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von Bechtolsheim F, Bielert F, Schmidt S, Buck N, Bodenstedt S, Speidel S, Lüneburg LM, Müller T, Fan Y, Bobbe T, Oppici L, Krzywinski J, Dobroschke J, Weitz J, Distler M, Oehme F. Can you feel the force just right? Tactile force feedback for training of minimally invasive surgery-evaluation of vibration feedback for adequate force application. Surg Endosc 2024; 38:3917-3928. [PMID: 38834723 PMCID: PMC11219423 DOI: 10.1007/s00464-024-10919-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 05/05/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Tissue handling is a crucial skill for surgeons and is challenging to learn. The aim of this study was to develop laparoscopic instruments with different integrated tactile vibration feedback by varying different tactile modalities and assess its effect on tissue handling skills. METHODS Standard laparoscopic instruments were equipped with a vibration effector, which was controlled by a microcomputer attached to a force sensor platform. One of three different vibration feedbacks (F1: double vibration > 2 N; F2: increasing vibration relative to force; F3: one vibration > 1.5 N and double vibration > 2 N) was applied to the instruments. In this multicenter crossover trial, surgical novices and expert surgeons performed two laparoscopic tasks (Peg transfer, laparoscopic suture, and knot) each with all the three vibration feedback modalities and once without any feedback, in a randomized order. The primary endpoint was force exertion. RESULTS A total of 57 subjects (15 surgeons, 42 surgical novices) were included in the trial. In the Peg transfer task, there were no differences between the tactile feedback modalities in terms of force application. However, in subgroup analysis, the use of F2 resulted in a significantly lower mean-force application (p-value = 0.02) among the student group. In the laparoscopic suture and knot task, all participants exerted significantly lower mean and peak forces using F2 (p-value < 0.01). These findings remained significant after subgroup analysis for both, the student and surgeon groups individually. The condition without tactile feedback led to the highest mean and peak force exertion compared to the three other feedback modalities. CONCLUSION Continuous tactile vibration feedback decreases the mean and peak force applied during laparoscopic training tasks. This effect is more pronounced in demanding tasks such as laparoscopic suturing and knot tying and might be more beneficial for students. Laparoscopic tasks without feedback lead to increased force application.
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Affiliation(s)
- Felix von Bechtolsheim
- Department of Visceral, Thoracic, and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany.
- Centre for Tactile Internet With Human-in-the-Loop (CeTI), Technische Universität Dresden, Dresden, Germany.
| | - Florian Bielert
- Department of Visceral, Thoracic, and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany
| | - Sofia Schmidt
- Department of Visceral, Thoracic, and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany
| | - Nathalie Buck
- Department of Visceral, Thoracic, and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany
| | - Sebastian Bodenstedt
- Division of Translational Surgical Oncology, National Center for Tumor Diseases Dresden, Dresden, Germany
- Centre for Tactile Internet With Human-in-the-Loop (CeTI), Technische Universität Dresden, Dresden, Germany
| | - Stefanie Speidel
- Division of Translational Surgical Oncology, National Center for Tumor Diseases Dresden, Dresden, Germany
- Centre for Tactile Internet With Human-in-the-Loop (CeTI), Technische Universität Dresden, Dresden, Germany
| | - Lisa-Marie Lüneburg
- Industrial Design Engineering, Technische Universität Dresden, Dresden, Germany
- Centre for Tactile Internet With Human-in-the-Loop (CeTI), Technische Universität Dresden, Dresden, Germany
| | - Thomas Müller
- Industrial Design Engineering, Technische Universität Dresden, Dresden, Germany
- Centre for Tactile Internet With Human-in-the-Loop (CeTI), Technische Universität Dresden, Dresden, Germany
| | - Yichen Fan
- Industrial Design Engineering, Technische Universität Dresden, Dresden, Germany
- Centre for Tactile Internet With Human-in-the-Loop (CeTI), Technische Universität Dresden, Dresden, Germany
| | - Tina Bobbe
- Industrial Design Engineering, Technische Universität Dresden, Dresden, Germany
- Centre for Tactile Internet With Human-in-the-Loop (CeTI), Technische Universität Dresden, Dresden, Germany
| | - Luca Oppici
- Department of Teacher Education and Outdoor Studies, Norwegian School of Sport Sciences, Oslo, Norway
| | - Jens Krzywinski
- Industrial Design Engineering, Technische Universität Dresden, Dresden, Germany
- Centre for Tactile Internet With Human-in-the-Loop (CeTI), Technische Universität Dresden, Dresden, Germany
| | - Jakob Dobroschke
- Department of General, Visceral and Thoracic Surgery, Proctology, Helios Klinikum Pirna, Pirna, Germany
| | - Jürgen Weitz
- Department of Visceral, Thoracic, and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany
- Centre for Tactile Internet With Human-in-the-Loop (CeTI), Technische Universität Dresden, Dresden, Germany
| | - Marius Distler
- Department of Visceral, Thoracic, and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany
- Centre for Tactile Internet With Human-in-the-Loop (CeTI), Technische Universität Dresden, Dresden, Germany
| | - Florian Oehme
- Department of Visceral, Thoracic, and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany
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Cesari V, Melfi F, Gemignani A, Menicucci D. Sensory substitution increases robotic surgical performance and sets the ground for a mediating role of the sense of embodiment: a systematic review. Heliyon 2023; 9:e21665. [PMID: 38027699 PMCID: PMC10656242 DOI: 10.1016/j.heliyon.2023.e21665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 09/17/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Sensory Substitution (SS) allows the elaboration of information via non preferential sensory modalities. This phenomenon occurs in robotic-assisted surgery (RAS), in which haptic feedback is lacking. It has been suggested that SS could sustain surgeons' proficiency by means of visual clues for inferring tactile information, that also promotes the feeling of haptic phantom sensations. A critical role in reaching a good performance in procedural tasks is also sustained by the Sense of Embodiment (SE), that is, the capacity to integrate objects into subjective bodily self-representation. As SE is enhanced by haptic sensations, we hypothesize a role of SS in promoting SE in RAS. Accordingly, the goal of this systematic review is to summarize the evidence pertaining the study of SS in RAS in order to highlight the impact on the performance, and to identify a mediating role of the SE in increasing dexterity in RAS. Eight studies selected from the MEDLINE and Scopus® databases met inclusion criteria for a qualitative synthesis. Results indicated that haptic to other modalities SS enhanced force consistency and accuracy, and decreased surgeon fatigue. Expert surgeons, as compared to novices, showed a better natural SS processing, testified by a proficient performance with and without SS aids. No studies investigated the mediating role of SE. These findings indicate that SS is subjected to learning and memory processes that help surgeons to rapidly derive haptic-correlates from visual clues, which are highly required for a good performance. Also, the higher ability of doing SS and the associated perception of haptic sensations might increase multisensory integration, which might sustain performance.
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Affiliation(s)
- Valentina Cesari
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, via Savi, 10, 56126, Pisa, Italy
| | - Franca Melfi
- Robotic Multispecialty Center for Surgery Robotic, Minimally Invasive Thoracic Surgery, University of Pisa, 56124 Pisa, Italy
| | - Angelo Gemignani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, via Savi, 10, 56126, Pisa, Italy
| | - Danilo Menicucci
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, via Savi, 10, 56126, Pisa, Italy
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3
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Green CA, Lin J, Higgins R, O'Sullivan PS, Huang E. Expertise in perception during robotic surgery (ExPeRtS): What we see and what we say. Am J Surg 2022; 224:908-913. [DOI: 10.1016/j.amjsurg.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 03/23/2022] [Accepted: 05/06/2022] [Indexed: 11/01/2022]
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Voskens FJ, van der Schans EM, Ruurda JP, Broeders IAMJ. Endoscopic surgery suturing techniques: a randomized study on learning. BMC Surg 2022; 22:59. [PMID: 35172810 PMCID: PMC8851769 DOI: 10.1186/s12893-022-01513-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 02/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Surgeons have widely adopted endoscopic suturing techniques using conventional laparoscopic instruments and the more advanced robotic systems. The FlexDex is a novel articulating laparoscopic needle driver providing enhanced dexterity in laparoscopic surgery. This study evaluates and compares the learning curve of endoscopic suturing with conventional laparoscopy, the FlexDex and robotic suturing in novices. METHODS Participants performed a minimal invasive suturing task in three different ways in a randomized order: with a conventional laparoscopic needle driver, using the FlexDex needle driver and third, using the Da Vinci Si surgical system. Primary outcome was suturing task time. Secondary outcome parameters were assessment of suturing quality and workload perception. RESULTS A total of 10 novice participants were included and completed a total of 300 sessions. Median (IQR) suturing time of the first 5 sessions was 231 s (188-291) in the laparoscopic group versus 378 s (282-471) in the FlexDex group versus 189 s (160-247) in the DaVinci Si group. The last 5 sessions showed significant reduction of median suturing time of 143 s (120-190), 232 s (180-265) and 172 s (134-199) respectively. Analysis identified that the learning curve for the laparoscopic needle driver and Da Vinci Si was reached in 5 sessions, compared to 8 sessions for the Flexdex. The laparoscopic needle driver and Da Vinci Si showed a significant shorter median suturing time compared to the FlexDex (p = 0.00). The FlexDex quality assessment scores were significantly lower compared to the laparoscopic (p = 0.00) and robotic (p = 0.00) scores and perceived workload remains high for the FlexDex users. CONCLUSIONS Ex vivo endoscopic suturing with the FlexDex demonstrated a prolonged learning curve compared to laparoscopic and robotic suturing. The learning curve of the FlexDex is fundamentally different from conventional laparoscopic and robotic instruments. This study provides further insights in the implementation and training of endoscopic suturing techniques.
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Affiliation(s)
- F J Voskens
- Department of Surgery, Meander Medical Center, Maatweg 3, Amersfoort, The Netherlands. .,University of Twente, Robotics and Mechatronics, Enschede, The Netherlands.
| | - E M van der Schans
- Department of Surgery, Meander Medical Center, Maatweg 3, Amersfoort, The Netherlands.,University of Twente, Robotics and Mechatronics, Enschede, The Netherlands
| | - J P Ruurda
- Department of Gastro-Intestinal and Oncologic Surgery, University Medical Center, Utrecht, The Netherlands
| | - I A M J Broeders
- Department of Surgery, Meander Medical Center, Maatweg 3, Amersfoort, The Netherlands.,University of Twente, Robotics and Mechatronics, Enschede, The Netherlands
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Belotto M, Coutinho L, Pacheco-Jr AM, Mitre AI, Fonseca EAD. INFLUENCE OF MINIMALLY INVASIVE LAPAROSCOPIC EXPERIENCE SKILLS ON ROBOTIC SURGERY DEXTERITY. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2022; 34:e1604. [PMID: 35019119 PMCID: PMC8735341 DOI: 10.1590/0102-672020210003e1604] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 02/04/2021] [Indexed: 12/02/2022]
Abstract
Background:
It is unclear if there is a natural transition from laparoscopic to robotic surgery with transfer of abilities.
Aim: To measure the performance and learning of basic robotic tasks in a simulator of individuals with different surgical background.
Methods:
Three groups were tested for robotic dexterity: a) experts in laparoscopic surgery (n=6); b) experts in open surgery (n=6); and c) non-medical subjects (n=4). All individuals were aged between 40-50 years. Five repetitions of four different simulated tasks were performed: spatial vision, bimanual coordination, hand-foot-eye coordination and motor skill.
Results:
Experts in laparoscopic surgery performed similar to non-medical individuals and better than experts in open surgery in three out of four tasks. All groups improved performance with repetition.
Conclusion:
Experts in laparoscopic surgery performed better than other groups but almost equally to non-medical individuals. Experts in open surgery had worst results. All groups improved performance with repetition.
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Affiliation(s)
- Marcos Belotto
- Department of Surgery, Pancreas Division, Santa Casa de São Paulo, São Paulo, SP, Brazil.,Sirio-Libanes Hospital, São Paulo, Brazil
| | | | - Adhemar M Pacheco-Jr
- Department of Surgery, Pancreas Division, Santa Casa de São Paulo, São Paulo, SP, Brazil
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6
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Green CA, Chern H, Rogers SJ, Reilly LM, O’Sullivan P. Transforming Surgical Education through a Resident Robotic Curriculum. ANNALS OF SURGERY OPEN 2021; 2:e076. [PMID: 37635816 PMCID: PMC10455299 DOI: 10.1097/as9.0000000000000076] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/07/2021] [Indexed: 11/26/2022] Open
Abstract
Objective Here, we describe a systematic approach to design, implement, and assess a robotic surgery curriculum for surgical residents. By describing our process, including identifying and addressing institutional challenges, we illustrate successful development of a robust curriculum. Summary Background Data As robotic-assisted surgeries increase, educational challenges have emerged and illustrate an alarming impact on medical training. Robotic curricula are frequently grounded in the industry's educational materials resulting in a variety of existing resident curricula that lack cognitive components and critical evaluation. As such, surgical educators struggle to identify the curricular restructuring needs that likely accompany emerging technologies. It is essential to develop a curricular framework for the surgical education community to approach the ongoing and inevitable integration of new technologies. Methods Our process parallels the widely accepted approach to curricular development in medical education described by Kern et al. Using this 6-step model, we describe derivation of a curriculum that was data driven, features multimodal educational strategies, and provides documentation methods that allow for continued evaluation and assessment at the individual and departmental level. Results This study highlights the systematic process of design, implementation and assessment of a robotic surgery curriculum for surgical residents. Built on a robust national and local needs assessment, and further strengthened by preemptive identification of institutional challenges, this curricular model includes a structured documentation system that allows for ongoing evaluation, assessment, and monitoring of curricular progress. Conclusions We illustrate a robustly built curricular structure that can be adopted, adapted, and successfully implemented at other training institutions around the world.
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Affiliation(s)
- Courtney A. Green
- From the Division of Trauma, Critical Care and General Surgery, Mayo Clinic Department of Surgery, Rochester, MN
| | - Hueylan Chern
- Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Stanley J. Rogers
- Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Linda M. Reilly
- Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Patricia O’Sullivan
- Department of Surgery, University of California San Francisco, San Francisco, CA
- Department of Medicine, University of California, San Francisco, San Francisco, CA
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Wang Y, Li Z, Yi B, Zhu S. Initial experience of Chinese surgical robot "Micro Hand S″ assisted versus open and laparoscopic total mesorectal excision for rectal cancer: Short-term outcomes in a single center. Asian J Surg 2021; 45:299-306. [PMID: 34147330 DOI: 10.1016/j.asjsur.2021.05.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/28/2021] [Accepted: 05/24/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND A Chinese surgical robot, Micro Hand S, was introduced for clinical use as a novel robotic platform. This study aimed to comprehensively compare the early experience of the Micro Hand S robot-assisted total mesorectal excision (TME) with conventional approaches. METHODS Between May 2017 and April 2018, 99 consecutive patients who underwent open, laparoscopic and Micro Hand S robot-assisted TME (O-/L-/RTME) for rectal cancer were included. Clinical and pathological outcomes were retrospectively analyzed. Surgical success as the primary endpoint was defined as the absence of (i) conversion, (ii) incomplete TME, (iii) involved circumferential and distal resection margins (CRM/DRM), (iv) severe complications. RESULTS The rate of surgical success was similar (89.7 vs. 86.4 vs. 84.6%, p = 0.851) in the three groups and the respective incidences were as follows: conversion (not applicable, 4.5 vs. 2.3%, p = 1.000), incomplete TME (6.9 vs. 6.8 vs. 3.8%, p = 0.980), involved CRM/DRM (0 vs. 2.3 vs. 3.8%, p = 0.592), severe complications (3.4 vs. 4.5 vs. 7.7%, p = 0.844). Compared with open and laparoscopic surgery, the robotic surgery was associated with longer operative time, less blood loss, earlier first flatus time and liquid intake time, and shorter length of hospital stay (p < 0.05). CONCLUSIONS The Micro Hand S assisted TME is safe and feasible, showing comparable outcomes than conventional approaches, with superiority in blood loss, recovery of bowel function, length of hospital stay, but with increased operative time.
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Affiliation(s)
- Yanlei Wang
- Department of General Surgery, Third Xiangya Hospital, Central South University, 138 Tongzipo Street, Changsha, 410013, Hunan, China
| | - Zheng Li
- Department of General Surgery, Third Xiangya Hospital, Central South University, 138 Tongzipo Street, Changsha, 410013, Hunan, China
| | - Bo Yi
- Department of General Surgery, Third Xiangya Hospital, Central South University, 138 Tongzipo Street, Changsha, 410013, Hunan, China.
| | - Shaihong Zhu
- Department of General Surgery, Third Xiangya Hospital, Central South University, 138 Tongzipo Street, Changsha, 410013, Hunan, China.
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Yang Y, Kong K, Li J, Wang S. Design and implementation of a hand-held robot-assisted minimally invasive surgical device with enhanced intuitive manipulability and stable grip force. Int J Med Robot 2021; 17:e2286. [PMID: 34022119 DOI: 10.1002/rcs.2286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/24/2021] [Accepted: 05/20/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The conventional hand-held minimally invasive surgical devices commonly suffer from non-intuitive manipulability and restricted flexibility for operation. METHODS A hand-held surgical device with enhanced intuitive manipulability and stable grip force was proposed for minimally invasive surgery (MIS). The dexterous instrument and isomorphic handle were designed, and the cable transmission structure and model of the instrument were analysed. A modelling method for grip force pre-compensation was proposed to produce stable grip forces under different posture. RESULTS The prototype of the proposed MIS device was developed, and the related experiments were carried out. The maximum opening angle error was 1.2°. Compared with the non-compensation model, the variation of grip force reduced 8 times with the pre-compensation model. The animal vivo experiments verified the feasibility and practicability of the device. CONCLUSIONS The proposed hand-held device could provide intuitive manipulability and stable operation, which contributes to the performance improvement of the MIS.
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Affiliation(s)
- Yingkan Yang
- Key Laboratory of Mechanism Theory and Equipment Design of Ministry of Education, Tianjin University, Tianjin, China
| | - Kang Kong
- Key Laboratory of Mechanism Theory and Equipment Design of Ministry of Education, Tianjin University, Tianjin, China
| | - Jianmin Li
- Key Laboratory of Mechanism Theory and Equipment Design of Ministry of Education, Tianjin University, Tianjin, China
| | - Shuxin Wang
- Key Laboratory of Mechanism Theory and Equipment Design of Ministry of Education, Tianjin University, Tianjin, China
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Rod J, Marret JB, Kohaut J, Aigrain Y, Jais JP, de Vries P, Lortat-Jacob S, Breaud J, Blanc T. Low-Cost Training Simulator for Open Dismembered Pyeloplasty: Development and Face Validation. JOURNAL OF SURGICAL EDUCATION 2018; 75:188-194. [PMID: 28778782 DOI: 10.1016/j.jsurg.2017.06.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 06/05/2017] [Accepted: 06/10/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE Surgical simulation has benefited from a surge in interest over the last decade because of the increasing need for a change in the traditional apprenticeship model of teaching surgery. Open surgery for ureteropelvic junction (UPJ) poses unique training challenges owing to smaller workspaces, and finer sutures used that require increased surgical dexterity when compared with adult analogues. We describe the development and face validation of a low-cost training simulator for open dismembered pyeloplasty. MATERIALS AND METHODS The simulator is built with A4 Kraft envelopes, catheter tip syringe filled with 30mL of air, tape, 260 modeling balloon, and 11-in party balloon. Evaluation of the device is based on an evaluation form including 11 items on a 5-point Likert-type scale. Thirty-one departments of pediatric surgery in France were contacted and received a pack containing 4 to 10 devices, already set up and ready for use, a tutorial and an evaluation form. Candidates were stratified according to their level of expertise. RESULTS A total of 180 devices were sent. Procedures on the device were performed 118 times (65%) by expert surgeons (n = 44), fellows (n = 25), and residents (n = 49). Statistically significant difference was noted for 4 items (anatomy, model exposition, UPJ resection, and difficulty) for the 3 levels of expertise. The global score evaluation for realistic items, face validity, and usability was 4.2 (range: 1-5). CONCLUSION This low-cost model is evaluated as an efficient tool for UPJ teaching and training. It shows promise as an educational tool.
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Affiliation(s)
- Julien Rod
- Department of Pediatric Surgery, University of Caen Hospital, France; Université de Caen Normandie, UFR Médecine, Caen, F-14000, France.
| | - Jean-Baptiste Marret
- Department of Pediatric Surgery, University of Caen Hospital, France; Université de Caen Normandie, UFR Médecine, Caen, F-14000, France
| | - Jules Kohaut
- Department of Pediatric Surgery, Hôpital Necker-Enfants Malades, Paris, France
| | - Yves Aigrain
- Department of Pediatric Surgery, Hôpital Necker-Enfants Malades, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, France
| | - Jean Philippe Jais
- Université Paris Descartes, Sorbonne Paris Cité, France; Department of Statistics, APHP, Hôpital Necker, Paris, France
| | | | | | - Jean Breaud
- Department of Pediatric Surgery, GCS CHU-Lenval, Nice, France; Simulation center, Nice-Sophia-Antipolis University, France
| | - Thomas Blanc
- Department of Pediatric Surgery, Hôpital Necker-Enfants Malades, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, France; INSERM U1151, Institut Necker Enfants Malades, Hôpital Necker-Enfants Malades, Paris, France
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10
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Amirabdollahian F, Livatino S, Vahedi B, Gudipati R, Sheen P, Gawrie-Mohan S, Vasdev N. Prevalence of haptic feedback in robot-mediated surgery: a systematic review of literature. J Robot Surg 2017; 12:11-25. [PMID: 29196867 DOI: 10.1007/s11701-017-0763-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 11/07/2017] [Indexed: 01/27/2023]
Abstract
With the successful uptake and inclusion of robotic systems in minimally invasive surgery and with the increasing application of robotic surgery (RS) in numerous surgical specialities worldwide, there is now a need to develop and enhance the technology further. One such improvement is the implementation and amalgamation of haptic feedback technology into RS which will permit the operating surgeon on the console to receive haptic information on the type of tissue being operated on. The main advantage of using this is to allow the operating surgeon to feel and control the amount of force applied to different tissues during surgery thus minimising the risk of tissue damage due to both the direct and indirect effects of excessive tissue force or tension being applied during RS. We performed a two-rater systematic review to identify the latest developments and potential avenues of improving technology in the application and implementation of haptic feedback technology to the operating surgeon on the console during RS. This review provides a summary of technological enhancements in RS, considering different stages of work, from proof of concept to cadaver tissue testing, surgery in animals, and finally real implementation in surgical practice. We identify that at the time of this review, while there is a unanimous agreement regarding need for haptic and tactile feedback, there are no solutions or products available that address this need. There is a scope and need for new developments in haptic augmentation for robot-mediated surgery with the aim of improving patient care and robotic surgical technology further.
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Affiliation(s)
| | - Salvatore Livatino
- School of Engineering, University of Hertfordshire, Hatfield, AL10 9AB, UK
| | - Behrad Vahedi
- School of Engineering, University of Hertfordshire, Hatfield, AL10 9AB, UK
| | - Radhika Gudipati
- School of Computer Science, University of Hertfordshire, Hatfield, AL10 9AB, UK
| | - Patrick Sheen
- School of Engineering, University of Hertfordshire, Hatfield, AL10 9AB, UK
| | | | - Nikhil Vasdev
- Department of Urology, Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital, Stevenage, SG1 4AB, UK.,School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Hertfordshire, AL10 9AB, UK
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11
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Jukes AK, Mascarenhas A, Murphy J, Stepan L, Muñoz TN, Callejas CA, Valentine R, Wormald P, Psaltis AJ. Stress response and communication in surgeons undergoing training in endoscopic management of major vessel hemorrhage: a mixed methods study. Int Forum Allergy Rhinol 2017; 7:576-583. [DOI: 10.1002/alr.21941] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/04/2017] [Accepted: 03/14/2017] [Indexed: 12/27/2022]
Affiliation(s)
- Alistair K. Jukes
- Department of Otolaryngology; Head and Neck Surgery; Queen Elizabeth Hospital; Adelaide Australia
- Department of Neurosurgery; Royal Adelaide Hospital; Adelaide Australia
| | - Annika Mascarenhas
- Department of Otolaryngology; Head and Neck Surgery; Queen Elizabeth Hospital; Adelaide Australia
| | - Jae Murphy
- Department of Otolaryngology; Head and Neck Surgery; Queen Elizabeth Hospital; Adelaide Australia
| | - Lia Stepan
- Department of Otolaryngology; Head and Neck Surgery; Queen Elizabeth Hospital; Adelaide Australia
| | - Tamara N. Muñoz
- Department of Otolaryngology; Pontificia Universidad Católica de Chile; Santiago Chile
| | - Claudio A. Callejas
- Department of Otolaryngology; Pontificia Universidad Católica de Chile; Santiago Chile
| | - Rowan Valentine
- Department of Otolaryngology; Head and Neck Surgery; Queen Elizabeth Hospital; Adelaide Australia
- Department of Otolaryngology; Royal Adelaide Hospital; Adelaide Australia
| | - P.J. Wormald
- Department of Otolaryngology; Head and Neck Surgery; Queen Elizabeth Hospital; Adelaide Australia
- Department of Medicine; University of Adelaide; Queen Elizabeth Hospital; Adelaide Australia
| | - Alkis J. Psaltis
- Department of Otolaryngology; Head and Neck Surgery; Queen Elizabeth Hospital; Adelaide Australia
- Department of Medicine; University of Adelaide; Queen Elizabeth Hospital; Adelaide Australia
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Abiri A, Paydar O, Tao A, LaRocca M, Liu K, Genovese B, Candler R, Grundfest WS, Dutson EP. Tensile strength and failure load of sutures for robotic surgery. Surg Endosc 2016; 31:3258-3270. [PMID: 27928670 DOI: 10.1007/s00464-016-5356-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 11/12/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Robotic surgical platforms have seen increased use among minimally invasive gastrointestinal surgeons (von Fraunhofer et al. in J Biomed Mater Res 19(5):595-600, 1985. doi: 10.1002/jbm.820190511 ). However, these systems still suffer from lack of haptic feedback, which results in exertion of excessive force, often leading to suture failures (Barbash et al. in Ann Surg 259(1):1-6, 2014. doi: 10.1097/SLA.0b013e3182a5c8b8 ). This work catalogs tensile strength and failure load among commonly used sutures in an effort to prevent robotic surgical consoles from exceeding identified thresholds. Trials were thus conducted on common sutures varying in material type, gauge size, rate of pulling force, and method of applied force. METHODS Polydioxanone, Silk, Vicryl, and Prolene, gauges 5-0 to 1-0, were pulled till failure using a commercial mechanical testing system. 2-0 and 3-0 sutures were further tested for the effect of pull rate on failure load at rates of 50, 200, and 400 mm/min. 3-0 sutures were also pulled till failure using a da Vinci robotic surgical system in unlooped, looped, and at the needle body arrangements. RESULTS Generally, Vicryl and PDS sutures had the highest mechanical strength (47-179 kN/cm2), while Silk had the lowest (40-106 kN/cm2). Larger diameter sutures withstand higher total force, but finer gauges consistently show higher force per unit area. The difference between material types becomes increasingly significant as the diameters decrease. Comparisons of identical suture materials and gauges show 27-50% improvement in the tensile strength over data obtained in 1985 (Ballantyne in Surg Endosc Other Interv Tech 16(10):1389-1402, 2002. doi: 10.1007/s00464-001-8283-7 ). No significant differences were observed when sutures were pulled at different rates. Reduction in suture strength appeared to be strongly affected by the technique used to manipulate the suture. CONCLUSIONS Availability of suture tensile strength and failure load data will help define software safety protocols for alerting a surgeon prior to suture failure during robotic surgery. Awareness of suture strength weakening with direct instrument manipulation may lead to the development of better techniques to further reduce intraoperative suture breakage.
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Affiliation(s)
- Ahmad Abiri
- UCLA Center for Advanced Surgical and Interventional Technology (CASIT), Los Angeles, CA, USA. .,UCLA Henry Samueli School of Engineering and Applied Science, Los Angeles, CA, USA.
| | - Omeed Paydar
- UCLA Center for Advanced Surgical and Interventional Technology (CASIT), Los Angeles, CA, USA.,UCLA Henry Samueli School of Engineering and Applied Science, Los Angeles, CA, USA
| | - Anna Tao
- UCLA Center for Advanced Surgical and Interventional Technology (CASIT), Los Angeles, CA, USA
| | - Megan LaRocca
- UCLA Center for Advanced Surgical and Interventional Technology (CASIT), Los Angeles, CA, USA
| | - Kang Liu
- UCLA Center for Advanced Surgical and Interventional Technology (CASIT), Los Angeles, CA, USA
| | - Bradley Genovese
- UCLA Center for Advanced Surgical and Interventional Technology (CASIT), Los Angeles, CA, USA.,UCLA Department of Surgery, Los Angeles, CA, USA
| | - Robert Candler
- UCLA Center for Advanced Surgical and Interventional Technology (CASIT), Los Angeles, CA, USA.,UCLA Henry Samueli School of Engineering and Applied Science, Los Angeles, CA, USA
| | - Warren S Grundfest
- UCLA Center for Advanced Surgical and Interventional Technology (CASIT), Los Angeles, CA, USA.,UCLA Henry Samueli School of Engineering and Applied Science, Los Angeles, CA, USA
| | - Erik P Dutson
- UCLA Center for Advanced Surgical and Interventional Technology (CASIT), Los Angeles, CA, USA.,UCLA Department of Surgery, Los Angeles, CA, USA
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Pinzon D, Byrns S, Zheng B. Prevailing Trends in Haptic Feedback Simulation for Minimally Invasive Surgery. Surg Innov 2016; 23:415-21. [PMID: 26839212 DOI: 10.1177/1553350616628680] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background The amount of direct hand-tool-tissue interaction and feedback in minimally invasive surgery varies from being attenuated in laparoscopy to being completely absent in robotic minimally invasive surgery. The role of haptic feedback during surgical skill acquisition and its emphasis in training have been a constant source of controversy. This review discusses the major developments in haptic simulation as they relate to surgical performance and the current research questions that remain unanswered. Search Strategy An in-depth review of the literature was performed using PubMed. Results A total of 198 abstracts were returned based on our search criteria. Three major areas of research were identified, including advancements in 1 of the 4 components of haptic systems, evaluating the effectiveness of haptic integration in simulators, and improvements to haptic feedback in robotic surgery. Conclusions Force feedback is the best method for tissue identification in minimally invasive surgery and haptic feedback provides the greatest benefit to surgical novices in the early stages of their training. New technology has improved our ability to capture, playback and enhance to utility of haptic cues in simulated surgery. Future research should focus on deciphering how haptic training in surgical education can increase performance, safety, and improve training efficiency.
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Affiliation(s)
- David Pinzon
- University of Alberta, Edmonton, Alberta, Canada
| | - Simon Byrns
- University of Alberta, Edmonton, Alberta, Canada
| | - Bin Zheng
- University of Alberta, Edmonton, Alberta, Canada
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An experimental study about haptic feedback in robotic surgery: may visual feedback substitute tactile feedback? J Robot Surg 2015; 10:57-61. [PMID: 26559538 DOI: 10.1007/s11701-015-0541-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 10/26/2015] [Indexed: 10/22/2022]
Abstract
The aim of this study is to demonstrate the hypothesis that the experience of the surgeon is sufficient to partially compensate for the lack of haptic feedback of the robotic system da Vinci Si HD (Intuitive (®) ). Twenty-five international surgeons belonging to different areas of surgical specialization were divided into two groups of investigation: experts and non-experts in the use of da Vinci Platform. This allocation was made on the basis of the following criteria: the number of performed procedures, the number of robotic working days and the number of true console hours. All participants underwent a specific test to assess their ability to recognize the thickness of custom-made membranes, without the availability of haptic feedback. After the performance of the surgeons, score was given according to an appropriate evaluation system (time, preciseness, force of tension and finding a metallic object). The analysis of the performances of participants provided the following results: an average score of 8.87 for the experts compared to 3.57 of non-experts with significant difference (P < 0.05). Other parameters of interest as the average time to conduct the test showed a result of 28.8 s for experts and 71.3 s of non-experts. After our results, a significant difference between the two groups in terms of performance was found. Our hypothesis that the expertise ability of the experts might partially overcome the lack of haptic feedback was confirmed. Probably visual feedback may play a role.
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