A Novel Device for Measuring Forces in Endoluminal Procedures

Abstract

In this paper a simple but effective measuring system for endoluminal procedures is presented. The device allows measuring forces during the endoluminal manipulation of tissues with a standard surgical instrument for laparoscopic procedures. The force measurement is performed by recording both the forces applied directly by the surgeon at the instrument handle and the reaction forces on the access port. The measuring system was used to measure the forces necessary for appropriate surgical manipulation of tissues during transanal endoscopic microsurgery (TEM). Ex-vivo and in-vivo measurements were performed, reported and discussed. The obtained data can be used for developing and appropriately dimensioning novel dedicated instrumentation for TEM procedures.Keywords Force measuring device for surgery, sensorized medical instrumentation, transanal endoscopic microsurgery (TEM), natural orifice translumenal endoscopic surgery (NOTES)

A Novel Telemanipulated Robotic Assistant for Surgical Endoscopy: Preclinical Application to ESD

“…Applicable forces practically appeared sufficient to grasp, lift and pull tissues and allowed the electrical instrument to safely dissect the mucosa and submucosa. Necessary forces evaluated in [24] (1 N) are slightly higher than the forces which can be applied by bending the instrument (0.9 N) (see Table I). However, in working conditions rotation and translation can help to provide higher forces.…”

“…It was observed that forces were mainly limited by the flexibility of the instrument's bendable tip, except for translation where the grasping force was the limiting factor. Ranzani et al [24] measured the necessary forces to lift and pull the mucosa in the scope of Transanal Endoscopic Microsurgery in the rectum. They obtained about 1 N for both directions.…”

Soft pop-up mechanisms for micro surgical tools: Design and characterization of compliant millimeter-scale articulated structures

“…The presented mechanisms demonstrated forces and dexterity that make them suitable candidates for designing novel micro surgical tools. Indeed, forces required in endoscopic procedures are typically below 1 N for endoluminal retraction tasks (tensioning the tissue for easing the cutting procedure) [9]. The possibility of easily scaling down the mechanisms makes the technology promising for procedures which are currently difficult to perform in a minimally invasive way, such as interventional bronchoscopy.…”

“…However, these solutions introduce technical challenges: proximal actuation requires cables along the endoscope, resulting in cable friction and backlash which can affect accuracy, controllability and thus intuitiveness of the system [3] [8]. Distal actuation approaches still lack viable technologies due to challenges for scalability and safety of the materials, currents and voltages needed [9]. A promising approach has been proposed by Webster et al where active cannulas are used in combination with conventional endoscopes for transurethral prostate surgery [10] and transoral lung surgery [11].…”

Deployable, Variable Stiffness, Cable Driven Robot for Minimally Invasive Surgery

“…In a study into the forces required to manipulate the gastric mucosa in a porcine model a maximum force of 2.26 N was required to stretch the mucosa, with the connective tissue to the stomach left intact, and a 1.13 N estimated mean force observed (Traeger et al, 2014 ). A separate study showed that <1.5 N was required for tissue manipulation in Transanal Endoscopic Microsurgery (TEM) (Ranzani et al, 2015 ). The robot should be able to exert forces above these values to meet the requirements of use in this application.…”