Abiri Ahmad, Paydar Omeed, Tao Anna, LaRocca Megan, Liu Kang, Genovese Bradley, Candler Robert, Grundfest Warren S, Dutson Erik P
UCLA Center for Advanced Surgical and Interventional Technology (CASIT), Los Angeles, CA, USA.
UCLA Henry Samueli School of Engineering and Applied Science, Los Angeles, CA, USA.
Surg Endosc. 2017 Aug;31(8):3258-3270. doi: 10.1007/s00464-016-5356-1. Epub 2016 Dec 7.
Robotic surgical platforms have seen increased use among minimally invasive gastrointestinal surgeons (von Fraunhofer et al. in J Biomed Mater Res 19(5):595-600, 1985. doi: 10.1002/jbm.820190511 ). However, these systems still suffer from lack of haptic feedback, which results in exertion of excessive force, often leading to suture failures (Barbash et al. in Ann Surg 259(1):1-6, 2014. doi: 10.1097/SLA.0b013e3182a5c8b8 ). This work catalogs tensile strength and failure load among commonly used sutures in an effort to prevent robotic surgical consoles from exceeding identified thresholds. Trials were thus conducted on common sutures varying in material type, gauge size, rate of pulling force, and method of applied force.
Polydioxanone, Silk, Vicryl, and Prolene, gauges 5-0 to 1-0, were pulled till failure using a commercial mechanical testing system. 2-0 and 3-0 sutures were further tested for the effect of pull rate on failure load at rates of 50, 200, and 400 mm/min. 3-0 sutures were also pulled till failure using a da Vinci robotic surgical system in unlooped, looped, and at the needle body arrangements.
Generally, Vicryl and PDS sutures had the highest mechanical strength (47-179 kN/cm), while Silk had the lowest (40-106 kN/cm). Larger diameter sutures withstand higher total force, but finer gauges consistently show higher force per unit area. The difference between material types becomes increasingly significant as the diameters decrease. Comparisons of identical suture materials and gauges show 27-50% improvement in the tensile strength over data obtained in 1985 (Ballantyne in Surg Endosc Other Interv Tech 16(10):1389-1402, 2002. doi: 10.1007/s00464-001-8283-7 ). No significant differences were observed when sutures were pulled at different rates. Reduction in suture strength appeared to be strongly affected by the technique used to manipulate the suture.
Availability of suture tensile strength and failure load data will help define software safety protocols for alerting a surgeon prior to suture failure during robotic surgery. Awareness of suture strength weakening with direct instrument manipulation may lead to the development of better techniques to further reduce intraoperative suture breakage.
机器人手术平台在微创胃肠外科医生中的使用日益增加（冯·弗劳恩霍夫等人，《生物医学材料研究杂志》，1985年，第19卷第5期，第595 - 600页。doi: 10.1002/jbm.820190511）。然而，这些系统仍然缺乏触觉反馈，这会导致施加过大的力，常常导致缝合失败（巴巴什等人，《外科学年鉴》，2014年，第259卷第1期，第1 - 6页。doi: 10.1097/SLA.0b013e3182a5c8b8）。这项工作对常用缝线的拉伸强度和破坏载荷进行了编目，以防止机器人手术控制台超过确定的阈值。因此，对材料类型、规格尺寸、拉力速率和施力方法各不相同的常用缝线进行了试验。
使用商用机械测试系统将5 - 0至1 - 0规格的聚二氧六环酮、丝线、薇乔和普理灵缝线拉伸直至断裂。对2 - 0和3 - 0缝线在50、200和400毫米/分钟的速率下进一步测试拉伸速率对破坏载荷的影响。还使用达芬奇机器人手术系统以未打环、打环和针体排列的方式将3 - 0缝线拉伸直至断裂。
一般来说，薇乔和聚二氧六环酮缝线具有最高的机械强度（47 - 179千牛/平方厘米），而丝线的机械强度最低（40 - 106千牛/平方厘米）。直径较大的缝线能承受更高的总力，但更细规格的缝线单位面积的力始终更高。随着直径减小，材料类型之间的差异变得越来越显著。相同缝线材料和规格的比较表明，与1985年获得的数据相比，拉伸强度提高了27 - 50%（巴兰坦，《外科内镜与其他介入技术》，2002年，第16卷第10期，第1389 - 1402页。doi: 10.1007/s00464-001-8283-7）。当以不同速率拉伸缝线时，未观察到显著差异。缝线强度的降低似乎受到操作缝线技术的强烈影响。
缝线拉伸强度和破坏载荷数据的可用性将有助于定义软件安全协议，以便在机器人手术期间在缝线失败前提醒外科医生。意识到直接器械操作会使缝线强度减弱，可能会促使开发更好的技术以进一步减少术中缝线断裂。
