Virtual reality in laparoscopic skills training: Is haptic feedback replaceable?

With the emphasis on laparoscopic skills training outside of the operating room (OR), simulators are constantly being developed and improved. Virtual reality (VR) trainers have been looking for solutions to compensate their lack of haptic feedback. A possible solution is the addition of kinematic interaction between laparoscopic instruments and objects. The aim of the study was to determine whether this interaction can replace haptic feedback that is naturally present in box trainers. Novices (n = 50) were randomly assigned to training in a conventional VR setup (VR-I), a VR environment with additional kinematic interaction (VR-II), a box trainer equivalent of these setups (Box-I or Box-II), or to a control group. An identical cylinder task was performed in all four training setups. The effect was established by comparing the performance before and after training during a tissue handling task, using Wilcoxon signed-rank tests. The controls did not improve significantly. The VR-I group improved in time, whereas VR-II and both box trainer groups improved in time, path length and motion in depth. With respect to haptic feedback, box training models are superior to VR systems. However, additional kinematic interaction between instruments and objects can be a promising surrogate for haptic feedback in VR systems.