Development of an Instrumented Surgical Setup for Quantifying Displacement and Force in Surgical Dissection

Abstract

Knowledge of positional and force properties of surgical dissection in neurosurgery is essential in developing simulation platforms for neurosurgical training such that realistic motion and perception can be conveyed to the trainee during practice. Most proposed models in literature utilize computational techniques to formulate required parameters. However, these models are not realistic enough compared to data obtained from experiments on real brain. Therefore, developing a setup to measure the position, orientation, and interaction forces will help researchers formulate realistic parameters. This paper presents the development of such a setup for quantification of displacements and tool-tissue interaction forces during performance of microsurgical tasks. A bipolar forceps is equipped with a set of force sensing elements to measure the tool-tissue interaction force components. The position and orientation of the forceps tips are measured by attaching a tracker to the bipolar forceps. To show proof-of-concept, an experienced surgeon and one assistant surgeon performed 35 neurosurgical tasks (320 trials) on a cadaver brain (previously-frozen) using the instrumented setup. Positional and force data of the bipolar forceps were recorded during surgical dissection of different brain structures. This paper reports results collected from two microsurgical tasks over 40 trials: dissection of sylvian cistern arachnoid (SCA) and dissection of middle cerebral artery (MCA). Results showed that the mean values of interaction forces during dissection of MCA were smaller than dissecting SCA. The maximum forces observed were 1.94 N and 1.75 N for SCA and MCA, respectively. The application of quantifying such parameters using the developed setup will be in training neurosurgery residents using surgical simulators in which the knowledge of brain tissue parameters is required to formulate the tissue model.

662 Tool-tissue Forces in Surgery: A Systematic Review

“…1). In regard to study demographics, all studies were primarily conducted at North American (n = 19) [2,4,14,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] or European (n = 26) [1,3,5, institutions (Supplementary Information 2). Articles were published in medical (n = 26) [2][3][4]14,[21][22][23]25,27,29,35,36,43,[46][47][48][49]51,53] or engineering (n = 19) [1,5,17-20,24,26,28,30-34, 37-42,44,45,50,52,54,55] journals between 1999 and 2020 (Supplementary Information 3).…”

“…Articles were published in medical (n = 26) [2][3][4]14,[21][22][23]25,27,29,35,36,43,[46][47][48][49]51,53] or engineering (n = 19) [1,5,17-20,24,26,28,30-34, 37-42,44,45,50,52,54,55] journals between 1999 and 2020 (Supplementary Information 3). Evidently, this is a new and expanding field, with more articles published in the last 5 years (n = 24) [2][3][4]14,17,19,22,23,25,26,28,[32][33][34][35]39,41,[45][46][47]50,[53][54][55] than the previous years combined (n = 21) [1,5,18,20,21,24,27,29-31,36-38,40,42-44, 48,49,51,52] (Supplementary Information 3).…”

“…In terms of surgical specialty (Supplementary Information 2, Table 1), the highest proportion of studies (in-vivo and ex-vivo models) were in general surgery (n = 14, 31.1%) [3,5,20,26,27,35,38,[41][42][43]49,51,54] with the majority of these involving laparoscopic procedures (n = 11) [3,5,26,34,38,[41][42][43]49,54,55]; followed by neurosurgery (n = 13, 28.89%) [1,2,4,14,22,23,25,28,33,37,44,52], ophthalmology (n = 5, 11.11%) [17][18][19]21,32], cardiothoracic (n = 3, 6.67%) [26,30,53], vascular surgery (n = 3, 6.67%) [29,40,50], obstetrics & gynaecology (n = 2, 4.4%)…”

“…2. Generally, across tasks and models, specialities requiring the smallest amount of mean forces were: ophthalmology (mean of average 0.04N) [17][18][19]21,32], vascular (mean of average 0.07N) [29,40,50], neurosurgery (mean of average 0.68N) [1,2,4,14,22,23,25,28,33,37,44,52] and cardiothoracic surgery (mean of average 1.47N) [26,30,53]. Higher mean of average forces, in ascending order, were seen in general surgery (mean of average 4.67N) [3,5,20,26,27,35,38,[41][42][43]49,51,54], otorhinolaryngology (mean of average 8.49N) [36,46], obstetrics and gynaecology (mean of average 8.69N) [39,45], urology (mean of average 9.79N) [24] and orthopaedic surgery (mean of average 210N) [47,48].…”

“…Across specialities and manoeuvres, nervous tissue (principally the brain & retina) required the least amount of force to manipulate (mean of average 0.4N, mean max 1.74N, n = 17) [1,2,4,[17][18][19][21][22][23]25,28,32,33,37,44,52] with retinal forces always below 0.01N (Table 1) [17][18][19]21,32]. Mean forces applied on epithelial tissues were higher (mean of average 3.8N, mean max 9.7N, n = 18) [3,14,20,24,26,27,29,35,38,[40][41][42][43]45,50,51,54], followed by muscle (mean of average 4.1N, mean max 6.7N, n = 3) [5,49,51], and connective tissue including bone (mean of average 45.8N, mean max 347.9N, n = 10) [20,26,30,31,36,…”