IEEE Trans Biomed Eng. 2019 Apr;66(4):1165-1171. doi: 10.1109/TBME.2018.2869417. Epub 2018 Sep 10.
As robotic surgery has increased in popularity, the lack of haptic feedback has become a growing issue due to the application of excessive forces that may lead to clinical problems such as intraoperative and postoperative suture breakage. Previous suture breakage warning systems have largely depended on visual and/or auditory feedback modalities, which have been shown to increase cognitive load and reduce operator performance. This work catalogues a new sensing technology and haptic feedback system (HFS) that can reduce instances of suture failure without negatively impacting performance outcomes including knot quality. Suture breakage is common in knot-tying as the pulling motion introduces prominent shear forces. A shear sensor mountable on the da Vinci robotic surgical system's Cadiere grasper detects forces that correlate to the suture's internal tension. HFS then provides vibration feedback to the operator as forces near a particular material's failure load. To validate the system, subjects tightened a total of four knots, two with the Haptic Feedback System (HFS) and two without feedback. The number of suture breakages were recorded and knot fidelity was evaluated by measuring knot slippage. Results showed that instances of suture failure were significantly reduced when HFS was enabled (p = 0.0078). Notably, knots tied with HFS also showed improved quality compared to those tied without feedback (p = 0.010). The results highlight the value of HFS in improving robotic procedure outcomes by reducing instances of suture failures, producing better knots, and reducing the need for corrective measures.
随着机器人手术的普及，由于应用了过大的力，触觉反馈的缺乏已成为一个日益严重的问题，这可能导致术中及术后缝线断裂等临床问题。以前的缝线断裂预警系统在很大程度上依赖于视觉和/或听觉反馈模式，这些模式已被证明会增加认知负荷并降低操作人员的绩效。这项工作记录了一种新的传感技术和触觉反馈系统（HFS），它可以减少缝线失效的情况，而不会对性能结果产生负面影响，包括结的质量。在打结过程中，缝线断裂很常见，因为拉动动作会产生明显的剪切力。一个可安装在达芬奇机器人手术系统的 Cadiere 抓手上的剪切传感器，可以检测到与缝线内部张力相关的力。然后，HFS 会在力接近特定材料的失效负载时向操作人员提供振动反馈。为了验证该系统，实验对象总共系了四个结，其中两个带有触觉反馈系统（HFS），两个没有反馈。记录了缝线断裂的次数，并通过测量结的滑移来评估结的保真度。结果表明，启用 HFS 时，缝线断裂的情况明显减少（p = 0.0078）。值得注意的是，与没有反馈的结相比，使用 HFS 系的结质量也有所提高（p = 0.010）。结果突出了 HFS 在通过减少缝线失效的情况、产生更好的结以及减少纠正措施的需求来改善机器人手术结果方面的价值。
