Effects of Force Feedback on Trainee Performance: A Pilot Study of the dV5 Surgical Robot.

INTRODUCTION

Lack of tactile sensation remains a limitation of robotic operations. The da Vinci 5 (dV5) surgical system uses force feedback (FFB) technology, allowing surgeons to sense forces exerted at the instrument tips. Limited studies report that FFB reduces excessive instrument force and enhances tissue manipulation. However, its role in trainee technical performance remains poorly characterized. This study aimed to evaluate the effects of FFB on trainee performance using validated technical rating scales.

METHODS

Participants in this pilot study included 4 trainees with varying levels of robotic experience (medical student, intern, clinical fourth year resident, advanced minimally invasive fellow). Each participant performed a simulated robotic lymphadenectomy on the dV5 console, twice with the aid of FFB and twice without. Performances were recorded and subsequently blinded for analysis by 6 faculty reviewers across 6 surgical specialties. Modified Robotic Objective Structured Assessment of Technical Skills (r-OSATS) and Global Evaluative Assessment of Robotic Skills (GEARS) were used to measure respect for tissue, instrument handling, and force sensitivity. Scores were compared across trainees with and without FFB using t-tests and ANOVA. Interobserver agreement among surgeon evaluators was assessed.

RESULTS

Across all participants, there were no significant differences in mean GEARS (14.81 vs 12.75, p = 0.4) and r-OSATS (14.25 vs 12.50, p = 0.5) scores between tasks performed with and without FFB. However, in the FFB group, median GEARS (14.8, interquartile range [IQR] 5.5) and r-OSATS (14.5, IQR 3.1) scores were higher compared to the non-FFB group for GEARS (12, IQR 7.5) and r-OSATS (10.8, IQR 7.5). Overall performance scores differed significantly for both GEARS (p = 0.02) and r-OSATS (p = 0.003) when stratified by training level, with more experienced trainees scoring higher. Out of all trainees, only the medical student experienced a wide difference in performance, with higher average GEARS (15.50 vs 8.50) and r-OSATS (14.75 vs 8.50) scoring with FFB, though only r-OSATS was statistically significant (p = 0.172 and p = 0.026). Interobserver agreement among evaluators was fair at r = 0.5.

CONCLUSIONS

Our findings suggest that novice trainees may experience benefit with FFB in the early learning curve of robotic skill acquisition. Future large-scale studies are warranted to understand the impact of FFB on trainee skill acquisition in robotic surgery.