IEEE Trans Biomed Eng. 2014 Feb;61(2):353-61. doi: 10.1109/TBME.2013.2279337.
In an open surgery, identification of precise margins for curative tissue resection is performed by manual palpation. This is not the case for minimally invasive and robotic procedures, where tactile feedback is either distorted or not available. In this paper, we introduce the concept of intraoperative wireless tissue palpation. The wireless palpation probe (WPP) is a cylindrical device (15 mm in diameter, 60 mm in length) that can be deployed through a trocar incision and directly controlled by the surgeon to create a volumetric stiffness distribution map of the region of interest. This map can then be used to guide the tissue resection to minimize healthy tissue loss. The wireless operation prevents the need for a dedicated port and reduces the chance of instrument clashing in the operating field. The WPP is able to measure in real time the indentation pressure with a sensitivity of 34 Pa, the indentation depth with an accuracy of 0.68 mm, and the probe position with a maximum error of 11.3 mm in a tridimensional workspace. The WPP was assessed on the benchtop in detecting the local stiffness of two different silicone tissue simulators (elastic modulus ranging from 45 to 220 kPa), showing a maximum relative error below 5%. Then, in vivo trials were aimed to identify an agar-gel lump injected into a porcine liver and to assess the device usability within the frame of a laparoscopic procedure. The stiffness map created intraoperatively by the WPP was compared with a map generated ex vivo by a standard uniaxial material tester, showing less than 8% local stiffness error at the site of the lump.
在开放式手术中,通过手动触诊来确定可治愈组织切除的精确边界。但在微创手术和机器人手术中并非如此,因为这些手术中触觉反馈要么失真,要么无法获得。在本文中,我们介绍了术中无线组织触诊的概念。无线触诊探头(WPP)是一种圆柱形装置(直径 15 毫米,长 60 毫米),可以通过套管切口部署,并由外科医生直接控制,以创建感兴趣区域的体积刚度分布图。然后,该地图可用于指导组织切除,以最大程度地减少健康组织的损失。无线操作可防止需要专用端口,并降低手术现场仪器碰撞的机会。WPP 能够实时测量压痕压力,灵敏度为 34 Pa,压痕深度精度为 0.68 毫米,在三维工作空间中探头位置的最大误差为 11.3 毫米。WPP 在检测两种不同的硅胶组织模拟器(弹性模量范围为 45 至 220 kPa)的局部刚度方面在台架上进行了评估,最大相对误差低于 5%。然后,进行了体内试验,以识别注入猪肝的琼脂凝胶肿块,并评估该设备在腹腔镜手术框架内的可用性。WPP 术中创建的刚度图与标准单轴材料试验机生成的离体图进行了比较,在肿块部位的局部刚度误差小于 8%。