Surgical Endoscopy

, Volume 13, Issue 5, pp 461–465 | Cite as

Human vs robotic organ retraction during laparoscopic Nissen fundoplication

  • B. K.  Poulose
  • M. F.  Kutka
  • M.  Mendoza-Sagaon
  • A. C.  Barnes
  • C.  Yang
  • R. H.  Taylor
  • M. A.  Talamini
Article

Abstract

Background: Advances in technique and instrumentation have enabled surgeons to perform an increasing number of complicated procedures through laparoscopy. However, these efforts have often been compromised by the exertion of excessive force when anatomical structures are retracted to create a clear view of the anatomy. Here, we present a comparative study of human and robotic performance in force-controlled organ retraction during laparoscopic Nissen fundoplication (LNF).

Methods: Six female pigs (20–25 kg) were anesthetized, intubated, and placed on mechanical ventilation; pneumoperitoneum (13 mmHg CO2) was established. A force-sensing retractor (FSR) was constructed to record the forces applied in retracting the stomach during dissection of the esophageal hiatus. The FSR was calibrated using known forces and then operated by either human alone or robot under human guidance using the FSR data. The esophageal hiatus was visualized and dissected, and LNF was completed.

Results: Less force was needed for robotic (74.3 ± 10.5 g; mean ± standard deviation) than for human (108.9 ± 34.3 g) retraction (p= 0.007) to obtain an optimal view of the esophageal hiatus. No significant differences were observed for retraction setup time (robot, 14.3 ± 0.8 min; human, 13.7 ± 9.9 min; mean ± SD) or hiatal dissection time (robot, 14.0 ± 3.0 min; human, 14.0 ± 6.1 min; mean ± SD).

Conclusions: These preliminary results illustrate our continuing effort to develop and evaluate an automated surgical assistant for laparoscopy. As more personnel-intensive advanced laparoscopic procedures are performed, robotic retraction is likely to offer a superior alternative to human retraction; it minimizes the forces exerted on the organs while maintaining excellent anatomical view.

Key words: Surgical robotics — Retraction devices — Laparoscopy — Force feedback 

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Copyright information

© Springer-Verlag New York Inc. 1999

Authors and Affiliations

  • B. K.  Poulose
    • 1
  • M. F.  Kutka
    • 1
  • M.  Mendoza-Sagaon
    • 1
  • A. C.  Barnes
    • 2
  • C.  Yang
    • 3
  • R. H.  Taylor
    • 3
  • M. A.  Talamini
    • 1
  1. 1.Department of Surgery, Johns Hopkins University School of Medicine, Blalock 665, 600 North Wolfe Street, Baltimore, MD 21287, USAUS
  2. 2.Department of Mechanical Engineering, Johns Hopkins University, 122 Latrobe Hall, Baltimore, MD 21218, USAUS
  3. 3.Department of Computer Science, Johns Hopkins University, 224 New Engineering Building, Baltimore, MD 21218, USAUS

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