Force-Sensing Silicone Retractor for Attachment to Surgical Suction Pipes

Real-Time Intraoperative Pressure Monitoring to Avoid Surgically Induced Localized Brain Injury Using a Miniaturized Piezoresistive Pressure Sensor

Neurosurgical procedures often cause damage to the brain tissue at the periphery from surgical manipulations. Especially during retraction, a large amount of pressure could be applied on the brain surface, which can damage it, leading to brain herniation, which can be fatal for patients. To resolve this issue, we have developed a pressure sensor that can be used to monitor the applied pressure during surgery for intraoperative care. This device was tested on a rodent model to create a superficial surgically induced damage profile for three different applied pressures (30, 50, and 70 mmHg) and compared to a standard intracranial pressure monitoring system. Magnetic resonance imaging has been performed after surgical procedures to detect the herniation caused by applied pressure. To evaluate the damage to brain cells and tissue rupture, histological analysis was performed using hematoxylin and eosin staining. A scoring system was developed to understand the severity of the surgically induced brain injury, which will help neurosurgeons to limit the pressure to an optimum point without causing damage.

A System for Characterizing Intraoperative Force Distribution During Operative Laryngoscopy

OBJECTIVE

This study aimed to create and validate an integrated data acquisition system for gauging the force distribution between a laryngoscope and soft-tissue during trans-oral surgery.

METHODS

Sixteen piezoresistive force sensors were interfaced to a laryngoscope and custom maxillary tooth guard. A protocol for calibrating the laryngoscope and maxilla sensors was developed using a motor-controlled linear stage and force measurements were validated against a digital scale. The system was initially tested during suspension laryngoscopy on three cadaver heads mounted on a cadaver head-holder. Intraoperative data was also collected from three patients undergoing head and neck tumor resection.

RESULTS

Mean calibration error of the scope sensors was less than 150 g (n = 3) and mean maxilla sensor error was less than 200 g (n = 3). Peak scope mag-forces of 8.09 ± 6.61 kg and peak maxilla forces of 7.62 ± 4.57 kg were experienced during the cadaver trials. The peak scope sensor mag-force recorded during the intraoperative cases was 24.7 ± 4.53 kg, and the peak maxilla force was 22.0 ± 4.60 kg.

CONCLUSION

The data acquisition system was successfully able to record intraoperative force distribution data. The usefulness of this technology in informing surgeons during trans-oral surgery should be further evaluated in patients with varying anatomic and procedural characteristics.

SIGNIFICANCE

Creation of a low-cost, integrated force-sensing system allows for the characterization of retraction forces at anatomic sites including the pharynx and larynx, brain, and abdomen. Real-time force detection provides surgeons with valuable intraoperative feedback and can be used to improve deformation models at various anatomic sites.

A Force-Visualized Silicone Retractor Attachable to Surgical Suction Pipes

This paper presents a force-visually-observable silicone retractor, which is an extension of a previously developed system that had the same functions of retracting, suction, and force sensing. These features provide not only high usability by reducing the number of tool changes, but also a safe choice of retracting by visualized force information. Suction is achieved by attaching the retractor to a suction pipe. The retractor has a deformable sensing component including a hole filled with a liquid. The hole is connected to an outer tube, and the liquid level displaced in proportion to the extent of deformation resulting from the retracting load. The liquid level is capable to be observed around the surgeon’s fingertips, which enhances the usability. The new hybrid structure of soft sensing and hard retracting allows the miniaturization of the retractor as well as a resolution of less than 0.05 N and a range of 0.1–0.7 N. The overall structure is made of silicone, which has the advantages of disposability, low cost, and easy sterilization/disinfection. This system was validated by conducting experiments.