Motor learning with force feedback instruments among laparoscopic surgeons and residents

Robotic-assisted surgery (RAS) enhances precision and ergonomics but lacks haptic feedback, limiting surgeons' ability to regulate force and develop efficient sensorimotor control. This study evaluated whether force feedback improves motor learning underlying robotic control among robotically naïve surgeons. Twenty-eight robot-naïve participants (14 residents, 14 laparoscopic surgeons) completed four simulated surgical tasks with ex-vivo porcine models on the da Vinci 5 system. Participants were assigned to Force Feedback (FFB) or non-Force Feedback (NOF) groups and completed repeated trials. Outcomes included applied force, technical performance, system control, cognitive workload, gaze, and operational time. FFB significantly reduced applied force across tasks over time by 24% (2.6 N vs. 3.4 N, p = .002) with greater reductions during force-sensitive tasks and among experienced surgeons. Participants using FFB demonstrated greater improvements in robotic control (GEARS; p = .037) with significant gains over time (p < .001), whereas NOF showed minimal change. Residents with NOF exhibited higher clutch frequency compared to FFB (p = .001), indicating less efficient system control over time. FFB reduced cognitive load based on smaller pupil diameter (3.7 mm vs. 4.1 mm, p = .021). Task efficiency improved with FFB (- 130 s, p = .030) without evidence of a speed-accuracy tradeoff. Gaze analyses indicated that brief fixation on force feedback displays was associated with lower applied force (p = .001). Findings suggest that Force Feedback instruments accelerate early skill acquisition as part of the learning curve associated with robotic control among surgeons with no prior robotic experience. Further research is needed to determine whether, how, and why the behavioral advantages observed with FFB translate to meaningful improvements in surgical performance and patient outcomes.