Department of Biomedical Information, Tokyo Medical and Dental University, Tokyo, Japan.
Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan.
Int J Comput Assist Radiol Surg. 2020 Oct;15(10):1653-1664. doi: 10.1007/s11548-020-02239-3. Epub 2020 Jul 30.
Noninvasiveness and stability are significant issues in laparoscopic liver resection. Inappropriate grasping force can cause damage or serious bleeding to the liver. In addition, instability of grasping can result unsafe operations or wavered cutting. We propose a surgical device to improve stability of liver manipulation.
A proposed device adheres to the liver surface with suction fixation, then tunes its stiffness to being hard and shapes like as a bulge on the liver surface to be grasped with laparoscopic forceps. It consists of two soft beams, a chamber sponge, membrane covering the device upper, suburb extrusion wing membrane, a vacuuming tube and to-be-grasped bars. The beams are designed as being non-stretchable and easy to bend. The device is connected to a medical vacuuming pump to vacuum air in the device and then gets hard to transfer forceps operation well. This stiffness tuning mechanism by pneumatic control features the device for achieving good liver shape followability and forceps operation propagation less invasively. The proposed device was tested with rubber phantoms and porcine livers on shape followability, stiffness transition, liver invasiveness and operational usability in the experiments.
Performance of the proposed device was assessed in experiments. The device showed good object-shape followability. It held the liver with 2.43-N force for vertical lifting and 4.90-N shear force with - 80 kPa vacuuming pressure. Invasiveness was reduced to acceptable level of liver damage. In usability test, the device grasped the liver stably and transferred surgical forceps operations to the liver surface well.
The proposed device showed effective performance to improve laparoscopic liver manipulation. It held the liver stably and less invasively and transferred forceps operation force to the liver surface well.
腹腔镜肝切除术中的非侵入性和稳定性是重要问题。不合适的抓握力可能会导致肝脏损伤或严重出血。此外，抓握的不稳定性可能会导致操作不安全或切割不稳定。我们提出了一种手术器械来改善肝脏操作的稳定性。
提出的装置通过吸力固定附着在肝脏表面上，然后调整其刚度使其变硬，并在肝脏表面上形成凸起形状，以便用腹腔镜夹抓住。它由两个软梁、一个腔海绵、覆盖装置上部的膜、郊区挤压翼膜、一个真空管和待抓握的棒组成。梁设计为不可拉伸且易于弯曲。该装置连接到医用真空泵以抽空装置中的空气，然后变硬以很好地传递夹操作。这种气动控制的刚度调节机构使该装置具有良好的肝脏形状跟随性和较少侵入性的夹操作传播性。该装置在橡胶体模和猪肝上进行了形状跟随性、刚度转换、肝脏侵入性和操作可用性的测试实验。
在实验中评估了所提出的装置的性能。该装置显示出良好的物体形状跟随性。它在垂直提升时用 2.43-N 的力抓住肝脏，在 -80kPa 的抽吸压力下用 4.90-N 的剪切力抓住肝脏。侵入性降低到可接受的肝脏损伤水平。在可用性测试中，该装置稳定地抓住肝脏，并很好地将手术夹操作传递到肝脏表面。
所提出的装置在改善腹腔镜肝操作方面表现出有效的性能。它稳定地抓住肝脏，侵入性较小，并很好地将夹操作力传递到肝脏表面。
