Tissue consistency perception in laparoscopy to define the level of fidelity in virtual reality simulation

Background: What degree of fidelity must a laparoscopic simulator have to achieve a training objective? This difficult question is addressed by studying the sensory interaction of surgeons in terms of a surgical skill: tissue consistency perception. Methods: A method for characterizing surgeon sensory interaction has been defined and applied in an effort to determine the relative importance of three components of perceptual surgical skill: visual cues, haptic information, and previous surgical knowledge and experience. Expert, intermediate, and novel surgeons were enrolled in the study. Users were asked to rank tissue consistency in four different conditions: a description of the tissue alone (Q), visual information alone (VI), tactile information alone (TI), and both visual and tactile information (VTI). Agreement between these stages was assessed by a coefficient of determination (R boolean AND 2). Conclusions: Virtual reality simulators need haptic devices with force feedback capability if tissue consistency information is to be delivered. On the other hand, the visual haptics concept has been associated with a kind of tactile memory developed by surgical experience.