Body wall force sensor for simulated minimally invasive surgery: Application to fetal surgery

Abstract

Abstract-Surgical interventions are increasingly executed minimal invasively. Surgeons insert instruments through tiny incisions in the body and pivot slender instruments to treat organs or tissue below the surface. While a blessing for patients, surgeons need to pay extra attention to overcome the fulcrum effect, reduced haptic feedback and deal with lost hand-eye coordination. The mental load might make it difficult to pay sufficient attention to the forces that are exerted on the body wall. In delicate procedures such as fetal surgery, this might be problematic as irreparable damage could cause premature delivery. As a first attempt to quantify the interaction forces applied on the patient's body wall, a novel 6 degrees of freedom force sensor was developed for an ex-vivo set up. The performance of the sensor was characterised. User experiments were conducted by 3 clinicians on a set up simulating a fetal surgical intervention. During these simulated interventions, the interaction forces were recorded and analysed when a normal instrument was employed. These results were compared with a session where a flexible instrument under haptic guidance was used. The conducted experiments resulted in interesting insights in the interaction forces and stresses that develop during such difficult surgical intervention. The results also implicated that haptic guidance schemes and the use of flexible instruments rather than rigid ones could have a significant impact on the stresses that occur at the body wall.

662 Tool-tissue Forces in Surgery: A Systematic Review

“…Generally, across tasks and models, specialities requiring the smallest amount of mean forces were: ophthalmology (mean of average 0.04N) [17][18][19]21,32], vascular (mean of average 0.07N) [29,40,50], neurosurgery (mean of average 0.68N) [1,2,4,14,22,23,25,28,33,37,44,52] and cardiothoracic surgery (mean of average 1.47N) [26,30,53]. Higher mean of average forces, in ascending order, were seen in general surgery (mean of average 4.67N) [3,5,20,26,27,35,38,[41][42][43]49,51,54], otorhinolaryngology (mean of average 8.49N) [36,46], obstetrics and gynaecology (mean of average 8.69N) [39,45], urology (mean of average 9.79N) [24] and orthopaedic surgery (mean of average 210N) [47,48].…”

“…Articles were published in medical (n = 26) [2][3][4]14,[21][22][23]25,27,29,35,36,43,[46][47][48][49]51,53] or engineering (n = 19) [1,5,17-20,24,26,28,30-34, 37-42,44,45,50,52,54,55] journals between 1999 and 2020 (Supplementary Information 3). Evidently, this is a new and expanding field, with more articles published in the last 5 years (n = 24) [2][3][4]14,17,19,22,23,25,26,28,[32][33][34][35]39,41,[45][46][47]50,[53][54][55] than the previous years combined (n = 21) [1,5,18,20,21,24,27,29-31,36-38,40,42-44, 48,49,51,52] (Supplementary Information 3).…”

“…Across specialities and manoeuvres, nervous tissue (principally the brain & retina) required the least amount of force to manipulate (mean of average 0.4N, mean max 1.74N, n = 17) [1,2,4,[17][18][19][21][22][23]25,28,32,33,37,44,52] with retinal forces always below 0.01N (Table 1) [17][18][19]21,32]. Mean forces applied on epithelial tissues were higher (mean of average 3.8N, mean max 9.7N, n = 18) [3,14,20,24,26,27,29,35,38,[40][41][42][43]45,50,51,54], followed by muscle (mean of average 4.1N, mean max 6.7N, n = 3) [5,49,51], and connective tissue including bone (mean of average 45.8N, mean max 347.9N, n = 10) [20,26,30,31,36,…”

A recent review and a taxonomy for hard and soft tissue visualization‐based mixed reality

“…Martinez‐Hernandez et al 16 used raw real‐time images and video captured by an iCub robot for the telesurgery. The researchers in References 1,14,15,18,51,and 52 used analyzed data like rendered images, demographics, surface models, and virtual objects. However, how these data could be achieved is not discussed in detail in any of the papers.…”

Leveraging the Fulcrum Point in Robotic Minimally Invasive Surgery

“…The aforementioned works build upon the assumption that the incision point exerts a pure force on the instrument. This ignores the fact that significant torques are applied on the body wall, just to be able to incline the instrument [21], even when the system is perfectly aligned. Force sensors are noisy and prone to drift.…”