Abstract
Background
In laparoscopy, impaired feedback information from the operation site and reduced instrument dexterity lead to high demands on surgeons’ skill and experience. Pre-clinical studies have shown that artificial tactile feedback (ATF) could significantly improve the quality of tactile feedback information. Additional information about interaction effects of tissue features when using ATF as well as related detection thresholds would be valuable for drawing conclusions on possible clinical application scenarios.
Objective
To identify surgical procedures in laparoscopy that could benefit from ATF in tissue examination through remote palpation.
Methods
We have developed a laparoscopic grasper capable of providing ATF by measuring the pressure distribution on one forceps jaw with a tactile sensor array. The data was presented graphically on the endoscopic screen. We conducted a study among surgeons and non-surgeons, comparing the capability to detect hidden objects through remote palpation with and without ATF. The data were analyzed using repeated-measures multiple analysis of variance (MANOVA) in two designs.
Results
ATF could enhance feedback information with significant positive effects on accuracy, speed, the reduction of the number of grasps, and user confidence. The positive effect of ATF turned out to be especially strong if hidden objects were either hard and too small or large and too soft to be recognized by remote palpation without ATF.
Conclusions
Our study contributes to the discussion on promising application scenarios of ATF-enhanced instrumentation in laparoscopic surgery. Based on our study results, such instrumentation may be valuable for detection and examination of hidden bodies or structures through remote palpation.
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Acknowledgements
We cordially thank L. Mailänder MA from the Training Centre for MIS of the University Hospital Tuebingen, Clinic for General, Visceral and Transplant Surgery, for her active support in conducting the study. The research leading to these results has received funding from the European Community’s Seventh Framework Programme (FP7-ICT-2007-2) under grant agreement no. 224565.
Disclosures
Authors Sebastian Schostek, Martin J. Binser, Fabian Rieber, Chi-Nghia Ho, Marc O. Schurr and Gerhard F. Bueß have no conflicts of interest or financial ties to disclose that might pose a conflict of interest.
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Schostek, S., Binser, M.J., Rieber, F. et al. Artificial tactile feedback can significantly improve tissue examination through remote palpation. Surg Endosc 24, 2299–2307 (2010). https://doi.org/10.1007/s00464-010-0956-7
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DOI: https://doi.org/10.1007/s00464-010-0956-7