Ye D, Mozaffari-Naeini H, Busart C, Thakor N V
Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, MD 21205, USA.
Int J Med Robot. 2005 Sep;1(3):21-30. doi: 10.1002/rcs.24.
Many surgical procedures require skillful manipulations of blood vessels, especially in conventional invasive or minimally invasive surgical procedures. Current surgical methods do not allow the surgeon to receive any real time feedback of the tissue properties when operating on the vessel. As a result, the unintentional application of excessive force may damage the blood vessel. To minimize such trauma, and to study the interaction of surgical instruments with the vessel structure, we have developed an integrated surgical testbed called MEMSurgery (Microelectromechanical Sensory augmented Surgery). The test-bed integrates four elements: a) force sensors mounted on surgical appliances, b) a feedback control mechanism utilizing the intrinsic mechanical properties of the blood vessel, c) feedback of the force applied on the tissue back to the surgeon through a haptic feedback device, and d) visual feedback by a graphical computer model of the vessel. Finally, we evaluate the performance of MEMSurgery by testing the hypothesis that the combination of haptic feedback, feedback control based on vascular mechanical properties, and real-time visual representation of the vessel will help the surgeon decrease the probability of applying excess force while occluding the blood vessel. To this end, we designed a rodent experimental model to obtain the ideal minimum occlusion force (MOF). After a series of human performance studies, and subsequent comparison to direct application of force on the forceps (without feedback), the results show that the probability of applying reasonable MOF increases from 35.5% to 80%. After a brief training period, the probability increases to 90%.
许多外科手术都需要熟练地操作血管，尤其是在传统的侵入性手术或微创手术中。目前的手术方法不允许外科医生在对血管进行手术时获得任何关于组织特性的实时反馈。因此，意外施加过大的力可能会损伤血管。为了将这种创伤降至最低，并研究手术器械与血管结构的相互作用，我们开发了一种名为MEMSurgery（微机电传感增强手术）的集成手术试验台。该试验台集成了四个要素：a）安装在手术器械上的力传感器；b）利用血管固有机械特性的反馈控制机制；c）通过触觉反馈设备将作用在组织上的力反馈给外科医生；d）通过血管的图形计算机模型进行视觉反馈。最后，我们通过测试以下假设来评估MEMSurgery的性能：触觉反馈、基于血管机械特性的反馈控制以及血管的实时视觉呈现相结合，将有助于外科医生在阻断血管时降低施加过大力量的可能性。为此，我们设计了一个啮齿动物实验模型来获得理想的最小阻断力（MOF）。经过一系列人体性能研究，并随后与直接在镊子上施加力（无反馈）进行比较，结果表明，施加合理MOF的概率从35.5%提高到了80%。经过短暂的训练期后，概率提高到了90%。
