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Page 2 of 8 Riaz et al. Mini-invasive Surg 2018;2:28 I http://dx.doi.org/10.20517/2574-1225.2018.41

INTRODUCTION
The physical and mental demands of laparoscopic surgery create a steep learning curve for surgical
trainees. A two-dimensional image of the operative field produced by laparoscope increases mental
workload of the surgeon as they estimate depth in real-time. A direct surgeon-tissue interaction is lost
and replaced by a surgeon-instrument-tissue interaction, posing various disadvantages in terms of haptic
stimulation; moreover, the nature of laparoscopic instruments diminishes the quality of tactile feedback
sensed through surgeon’s hands.

Haptic feedback is defined as a force perceived by the surgeon that acts in the direction opposite to which
he or she applies traction. Tactile feedback is defined as a response which one experiences as touch and
is a part of haptic feedback. The ability of the skilled surgeon to mentally reconstruct and experience
tactile feedback provides a more accurate estimate of the amount of force required to apply onto human
tissue during a surgical procedure. Simulating these modes of feedback during mental training is thought
to reduce cerebral workload during a laparoscopic procedure, ultimately benefiting other aspects of the
surgery by efficiently allocating mental capacity. This lead to the hypothesis that mental trainings could
be implemented to improve mental reconstruction of haptic and tactile feedback in a surgical novice. This
may aid in training and help reduce the learning curve for laparoscopic surgery.

While studying mental haptic feedback reconstruction, it was estimated that dominant hands and non-
dominant hands play different roles and their influence on the task performance cannot be ignored. The
dominant hand has better precision and fine motor movements. Therefore, in a laparoscopic surgery, it
is traditionally used for manoeuvring instruments such as cutting hooks and needle holders. The non-
dominant hand is largely involved in retraction of tissue, often to expose an area underneath. Most
commonly, it is used to hold a tissue plane to assist in intracorporeal procedures such as laparoscopic
[1]
suturing .

This pilot study aims to study the effects of mental training on a specific psychomotor skill acquired after a
brief session of kinaesthetic learning.

METHODS
Mental training for skill acquisition was tested using a mixed-method design. Comparisons were made
between subjects who underwent mental rehearsal and those who did not. The evidence of skill acquisition
between the dominant and non-dominant hands was also studied.

Candidates
Twenty medical students with no prior laparoscopic experience were invited to participate in this study.
Candidates were randomised into two groups; mental training and control. Both groups had equal
proportions of left and right hand dominant, in addition to equal numbers of male and female participants.
Each received the same introduction but candidates were not informed of their group allocation until they
have done baseline assessment.

The studied group received a mental training for two minutes in the form of displayed instructions in
specific order [Figure 1].

The control group underwent a simple laparoscopic distraction exercise [Figure 2]. The distraction exercise
was designed to simulate realistic conditions in surgeons who do not conduct mental training. A laptop
attached to an external webcam was held by the observer which displayed the working space for the