IEEE Trans Biomed Eng. 2020 Dec;67(12):3452-3463. doi: 10.1109/TBME.2020.2987646. Epub 2020 Nov 19.
Intraoperative palpation is a surgical gesture jeopardized by the lack of haptic feedback which affects robotic minimally invasive surgery. Restoring the force reflection in teleoperated systems may improve both surgeons' performance and procedures' outcome.
A force-based sensing approach was developed, based on a cable-driven parallel manipulator with anticipated seamless and low-cost integration capabilities in teleoperated robotic surgery. No force sensor on the end-effector is used, but tissue probing forces are estimated from measured cable tensions. A user study involving surgical trainees (n = 22) was conducted to experimentally evaluate the platform in two palpation-based test-cases on silicone phantoms. Two modalities were compared: visual feedback alone and both visual + haptic feedbacks available at the master site.
Surgical trainees' preference for the modality providing both visual and haptic feedback is corroborated by both quantitative and qualitative metrics. Hard nodules detection sensitivity improves (94.35 ± 9.1% vs 76.09 ± 19.15% for visual feedback alone), while also exerting smaller forces (4.13 ± 1.02 N vs 4.82 ± 0.81 N for visual feedback alone) on the phantom tissues. At the same time, the subjective perceived workload decreases.
Tissue-probe contact forces are estimated in a low cost and unique way, without the need of force sensors on the end-effector. Haptics demonstrated an improvement in the tumor detection rate, a reduction of the probing forces, and a decrease in the perceived workload for the trainees.
Relevant benefits are demonstrated from the usage of combined cable-driven parallel manipulators and haptics during robotic minimally invasive procedures. The translation of robotic intraoperative palpation to clinical practice could improve the detection and dissection of cancer nodules.
术中触诊是一种手术动作，由于缺乏触觉反馈而受到影响，这会影响机器人微创手术。在遥操作系统中恢复力反射可能会提高外科医生的手术效果和手术结果。
开发了一种基于力的传感方法，该方法基于一种电缆驱动的并联机器人，具有在遥操作机器人手术中预期的无缝和低成本集成能力。末端执行器上不使用力传感器，而是从测量的电缆张力估计组织探测力。一项涉及外科实习生（n=22）的研究通过在硅胶模型上进行两项基于触诊的测试案例，对该平台进行了实验评估。比较了两种模式：仅视觉反馈和主站点同时提供视觉和触觉反馈。
外科实习生对提供视觉和触觉反馈的模式的偏好，得到了定量和定性指标的证实。硬结节检测灵敏度提高（94.35±9.1%比单独视觉反馈的 76.09±19.15%），同时对模型组织施加的力也更小（4.13±1.02 N 比单独视觉反馈的 4.82±0.81 N）。同时，主观感知的工作量也降低了。
以低成本和独特的方式估计组织探头接触力，而无需末端执行器上的力传感器。触觉在提高肿瘤检测率、降低探测力和降低实习生感知的工作负荷方面表现出了优势。
在机器人微创手术过程中使用组合的电缆驱动并联机器人和触觉，证明了相关的益处。将机器人术中触诊转化为临床实践，可以提高癌症结节的检测和分离。
