Multimodal Robot-Assisted Instrument Interaction for Solo Laparoscopic Sacrocolpopexy

Abstract

Laparoscopic sacrocolpopexy (LSC) involves at least three clinicians who are required to operate under non-ergonomic postures for long periods of time. Furthermore, LSC is characterized by miscommunication and high vaginal vault manipulation forces which possibly lead to overtensioning of tissue.This work presents a multimodal robotic assistance approach for solo LSC. Multimodality provides a set of instrument interaction modes that allows the surgeon to operate in close vicinity with the patient. It increases situational awareness and avoids miscommunication while ensuring safe vaginal vault exposure.The robotic setup is experimentally validated by ten gynecologists who performed a vaginal mesh fixation task on a box trainer. When compared to manual surgery, it was found that robotic assistance allows the solo surgeon to operate as fast (24.07 ± 1.63 min vs. 23.75 ± 1.54 min, p = 0.49) and with lower peak forces (12.23 ± 3.03 N vs. 9.26 ± 1.41 N, p = 0.02) applied to the vaginal vault.The results are promising as they show that the multimodal approach allows for robot-assisted solo surgery. This way, it frees clinicians from non-ergonomic tasks while maintaining similar surgery times and quality. Moreover, it reduces the risk of overtensioning of the vaginal tissue.