Wee Justin, Azzie Georges, Drake James, Gerstle J Ted
1 Center for Image Guided Innovation and Therapeutic Intervention, The Hospital for Sick Children, University of Toronto , Toronto, Canada .
2 Department of Surgery, The Hospital for Sick Children, University of Toronto , Toronto, Canada .
J Laparoendosc Adv Surg Tech A. 2018 Jul;28(7):899-905. doi: 10.1089/lap.2017.0293. Epub 2018 Jun 19.
Mastering proper force manipulation in minimally invasive surgery can take many hours of practice and training. Improper force control can lead to necrosis, infection, and scarring. A force-sensing skin (FSS) has been developed, which measures forces at the distal end of minimal access surgeries' (MAS) instruments without altering the instrument's structural integrity or the surgical workflow, and acts as a minimally disruptive add-on to any MAS instrument.
A proof of concept study was conducted using a FSS-equipped 5 mm straight-tip needle holder. Participants (n = 19: 3 novices, 11 fellows, and 5 staff surgeons) performed one intracorporeal suturing knot task (ISKT). Using participant task video footage, each participant's two puncture forces (each wall of the Penrose drain) and three knot tightening forces were measured. Force metrics from the three expertise groups were compared using analysis of variance (ANOVA) and Tukey's honest significance test with statistical significance assessed at P < .05.
Preliminary ISKT force metric data showed differences between novices and more experienced fellows and surgeons. Of the five stages of the ISKT evaluated, the first puncture force of the Penrose drain seemed to best reflect the difference in skill among participants. The study demonstrated ISKT knot tightening and puncture force ranges across three expertise levels (novices, surgical fellows, and staff surgeons) of 0.586 to 6.089 newtons (N) and 0.852 to 2.915 N, respectively.
The investigation of force metrics is important for the implementation of future force feedback systems as it can provide real-time information to surgeons in training and the operating theater.
掌握微创手术中的适当力操作需要数小时的练习和培训。力控制不当会导致坏死、感染和瘢痕形成。一种力敏皮肤（FSS）已被开发出来，它可以在不改变微创手术（MAS）器械结构完整性或手术流程的情况下测量器械远端的力，并作为任何MAS器械的微创附加装置。
使用配备FSS的5毫米直头持针器进行了一项概念验证研究。参与者（n = 19：3名新手、11名住院医师和5名外科主治医师）进行了一项体内缝合打结任务（ISKT）。使用参与者任务视频片段，测量了每个参与者的两种穿刺力（彭罗斯引流管的每一侧壁）和三种打结收紧力。使用方差分析（ANOVA）和图基诚实显著性检验比较了三个专业组的力指标，以P < 0.05评估统计学显著性。
初步的ISKT力指标数据显示新手与经验更丰富的住院医师和外科医生之间存在差异。在评估的ISKT的五个阶段中，彭罗斯引流管的首次穿刺力似乎最能反映参与者之间的技能差异。该研究表明，ISKT打结收紧力和穿刺力在新手、外科住院医师和外科主治医师三个专业水平上的范围分别为0.586至6.089牛顿（N）和0.852至2.915 N。
力指标的研究对于未来力反馈系统的实施很重要，因为它可以为培训中的外科医生和手术室提供实时信息。
