@article{3125649,
    title = "Virtual reality-based assessment of basic laparoscopic skills using the Leap Motion controller",
    author = "Lahanas, V. and Loukas, C. and Georgiou, K. and Lababidi, H. and Al-Jaroudi, D.",
    journal = "Surgical Endoscopy",
    year = "2017",
    volume = "31",
    number = "12",
    pages = "5012-5023",
    publisher = "Springer New York LLC",
    issn = "0930-2794, 1432-2218",
    doi = "10.1007/s00464-017-5503-3",
    keywords = "abdominal cavity;  Article;  depth perception;  eye hand coordination;  face validity;  hand movement;  human;  laparoscopic surgery;  priority journal;  qualitative analysis;  simulation training;  skill;  surgeon;  surgical training;  tactile feedback;  virtual reality;  clinical competence;  computer interface;  education;  laparoscopy;  procedures;  questionnaire;  reproducibility;  spatial orientation;  statistics and numerical data;  surgery, Abdominal Cavity;  Clinical Competence;  Humans;  Laparoscopy;  Orientation, Spatial;  Reproducibility of Results;  Simulation Training;  Surgeons;  Surveys and Questionnaires;  User-Computer Interface;  Virtual Reality",
    abstract = "Background: The majority of the current surgical simulators employ specialized sensory equipment for instrument tracking. The Leap Motion controller is a new device able to track linear objects with sub-millimeter accuracy. The aim of this study was to investigate the potential of a virtual reality (VR) simulator for assessment of basic laparoscopic skills, based on the low-cost Leap Motion controller. Methods: A simple interface was constructed to simulate the insertion point of the instruments into the abdominal cavity. The controller provided information about the position and orientation of the instruments. Custom tools were constructed to simulate the laparoscopic setup. Three basic VR tasks were developed: camera navigation (CN), instrument navigation (IN), and bimanual operation (BO). The experiments were carried out in two simulation centers: MPLSC (Athens, Greece) and CRESENT (Riyadh, Kingdom of Saudi Arabia). Two groups of surgeons (28 experts and 21 novices) participated in the study by performing the VR tasks. Skills assessment metrics included time, pathlength, and two task-specific errors. The face validity of the training scenarios was also investigated via a questionnaire completed by the participants. Results: Expert surgeons significantly outperformed novices in all assessment metrics for IN and BO (p < 0.05). For CN, a significant difference was found in one error metric (p < 0.05). The greatest difference between the performances of the two groups occurred for BO. Qualitative analysis of the instrument trajectory revealed that experts performed more delicate movements compared to novices. Subjects’ ratings on the feedback questionnaire highlighted the training value of the system. Conclusions: This study provides evidence regarding the potential use of the Leap Motion controller for assessment of basic laparoscopic skills. The proposed system allowed the evaluation of dexterity of the hand movements. Future work will involve comparison studies with validated simulators and development of advanced training scenarios on current Leap Motion controller. © 2017, Springer Science+Business Media New York."
}