Effect of laparoscopic grasper force transmission ratio on grasp control

Putten, Eleonora P. Westebring-van der; Dobbelsteen, John J. van den; Goossens, Richard; Jakimowicz, Jack J.; Dankelman, Jenny

doi:10.1007/s00464-008-0107-6

Cited by 34 publications

(14 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The mechanical efficiency (i.e. the force transmission ratios resulting from a combination of frictional losses, force multiplication factors and hysteresis) of each grasper was determined by measuring pinch force at the tip when handle forces were varied (for a full description see (Westebring-van der Putten et al 2009). In order to generate the same tip force, the high-efficient grasper (GH) required less effort (the force transmission ratio during a squeeze and release action is 2.0 and 1.2 respectively) from the participant than the low-efficient grasper (GL) (the force transmission ratio during a squeeze and release action is 6.3 and 2.0 respectively).…”

Section: Instruments Usedmentioning

confidence: 99%

See 1 more Smart Citation

Force feedback requirements for efficient laparoscopic grasp control

et al. 2009

Self Cite

View full text Add to dashboard Cite

During laparoscopic grasping, tissue damage may occur due to use of excessive grasp forces and tissue slippage, whereas in barehanded grasping, humans control their grasp to prevent slippage and use of excessive force (safe grasp). This study investigates the differences in grasp control during barehanded and laparoscopic lifts. Ten novices performed lifts in order to compare pinch forces under four conditions: barehanded; using tweezers; a low-efficient grasper; and a high-efficient grasper. Results showed that participants increased their pinch force significantly later during a barehanded lift (at a pull-force level of 2.63 N) than when lifting laparoscopically (from pull-force levels of 0.77 to 1.08 N). In barehanded lifts all participants could accomplish a safe grasp, whereas in laparoscopic lifts excessive force (up to 7.9 N) and slippage (up to 38% of the trials) occurred frequently. For novices, it can be concluded that force feedback (additional to the hand-tool interface), as in skin-tissue contact, is a prerequisite to maintain a safe grasp. Much is known about grasp control during barehanded object manipulation, especially the control of pinch forces to changing loading, whereas little is known about force perception and grasp control during tool usage. This knowledge is a prerequisite for the ergonomic design of tools that are used to manipulate objects.

show abstract

Section: Instruments Usedmentioning

confidence: 99%

“…The learning curve for this task has previously been investigated by Westebring-van der Putten et al (2009). A safe lift was defined as a lift without slip and which did not exceed 10 N of pinch force.…”

Section: General Proceduresmentioning

confidence: 99%

Force feedback requirements for efficient laparoscopic grasp control

et al. 2009

Self Cite

View full text Add to dashboard Cite

show abstract

“…However, the loss of haptic feedback in minimally invasive surgery (MIS), due to resistance inside the trocars and the use of long laparoscopic instruments, hinders the estimation of applied forces in instrument–tissue interaction [4, 5]. This problem translates, for example, into more difficulties when learning to safely apply force in a laparoscopic grasp than to learn the same with barehanded lifts [6]. To facilitate training of tissue-handling skills, a force measurement platform has been developed for the box trainer [7].…”

mentioning

confidence: 99%

Suturing intraabdominal organs: when do we cause tissue damage?

et al. 2011

Self Cite

View full text Add to dashboard Cite

BackgroundIt is generally assumed that safety of tissue manipulations during (laparoscopic) surgery is related to the magnitude of force that is exerted on the tissue. To provide trainees with performance feedback about tissue-handling skills, it is essential to define objective criteria for judging the safety of applied forces. To be of clinical relevance, these criteria should relate the applied forces to the risk of tissue damage. This experimental study was conducted to determine which tractive forces during suturing cause tissue damage in different types of porcine tissues.MethodsTractive forces were applied on eight different tissue types (fascia, aorta, vena cava, peritoneum, small and large bowel, uterus, and fallopian tube) of 10 different pigs by placing increasingly higher loads on sutures in the tissue. We determined the load at what tissue damage occurred through visual inspection of the tissue. For each tissue sample, three consecutive measurements were performed.ResultsThe average maximum acceptable force varied between 11.43 N for fascia to 1.25 N for fallopian tube. The difference in allowable force between these two structures is almost tenfold. Small bowel can be handled with a tractive force almost 1.5-fold higher than large bowel.ConclusionsEach tissue type was found to have its own individual range of acceptable maximum forces before visual tissue damage occurs. With the results presented in this study, it is possible to provide clinically relevant and validated feedback to trainees about their tissue-handling skills.

show abstract

“…During laparoscopic surgery in particular, a type of indirect haptic feedback can be obtained. 15 With the robot, this type of feedback is not possible, 16,17 and its positioning (cranially) is hindering access to the patient, as in many upper GI procedures.…”

Section: Discussionmentioning

confidence: 99%