title: Force sensing in natural orifice transluminal endoscopic surgery.
abstract: BACKGROUND
  Natural orifice transluminal endoscopic surgery (NOTES) may represent the next frontier for therapeutic minimally invasive surgery; however, its feasibility is currently limited by the lack of suitable instruments. Identifying the forces required to manipulate tissue during NOTES is a necessary first step in the development of better instrumentation.
  
  
  METHODS
  Sensorized instruments were used to measure the forces acting at the tip of the instruments during transgastric and transperineal NOTES procedures performed in two female pigs. The maximum and average forces when handling tissue were determined and compared.
  
  
  RESULTS
  The results show that, for the transgastric approach, the average forces required are significantly less than in the transperineal approach (43% less), and that the maximum forces required are almost 8 and 16 N in the transgastric and transperineal approaches, respectively. The forces were higher than 5 N in 1.6% of the measurements in the transgastric approach and 2.9% in the transperineal approach.
  
  
  CONCLUSIONS
  This study presents an experimental measurement of tissue manipulation forces in a NOTES procedure. This information may be valuable for research groups interested in developing NOTES instruments and devices. It is recommended that NOTES instruments be designed to easily handle forces as high as 16 N.
authors.affiliation: CSTAR, Lawson Health Research Institute, 339 Windermere Road, London, ON, N6A 5A5, Canada. analuisa.trejos@lhsc.on.ca
authors.forename: Ana Luisa
authors.initials: AL
authors.lastname: Trejos
authors.forename: Shiva
authors.initials: S
authors.lastname: Jayaraman
authors.forename: Rajni V
authors.initials: RV
authors.lastname: Patel
authors.forename: Michael D
authors.initials: MD
authors.lastname: Naish
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Schlachta
mesh_terms: D000818:Animals; D002138:Calibration; D004867:Equipment Design; D056228:Feedback, Sensory; D005260:Female; D020699:Gastroscopes; D006801:Humans; D057605:Natural Orifice Endoscopic Surgery / Q000295:instrumentation*; D010502:Perineum; D011312:Pressure; D013270:Stomach; D013314:Stress, Mechanical; D013525:Surgical Instruments; D034421:Sus scrofa; D013552:Swine; D014110:Touch