Visuo-haptic feedback for 1-D guidance in laparoscopic surgery

Due mainly to drastically shortened recovery times and lower overall cost, minimally invasive surgery (MIS) is growing standard for many surgical interventions. However, associated loss of visual depth perception, difficult hand-eye coordination and distorted haptic sensation tend to complicate this task for the surgeon. In this paper, we explore the potential of simple visual, haptic or combined visual and haptic cues for intuitively assisting surgeons in moving their instrument tip within a predefined 3-D plane. 23 subjects carried out trajectory following tasks within a plane under provision of 9 different combinations of visual and haptic guidance feedback. Evaluated forms of haptic feedback encompassed both tactile cues and kinaesthetic feedback using soft virtual fixtures. Results show clear superiority of soft guidance virtual fixtures over other forms of feedback, leading to performance levels above those obtained in open surgery. However, promising results for the use of cutaneous vibrotactile feedback are also obtained, with potential for integration in MIS tool handles.