BackgroundRobotic 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.Materials and methodsNine 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.ResultsIn 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.ConclusionThe 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.

The tactile mechanoreceptor is an effective tool for detection of impalpable pulmonary lesions during thoracoscopy.

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Background and Aims Small gastric or colorectal tumours can be visually undetectable during laparoscopic surgeries, and available methods still do not provide a 100% localisation rate. Thus, new methods for further improvements in tumour localisation are highly desirable. In this study, we evaluated the usage of the Medical Tactile Endosurgical Complex (MTEC) in gastrointestinal surgery for localisation of tumours. The MTEC provides the possibility of instrumental mechanoreceptoric palpation, which serves as an analogue of conventional manual palpation. Methods Ninety-six elective surgeries were performed, including 48 open surgeries, 43 laparoscopies, and 5 robot-assisted surgeries. The 20 mm version of the MTEC tactile mechanoreceptor was used in open surgeries, and the 10 mm version in laparoscopic and robot-assisted surgeries. Results The mean time of instrumental mechanoreceptoric palpation was 3 minutes 12 seconds for open surgeries, which constituted the early stage of the learning curve, and 3 minutes 34 seconds for laparoscopic surgeries. No side effects or postoperative complications related to instrumental mechanoreceptoric palpation were observed, and this procedure provided data sufficient for tumour localisation in more than 95% of cases. Conclusion Instrumental mechanoreceptoric palpation performed using MTEC is a simple, safe, and reliable method for tumour localisation in gastrointestinal laparoscopic surgery.

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Relevance. In our country, as part of the digitalization of healthcare, a number of organizational decisions have been made and are being implemented to optimize the medical evacuation of the sick and injured in emergency situations. The digital transformation of healthcare in order to address the issues of treatment correction, patient transportability and the feasibility of medical evacuation to the greatest degree is realized so far only in the form of telemedicine consultations. At the same time, the latest developments can already be applied, allowing the use of advanced information technologies, including artificial intelligence technologies, for each sick or injured during medical evacuation in the prehospital and hospital periods in the event of emergency response and during everyday work. One of such developments could be the creation of a portable isolated robotic medical module.Intention: To justify the concept of a portable, isolated robotic medical module for the medical evacuation of the sick and injured using advanced medical digital technologies.Methodology. Based on an analysis of the advanced medical equipment, medical materials, digital medical technologies, many years of comprehensive in-house experience in medical evacuation, an information and patent search was conducted for conceptual solutions to create a portable isolated robotic medical module (Module) for medical evacuation of the sick and injured in the daily life and emergency situations.Results and Discussion. A key solution to the problem is to implement the following original ideas. Firstly, it is the “block” principle of layout of the Module structure. In the first (upper) block, robotic diagnostic and medical equipment, control systems and telemetry communications are installed. If you need to work offline, the unit is protected from external influences. The second (middle) block is designed to accommodate a patient who receives medical care. The unit can be completely isolated from the external environment, a comfortable internal environment is created and elements of a video communication system are placed. The third (lower) block contains systems for patient’s life support and autonomic operation, and can be delivered on board the vehicle separately from the first and second blocks. The mass of the third block is not critical for the mass of theModule as a whole. Secondly, there is an idea of using special removable and replaceable shells to isolate the Module from adverse weather conditions. It is possible to use a removable cover made of protective materials. For the conditions of the Far North, these are heat-conserving materials, for the conditions of armed conflict - para-aramid fiber (Kevlar). Thirdly, ergonomic location of medical equipment above the patient provides convenient maintenance of equipment for medical manipulations. In this case, observation and treatment are not interrupted when moving the patient from one vehicle to another.Conclusion. Advanced digital medical technologies in the medical evacuation of the sick and injured within the concept of a portable, isolated, robotic medical module can significantly reduce risks and apply a patient-oriented approach during the medical evacuation of each patient. This makes a significant contribution to the development of medical evacuation and practical medicine.