Surgical Endoscopy

, Volume 25, Issue 1, pp 186–192 | Cite as

Force sensing in natural orifice transluminal endoscopic surgery

  • Ana Luisa TrejosEmail author
  • Shiva Jayaraman
  • Rajni V. Patel
  • Michael D. Naish
  • Christopher M. Schlachta



Natural orifice transluminal endoscopic surgery (NOTES) may represent the next frontier for therapeutic minimally invasive surgery; however, its feasibility is currently limited by the lack of suitable instruments. Identifying the forces required to manipulate tissue during NOTES is a necessary first step in the development of better instrumentation.


Sensorized instruments were used to measure the forces acting at the tip of the instruments during transgastric and transperineal NOTES procedures performed in two female pigs. The maximum and average forces when handling tissue were determined and compared.


The results show that, for the transgastric approach, the average forces required are significantly less than in the transperineal approach (43% less), and that the maximum forces required are almost 8 and 16 N in the transgastric and transperineal approaches, respectively. The forces were higher than 5 N in 1.6% of the measurements in the transgastric approach and 2.9% in the transperineal approach.


This study presents an experimental measurement of tissue manipulation forces in a NOTES procedure. This information may be valuable for research groups interested in developing NOTES instruments and devices. It is recommended that NOTES instruments be designed to easily handle forces as high as 16 N.


Natural orifice surgery Force sensing Mechatronic design Applied forces 



The authors would like to acknowledge Jerry Dafoe from the Boundary Layer Wind Tunnel Laboratory at UWO for his technical support with strain gage attachment; Quanser Inc. for providing the gage amplifiers and the interface to the computer through their Q8 boards; Harman Bassan for developing the data acquisition software; Aleksandar Mihaylov, Ranjani Sabarinathan, Carolina Subirós, and Abelardo Escoto for their assistance preparing the instruments and processing the data: and all of the staff at CSTAR for their continued technical assistance. This research was supported by the Natural Sciences and Engineering Research Council (NSERC) of Canada under grants 1345-07 (R.V. Patel), 312383-2005 (M.D. Naish); and by infrastructure grants from the Canada Foundation for Innovation awarded to the London Health Sciences Centre (Canadian Surgical Technologies & Advanced Robotics) and to The University of Western Ontario (R.V. Patel). The two-channel gastroscope and supporting equipment were provided by Olympus Canada, Inc.


Authors A.L. Trejos, S. Jayaraman, R.V. Patel, M.D. Naish, and C.M. Schlachta have no conflicts of interest or financial ties to disclose.


  1. 1.
    Bardaro SJ, Swanström L (2006) Development of advanced endoscopes for natural orifice transluminal endoscopic surgery (NOTES). Minim Invasive Ther Allied Technol 15(6):378–383CrossRefPubMedGoogle Scholar
  2. 2.
    McGee MF, Rosen MJ, Marks J, Onders RP, Chak A, Faulx A, Chen VK, Ponsky J (2006) A primer on natural orifice transluminal endoscopic surgery: building a new paradigm. Surg Innov 13(2):86–93CrossRefPubMedGoogle Scholar
  3. 3.
    Rattner D, Kalloo A (2006) ASGE/SAGES working group on natural orifice translumenal endoscopic surgery. Surg Endosc 20(2):329–333CrossRefPubMedGoogle Scholar
  4. 4.
    Giday SA, Kantsevoy SV, Kalloo AN (2006) Principle and history of natural orifice translumenal endoscopic surgery (NOTES). Minim Invasive Ther Allied Technol 15(6):373–377CrossRefPubMedGoogle Scholar
  5. 5.
    Swain P (2007) A justification for NOTES-natural orifice translumenal endosurgery. Gastrointest Endosc 65(3):514–516CrossRefPubMedGoogle Scholar
  6. 6.
    Sodergren M, Clark J, Athanasiou T, Teare J, Yang G-Z, Darzi A (2009) Natural orifice translumenal endoscopic surgery: critical appraisal of applications in clinical practice. Surg Endosc 23(4):680–687CrossRefPubMedGoogle Scholar
  7. 7.
    Wagh MS, Thompson CC (2007) Surgery insight: natural orifice transluminal endoscopic surgery—an analysis of work to date. Nat Clin Pract Gastroenterol Hepatol 4(7):386–392CrossRefPubMedGoogle Scholar
  8. 8.
    Spaun GO, Swanström LL (2008) Quo vadis NOTES? Eur Surg 40(5):211–219CrossRefGoogle Scholar
  9. 9.
    Larkin D (2007) Minimally invasive surgical instrument system. US patent 2008/0065100, 13 June 2007Google Scholar
  10. 10.
    Phee SJ, Low SC, Sun ZL, Ho KY, Huang WM, Thant ZM (2008) Robotic system for no-scar gastrointestinal surgery. Int J Med Robot Comput Assist Surg 4(1):15–22CrossRefGoogle Scholar
  11. 11.
    Valdastri P, Tognarelli S, Menciassi A, Dario P (2009) A scalable platform for biomechanical studies of tissue cutting forces. Meas Sci Technol 20(4):1–11CrossRefGoogle Scholar
  12. 12.
    Rosen J, MacFarlane M, Richards C, Hannaford B, Sinanan M (1999) Surgeon-tool force/torque signatures—evaluation of surgical skills in minimally invasive surgery. Proceedings of Medicine Meets Virtual Reality, San Francisco, CA, pp. 290–296Google Scholar
  13. 13.
    Jayaraman S, Schlachta CM (2009) Transgastric and transperineal natural orifice translumenal endoscopic surgery (NOTES) in an appendectomy test bed. Surg Innov 16(3):223–227CrossRefPubMedGoogle Scholar
  14. 14.
    Sumiyama K, Gostout CJ, Rajan E, Bakken TA, Deters JL, Knipschield MA, Hawes RH, Kalloo AN, Pasricha PJ, Chung S, Kantsevoy SV, Cotton PB (2006) Pilot study of the porcine uterine horn as an in vivo appendicitis model for development of endoscopic transgastric appendectomy. Gastrointest Endosc 64(5):808–812CrossRefPubMedGoogle Scholar
  15. 15.
    Trejos AL, Patel RV, Naish MD (2010) Force sensing and its application in minimally invasive surgery and therapy: a survey. Proceedings of the Institution of Mechanical Engineers, Part C: Journal of Mechanical Engineering Science Special Issue on Robots and Devices in Surgery, in pressGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Ana Luisa Trejos
    • 1
    • 2
    Email author
  • Shiva Jayaraman
    • 1
    • 3
  • Rajni V. Patel
    • 1
    • 2
    • 3
  • Michael D. Naish
    • 1
    • 2
    • 4
  • Christopher M. Schlachta
    • 1
    • 3
  1. 1.CSTAR (Canadian Surgical Technologies & Advanced Robotics)Lawson Health Research InstituteLondonCanada
  2. 2.Department of Electrical and Computer Engineering, Faculty of EngineeringThe University of Western OntarioLondonCanada
  3. 3.Department of Surgery, Schulich School of Medicine and DentistryThe University of Western OntarioLondonCanada
  4. 4.Department of Mechanical and Materials Engineering, Faculty of EngineeringThe University of Western OntarioLondonCanada

Personalised recommendations