Instrumental tactile diagnostics in robot-assisted surgery.
BACKGROUND
Robotic surgery has gained wide acceptance due to minimizing trauma in patients. However, the lack of tactile feedback is an essential limiting factor for the further expansion. In robotic surgery, feedback related to touch is currently kinesthetic, and it is mainly aimed at the minimization of force applied to tissues and organs. Design and implementation of diagnostic tactile feedback is still an open problem. We hypothesized that a sufficient tactile feedback in robot-assisted surgery can be provided by utilization of Medical Tactile Endosurgical Complex (MTEC), which is a novel specialized tool that is already commercially available in the Russian Federation. MTEC allows registration of tactile images by a mechanoreceptor, real-time visualization of these images, and reproduction of images via a tactile display.


METHODS
Nine elective surgeries were performed with da Vinci™ robotic system. An assistant performed tactile examination through an additional port under the guidance of a surgeon during revision of tissues. The operating surgeon sensed registered tactile data using a tactile display, and the assistant inspected the visualization of tactile data. First, surgeries where lesion boundaries were visually detectable were performed. The goal was to promote cooperation between the surgeon and the assistant and to train them in perception of the tactile feedback. Then, instrumental tactile diagnostics was utilized in case of visually undetectable boundaries.


RESULTS
In robot-assisted surgeries where lesion boundaries were not visually detectable, instrumental tactile diagnostics performed using MTEC provided valid identification and localization of lesions. The results of instrumental tactile diagnostics were concordant with the results of intraoperative ultrasound examination. However, in certain cases, for example, thoracoscopy, ultrasound examination is inapplicable, while MTEC-based tactile diagnostics can be efficiently utilized.


CONCLUSIONS
The study proved that MTEC can be efficiently used in robot-assisted surgery allowing correct localization of visually undetectable lesions and visually undetectable boundaries of pathological changes of tissues.
Faculty of Mechanics and Mathematics; Institute of Mathematical Studies of Complex Systems, Lomonosov Moscow State University.
Rozalia F
RF
Solodova
Faculty of Mechanics and Mathematics; Institute of Mathematical Studies of Complex Systems, Lomonosov Moscow State University.
Vladimir V
VV
Galatenko
1st Surgery Department, Clinical Hospital 31, Moscow, Russia.
Eldar R
ER
Nakashidze
1st Surgery Department, Clinical Hospital 31, Moscow, Russia.
Igor L
IL
Andreytsev
Faculty of Mechanics and Mathematics.
Alexey V
AV
Galatenko
Institute of Mathematical Studies of Complex Systems, Lomonosov Moscow State University.
Dmitriy K
DK
Senchik
Faculty of Mechanics and Mathematics.
Vladimir M
VM
Staroverov
Faculty of Mechanics and Mathematics; Institute of Mathematical Studies of Complex Systems, Lomonosov Moscow State University.
Vladimir E
VE
Podolskii
Faculty of Mechanics and Mathematics; Institute of Mathematical Studies of Complex Systems, Lomonosov Moscow State University.
Mikhail E
ME
Sokolov
Faculty of Mechanics and Mathematics; Institute of Mathematical Studies of Complex Systems, Lomonosov Moscow State University.
Victor A
VA
Sadovnichy
Medical Tactile Endosurgical Complex; instrumental palpation; tactile feedback; tactile lesion localization