The Role of Direct and Visual Force Feedback in Suturing Using a 7-DOF Dual-Arm Teleoperated System

Abstract

The lack of haptic feedback in robotics-assisted surgery can result in tissue damage or accidental tool-tissue hits. This paper focuses on exploring the effect of haptic feedback via direct force reflection and visual presentation of force magnitudes on performance during suturing in robotics-assisted minimally invasive surgery (RAMIS). For this purpose, a haptics-enabled dual-arm master-slave teleoperation system capable of measuring tool-tissue interaction forces in all seven Degrees-of-Freedom (DOFs) was used. Two suturing tasks, tissue puncturing and knot-tightening, were chosen to assess user skills when suturing on phantom tissue. Sixteen subjects participated in the trials and their performance was evaluated from various points of view: force consistency, number of accidental hits with tissue, amount of tissue damage, quality of the suture knot, and the time required to accomplish the task. According to the results, visual force feedback was not very useful during the tissue puncturing task as different users needed different amounts of force depending on the penetration of the needle into the tissue. Direct force feedback, however, was more useful for this task to apply less force and to minimize the amount of damage to the tissue. Statistical results also reveal that both visual and direct force feedback were required for effective knot tightening: direct force feedback could reduce the number of accidental hits with the tissue and also the amount of tissue damage, while visual force feedback could help to securely tighten the suture knots and maintain force consistency among different trials/users. These results provide evidence of the importance of 7-DOF force reflection when performing complex tasks in a RAMIS setting.

Surgeon-Centered Analysis of Robot-Assisted Needle Driving Under Different Force Feedback Conditions

“…Results were inconclusive and were task dependent. We expected to find statistically significant differences between the three force feedback conditions, and more specifically, we expected to find worse performance at the end of teleoperation without force feedback compared to the other two force feedback conditions, as in Talasaz et al (2017), Currie et al (2017), and Gwilliam et al (2009), and applied forces in Okamura and Verner (2009) and Santos-Carreras et al (2010). Surprisingly, we did not see such differences for all the contrasts and metrics except one, consistently with task completion time in Verner and Okamura (2007), Santos-Carreras et al (2010), and task error in Okamura and Verner (2009).…”

“…Up to performing this research, several studies compared conditions with force feedback (usually one algorithm of force feedback) to no force feedback condition, and usually added another condition with the force feedback as visual information (Tholey et al, 2005;Arata et al, 2008;Gwilliam et al, 2009;Santos-Carreras et al, 2010;Talasaz et al, 2017). Results were inconclusive and were task dependent.…”

“…The benefit of haptic feedback to surgery is not yet fully understood (Okamura and Verner, 2009;Gibo et al, 2014;Yang et al, 2015;Talasaz et al, 2017). In a meta-analysis on the effect of force feedback, Weber and Schneider (2014) found that haptic feedback reduces the amount of force applied, but the reduction is smaller when depth perception is available.…”

Haptic feedback in the da Vinci Research Kit (dVRK): A user study based on grasping, palpation, and incision tasks

“…Hence, some future developments could also focus on reflecting the mechanical actions directly to the native dVRK masters, thus extending task space to bimanual procedures (yet renouncing to active feedback in grasping, since the related DoF is not active). However, for relevant tasks like knot tying, for which robotic surgeons struggle to detect the proper force intensity they are applying on the suture thread, the trade‐off between bimanual operation and active grasping seems not to be trivial. In parallel, more extensive investigations on grasping with enhanced master devices like the sigma.7 would permit to understand the potential benefits of force feedback over a wider range of tasks, including the aforementioned retraction maneuvers.…”

“…After several years during which the lack of haptic feedback was considered a limitation for the dV, 9 the mainstream opinion has become that robotic surgeons (necessarily trained on the dV) can compensate by using visual feedback, so that they do not suffer from that shortage. 10 On the other hand, many research studies claimed clear benefits from haptic feedback restoration for clinical applications/tasks requiring mechanical contrast perception for tissue discrimination (intraoperative palpation [11][12][13][14][15] ), precise tool-tissue interaction force rendering (incision/ dissection, 3,[16][17][18][19] catheter steering, 20 needle driving/suturing [21][22][23][24][25] ), or tissue/organ safe manipulation (tissue clutching, organ retraction 26,27 ).…”