Department of Mechanical Engineering and Applied Mechanics, University of Pennsylvania, 144 Towne Building, 220 South 33rd Street, Philadelphia, PA 19104, USA.
Surg Endosc. 2013 Feb;27(2):656-64. doi: 10.1007/s00464-012-2452-8. Epub 2012 Jul 18.
Robotic minimally invasive surgery (RMIS) lacks the haptic (kinesthetic and tactile) cues that surgeons are accustomed to receiving in open and laparoscopic surgery. We previously introduced a method for adding tactile and audio feedback of tool vibrations to RMIS systems, creating sensations similar to what one feels and hears when using a laparoscopic tool. Our prior work showed that surgeons performing box-trainer tasks significantly preferred having this feedback and believed that it helped them concentrate on the task, but we did not know how well our approach would work in a clinically relevant setting. This study constituted the first in vivo test of our system.
Accelerometers that measure tool vibrations were mounted to the patient-side manipulators of a da Vinci S surgical system. The measured vibrations were recorded and presented to the surgeon through vibrotactile and audio channels while two transperitoneal nephrectomies and two mid-ureteral dissections with uretero-ureterostomy were completed on a porcine model. We examined 30 minutes of resulting video to identify and tag manipulation events, aiming to determine whether our system can measure significant and meaningful tool vibrations during in vivo procedures.
A total of 1,404 manipulation events were identified. Analysis of each event's accelerations indicated that 82 % of these events resulted in significant vibrations. The magnitude of the accelerations measured for different manipulation events varied widely, with hard contact causing the largest cues.
This study demonstrates the feasibility of providing tool vibration feedback during in vivo RMIS. Significant tool vibrations were reliably measured for the majority of events during standard urological procedures on a porcine model, while real-time, naturalistic tactile and audio tool vibration feedback was provided to the surgeon. The feedback system's modules were easily implemented outside the sterile field of the da Vinci S and did not interfere with the surgical procedure.
机器人微创手术 (RMIS) 缺乏外科医生在开放式和腹腔镜手术中习惯接收的触觉（运动觉和触觉）提示。我们之前介绍了一种为 RMIS 系统添加工具振动触觉和音频反馈的方法，从而产生类似于使用腹腔镜工具时所感觉到和听到的感觉。我们之前的工作表明，执行盒式训练任务的外科医生非常喜欢这种反馈，并认为这有助于他们专注于任务，但我们不知道我们的方法在临床相关环境中的效果如何。这项研究是我们系统的首次体内测试。
将测量工具振动的加速度计安装到达芬奇 S 手术系统的患者侧操作器上。测量到的振动被记录下来，并通过振动触觉和音频通道呈现给外科医生，同时在猪模型上完成了两次经腹腔肾切除术和两次中段输尿管切开术及输尿管-输尿管吻合术。我们检查了 30 分钟的视频，以识别和标记操作事件，旨在确定我们的系统是否可以在体内手术过程中测量到重要且有意义的工具振动。
共识别出 1404 个操作事件。对每个事件的加速度进行分析表明，其中 82%的事件产生了明显的振动。不同操作事件的加速度测量值差异很大，硬接触会产生最大的提示。
这项研究证明了在体内 RMIS 中提供工具振动反馈的可行性。在猪模型上进行的标准泌尿科手术过程中，大多数事件都可靠地测量到明显的工具振动，同时为外科医生提供了实时、自然的触觉和音频工具振动反馈。反馈系统的模块易于在达芬奇 S 的无菌区域外实施，且不会干扰手术过程。
