Suture Breakage Warning System for Robotic Surgery

Abiri, Ahmad; Askari, Syed J.; Tao, Anna; Juo, Yen-Yi; Dai, Yongheng; Pensa, Jake; Candler, Robert N.; Dutson, Erik; Grundfest, Warren S.

doi:10.1109/tbme.2018.2869417

Cited by 29 publications

(20 citation statements)

References 48 publications

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“…Our prior studies used 4 trials per subjects (Abiri et al 2018), while in this study each subject performed 10 trials. In order to investigate the potential for improvement through training as compared to our prior studies, we consider the first 4 trials for each subject as an initial training, or break-in, period.…”

Section: Resultsmentioning

confidence: 99%

“…The vibratory feedback system, described in greater detail in prior publication (Abiri et al 2018), was setup to provide two levels of vibratory feedback of increasing intensity. These vibrotactile feedback levels were attained by controlling the input voltage to an Eccentric Rotating Mass (ERM) vibration motor.…”

Section: Methods and Proceduresmentioning

confidence: 99%

“…In prior work, our group designed and validated a vibrotactile feedback system using an uniaxial commercial piezoresistive sensor (Abiri et al 2018). A limitation of the uniaxial system is that the surgeon rarely pulls the suture in only one direction.…”

Section: Introductionmentioning

confidence: 99%

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Biaxial sensing suture breakage warning system for robotic surgery

Dai

Abiri²,

Pensa

et al. 2019

Biomed Microdevices

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The number of procedures performed with robotic surgery may exceed one million globally in 2018. The continual lack of haptic feedback, however, forces surgeons to rely on visual cues in order to avoid breaking sutures due to excessive applied force. To mitigate this problem, the authors developed and validated a novel grasper-integrated system with biaxial shear sensing and haptic feedback to warn the operator prior to anticipated suture breakage. Furthermore, the design enables facile suture manipulation without a degradation in efficacy, as determined via measured tightness of resulting suture knots. Biaxial shear sensors were integrated with a da Vinci robotic surgical system. Novice subjects (n =17) were instructed to tighten 10 knots, five times with the Haptic Feedback System (HFS) enabled, five times with the system disabled. Seven suture failures occurred in trials with HFS enabled while seventeen occurred in trials without feedback. The biaxial shear sensing system reduced the incidence of suture failure by 59% (p = 0.0371). It also resulted in 25% lower average applied force in comparison to trials without feedback (p = 0.00034), which is relevant because average force was observed to play a role in suture breakage (p = 0.03925). An observed 55% decrease in standard deviation of knot quality when using the HFS also indicates an improvement in consistency when using the feedback system. These results suggest this system may improve outcomes related to knot tying tasks in robotic surgery and reduce instances of suture failure while not degrading the quality of knots produced.

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Section: Resultsmentioning

confidence: 99%

Section: Methods and Proceduresmentioning

confidence: 99%

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Biaxial sensing suture breakage warning system for robotic surgery

Dai

Abiri²,

Pensa

et al. 2019

Biomed Microdevices

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“…As a result, our deep learning network can estimate the tensile force of sutures in soft objects under the conditions shown from untrained views. In previous studies, a force sensor was used to measure the interaction forces [ 8 , 9 , 10 , 11 ]; however, such methods suffer from numerous constraints such as cost, biocompatibility, sterilization, and miniaturization. Moreover, in previous studies using available information from models of the surgical tool and motor devices [ 13 , 14 ], the parameter values of the surgical tool need to be accurately known, and a precise accurate estimation is difficult because the motor is placed behind a trocar.…”

Section: Discussionmentioning

confidence: 99%

“…In direct force sensing, the force is measured at or near the point where the surgical tool and organs interact. Abiri et al [ 8 ] developed a device using a piezoresistive sensor that can be attached to the tip of a surgical tool. In addition, Reiley et al [ 9 ] used a strain gauge attached along the shaft of a surgical tool to measure the interaction force.…”

Section: Introductionmentioning

confidence: 99%

Vision-Based Suture Tensile Force Estimation in Robotic Surgery

Jung

Kwak

Lim

2020

Sensors

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Compared to laparoscopy, robotics-assisted minimally invasive surgery has the problem of an absence of force feedback, which is important to prevent a breakage of the suture. To overcome this problem, surgeons infer the suture force from their proprioception and 2D image by comparing them to the training experience. Based on this idea, a deep-learning-based method using a single image and robot position to estimate the tensile force of the sutures without a force sensor is proposed. A neural network structure with a modified Inception Resnet-V2 and Long Short Term Memory (LSTM) networks is used to estimate the suture pulling force. The feasibility of proposed network is verified using the generated DB, recording the interaction under the condition of two different artificial skins and two different situations (in vivo and in vitro) at 13 viewing angles of the images by changing the tool positions collected from the master-slave robotic system. From the evaluation conducted to show the feasibility of the interaction force estimation, the proposed learning models successfully estimated the tensile force at 10 unseen viewing angles during training.

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The effect of Xylocaine spray on suture material degradation

Jannati,

Sørensen,

Gommesen

et al. 2024

Intl J Gynecology & Obste

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ObjectivesTo compare the tensile strength of fast absorbable Polyglactin 910 suture material when impregnated with various agents for local anesthesia and to investigate whether the presence of ethanol in Xylocaine spray could explain a potential reduction in tensile strength after use of Xylocaine spray.MethodsIn all, 120 suture samples of Polyglactin 910 were divided into four groups of 30. These four groups were randomly impregnated with isotonic sodium chloride, isotonic sodium chloride plus Xylocaine spray, isotonic sodium chloride plus Xylocaine gel, or isotonic sodium chloride plus ethanol. After impregnation, the sutures were stored in sealed glass tubes in a heating cabinet at 37°C for 72 h. Thereafter, the tensile strength of these 120 samples was assessed by a universal tensile testing machine. The maximal force needed to break the suture material was recorded in newtons (N).ResultsFast absorbable Polyglactin 910 suture material impregnated with Xylocaine spray or ethanol showed weakened tensile strength (mean values 11.40 and 11.86 N, respectively), whereas the specimens impregnated with Xylocaine gel or sodium chloride retained their tensile strength better (mean values 13.81 and 13.28 N, respectively; mean difference between Xylocaine gel and Xylocaine spray −2.41 N, P < 0.001).ConclusionIn this in vitro experiment, ethanol and Xylocaine spray weakened the tensile strength of fast absorbable Polyglactin 910 sutures. Use of Xylocaine spray, which contains ethanol, for local anesthesia might lead to early breakdown of the suture material and wound rupture. The authors suggest caution when using Xylocaine spray in combination with fast absorbable Polyglactin 910 suture.

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Suture Breakage Warning System for Robotic Surgery

Cited by 29 publications

References 48 publications

Biaxial sensing suture breakage warning system for robotic surgery

Biaxial sensing suture breakage warning system for robotic surgery

Vision-Based Suture Tensile Force Estimation in Robotic Surgery

The effect of Xylocaine spray on suture material degradation

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