Oct 27.

Authors

Luca Oppici^{1

2

3}, Kim Grütters⁴, Felix Bechtolsheim^{5

6}, Stefanie Speidel^{5

7}

Affiliations

¹ Psychology of Learning and Instruction, Department of Psychology, School of Science, Technische Universität Dresden, Zellescher Weg 17, 01069, Dresden, Germany. luca.oppici@tu-dresden.de.
² Centre for Tactile Internet with Human-in-the-Loop (CeTI), Technische Universität Dresden, Dresden, Germany. luca.oppici@tu-dresden.de.
³ Norwegian School of Sport Sciences, Oslo, Norway. luca.oppici@tu-dresden.de.
⁴ Psychology of Learning and Instruction, Department of Psychology, School of Science, Technische Universität Dresden, Zellescher Weg 17, 01069, Dresden, Germany.
⁵ Centre for Tactile Internet with Human-in-the-Loop (CeTI), Technische Universität Dresden, Dresden, Germany.
⁶ Department of Visceral, Thoracic- and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
⁷ Division of Translational Surgical Oncology, National Center for Tumor Diseases Dresden, Dresden, Germany.

Abstract

Background: Force feedback is a critical element for performing and learning surgical suturing skill. Force feedback is impoverished or not present at all in non-open surgery (i.e., in simulation, laparoscopic, and robotic-assisted surgery), but it can be augmented using different modalities. This rapid, systematic review examines how the modality of delivering force feedback influences the performance and learning of surgical suturing skills.

Methods: An electronic search was performed on PubMed/MEDLINE, Web of Science, and Embase databases to identify relevant articles. The results were synthesized using vote counting based on direction of effect.

Results: A total of nine studies of medium-to-low quality were included. The synthesis of results suggests that the visual modality could be more beneficial than the tactile and auditory modalities in improving force control and that auditory and tactile modalities could be more beneficial than the visual modality in improving suturing performance. Results are mixed and unclear with regards to how modality affects the reduction of force magnitude and unclear when unimodal was compared to multimodal feedback. The studies have a general low level of evidence.

Conclusion: The low number of studies with low methodological quality and low level of evidence (most were proof of concept) prevents us from drawing any meaningful conclusion and as such it is currently unknown whether and how force feedback modality influences surgical suturing skill. Speculatively, the visual modality may be more beneficial for improving the control of exerted force, while auditory and tactile modalities may be more effective in improving the overall suturing performance. We consider the issue of feedback modality to be highly relevant in this field, and we encourage future research to conduct further investigation integrating principles from learning psychology and neuroscience: identify feedback goal, context, and skill level and then design and compare feedback modalities accordingly.

Keywords: Knot tying; Needle inserting; Surgery; Surgical education; Surgical training.

Publication types

Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Feedback
Humans
Internship and Residency*
Learning
Motivation
Robotic Surgical Procedures*