title: Artificial tactile feedback can significantly improve tissue examination through remote palpation.
abstract: BACKGROUND
  In laparoscopy, impaired feedback information from the operation site and reduced instrument dexterity lead to high demands on surgeons' skill and experience. Pre-clinical studies have shown that artificial tactile feedback (ATF) could significantly improve the quality of tactile feedback information. Additional information about interaction effects of tissue features when using ATF as well as related detection thresholds would be valuable for drawing conclusions on possible clinical application scenarios.
  
  
  OBJECTIVE
  To identify surgical procedures in laparoscopy that could benefit from ATF in tissue examination through remote palpation.
  
  
  METHODS
  We have developed a laparoscopic grasper capable of providing ATF by measuring the pressure distribution on one forceps jaw with a tactile sensor array. The data was presented graphically on the endoscopic screen. We conducted a study among surgeons and non-surgeons, comparing the capability to detect hidden objects through remote palpation with and without ATF. The data were analyzed using repeated-measures multiple analysis of variance (MANOVA) in two designs.
  
  
  RESULTS
  ATF could enhance feedback information with significant positive effects on accuracy, speed, the reduction of the number of grasps, and user confidence. The positive effect of ATF turned out to be especially strong if hidden objects were either hard and too small or large and too soft to be recognized by remote palpation without ATF.
  
  
  CONCLUSIONS
  Our study contributes to the discussion on promising application scenarios of ATF-enhanced instrumentation in laparoscopic surgery. Based on our study results, such instrumentation may be valuable for detection and examination of hidden bodies or structures through remote palpation.
authors.affiliation: novineon Healthcare Technology Partners GmbH, Dorfackerstr. 26, 72074, Tuebingen, Germany. sebastian.schostek@novineon.com
authors.forename: Sebastian
authors.initials: S
authors.lastname: Schostek
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Binser
authors.forename: Fabian
authors.initials: F
authors.lastname: Rieber
authors.forename: Chi-Nghia
authors.initials: CN
authors.lastname: Ho
authors.forename: Marc O
authors.initials: MO
authors.lastname: Schurr
authors.forename: Gerhard F
authors.initials: GF
authors.lastname: Buess
mesh_terms: D000704:Analysis of Variance; D004867:Equipment Design; D005246:Feedback; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D010173:Palpation / Q000295:instrumentation / Q000379:methods*; D014110:Touch