title: Force sensing in surgical sutures.
abstract: The tension in a suture is an important factor in the process of wound healing. If there is too much tension in the suture, the blood flow is restricted and necrosis can occur. If the tension is too low, the incision opens up and cannot heal properly. The purpose of this paper is to describe the design and evaluation of the Stitch Force (SF) sensor and the Hook-In Force (HIF) sensor. These sensors were developed to measure the force on a tensioned suture inside a closed incision and to measure the pulling force used to close the incision. The accuracy of both sensors is high enough to determine the relation between the force in the thread of a stitch and the pulling force applied on the suture by the physician. In a pilot study, a continuous suture of 7 stitches was applied on the fascia of the abdominal wall of multiple pigs to study this relationship. The results show that the max force in the thread of the second stitch drops from 3 (SD 1.2) to 1 (SD 0.3) newton after the 4(th) stitch was placed. During placement of the 5(th), 6(th) and 7(th) stitch, the force in the 2(nd) stitch was not influenced anymore. This study indicates that in a continuous suture the force in the thread remains constant up to more than 3 stiches away from the pulled loose end of the suture. When a force feedback tool is developed specially for suturing in surgery on patients, the proposed sensors can be used to determine safety threshold for different types of tissue and sutures.
authors.affiliation: Department of Biomechanical Engineering, Technical University Delft, Delft, The Netherlands.
authors.forename: Tim
authors.initials: T
authors.lastname: Horeman
authors.affiliation: Department of Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Evert-Jan
authors.initials: EJ
authors.lastname: Meijer
authors.affiliation: Department of Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Joris J
authors.initials: JJ
authors.lastname: Harlaar
authors.affiliation: Department of Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Johan F
authors.initials: JF
authors.lastname: Lange
authors.affiliation: Department of Biomechanical Engineering, Technical University Delft, Delft, The Netherlands.
authors.forename: John J
authors.initials: JJ
authors.lastname: van den Dobbelsteen
authors.affiliation: Department of Biomechanical Engineering, Technical University Delft, Delft, The Netherlands.
authors.forename: Jenny
authors.initials: J
authors.lastname: Dankelman
mesh_terms: D034861:Abdominal Wall / Q000601:surgery; D000818:Animals; D004867:Equipment Design; D012984:Software; D013314:Stress, Mechanical; D013536:Suture Techniques / Q000295:instrumentation* / Q000592:standards / Q000706:statistics & numerical data; D013537:Sutures / Q000592:standards*; D013552:Swine; D014945:Wound Healing / Q000502:physiology*