Real-Time Measurement of the Tool-Tissue Interaction in Minimally Invasive Abdominal Surgery: The First Step to Developing the Next Generation of Smart Laparoscopic Instruments.
Introduction Analysis of force application in laparoscopic surgery is critical to understanding the nature of the tool-tissue interaction. The aim of this study is to provide real-time data about manipulations to abdominal organs. Methods An instrumented short fenestrated grasper was used in an in vivo porcine model, measuring force at the grasper handle. Grasping force and duration over 5 small bowel manipulation tasks were analyzed. Forces required to retract gallbladder, bladder, small bowel, large bowel, and rectum were measured over 30 seconds. Four parameters were calculated-T(hold), the grasp time; T(close), time taken for the jaws to close; F(max), maximum force reached; and F(rms), root mean square force (representing the average force across the grasp time). Results Mean F(max) to manipulate the small bowel was 20.5 N (±7.2) and F(rms) was 13.7 N (±5.4). Mean T(close) was 0.52 seconds (±0.26) and T(hold) was 3.87 seconds (±1.5). In individual organs, mean F(max) was 49 N (±15) to manipulate the rectum and 59 N (±13.4) for the colon. The mean F(max) for bladder and gallbladder retraction was 28.8 N (±7.4) and 50.7 N (±3.8), respectively. All organs exhibited force relaxation, the F(rms) reduced to below 25 N for all organs except the small bowel, with a mean F(rms) of less than 10 N. Conclusion This study has commenced the process of quantifying tool-tissue interaction. The static measurements discussed here should evolve to include dynamic measurements such as shear, torque, and retraction forces, and be correlated with evidence of histological damage to tissue.
University of Leeds, Leeds, UK.
Jenifer
J
Barrie
St. James's University Hospital, Leeds, UK d.g.jayne@leeds.ac.uk.
David G
DG
Jayne
University of Leeds, Leeds, UK.
Anne
A
Neville
University of Leeds, Leeds, UK.
Louise
L
Hunter
University of Leeds, Leeds, UK.
Adrian J
AJ
Hood
University of Leeds, Leeds, UK.
Peter R
PR
Culmer
D034841:Abdominal Cavity / Q000601:surgery*; D000818:Animals; D001698:Biomedical Engineering; D004867:Equipment Design; D004869:Equipment Safety; D006804:Ergonomics; D007431:Intraoperative Complications / Q000517:prevention & control*; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D023421:Models, Animal; D061646:Operative Time; D018570:Risk Assessment; D013525:Surgical Instruments; D013552:Swine
biomedical engineering; colorectal surgery; ergonomics and/or human factors study