Evaluation of Haptic Feedback on Bimanually Teleoperated Laparoscopy for Endometriosis Surgery

Abstract

Robotic minimal invasive surgery is gaining acceptance in surgical care. In contrast with the appreciated three-dimensional vision and enhanced dexterity, haptic feedback is not offered. For this reason, robotics is not considered beneficial for delicate interventions such as the endometriosis. Overall, haptic feedback remains debatable and yet unproven except for some simple scenarios such as fundamentals of laparoscopic surgery exercises. Objective: This work investigates the benefits of haptic feedback on more complex surgical gestures, manipulating delicate tissue through coordination between multiple instruments. Methods: A new training exercise, “endometriosis surgery exercise” (ESE) has been devised approximating the setting for monocular robotic endometriosis treatment. A bimanual bilateral teleoperation setup was designed for laparoscopic laser surgery. Haptic guidance and haptic feedback are, respectively, offered to the operator. User experiments have been conducted to assess the validity of ESE and examine possible advantages of haptic technology during execution of bimanual surgery. Results: Content and face validity of ESE were established by participating surgeons. Surgeons suggested ESE also as a mean to train lasering skills, and interaction forces on endometriotic tissue were found to be significantly lower when a bilateral controller is used. Collisions between instruments and the environment were less frequent and so were situations marked as potentially dangerous. Conclusion: This study provides some promising results suggesting that haptics may offer a distinct advantage in complex robotic interventions were fragile tissue is manipulated. Significance: Patients need to know whether it should be incorporated. Improved understanding of the value of haptics is important as current commercial surgical robots are widely used but do not offer haptics.

Tool-tissue forces in surgery: A systematic review

“…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 , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] ] 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) [ <...>…”

“…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] , [18] , [19] , [20] , 24 , 26 , 28 , [30] , [31] , [32] , [33] , [34] , [37] , [38] , [39] , [40] , [41] , [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] , …”

“…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%) [ 39 , 45 ], orthopaedics (n = 2, 4.4%) [ 47 , 48 ], otorhinolaryngology (n = 2, 4.4%) [ 36 , 46 ] and urology (n = 1, 2.2%) [ 24 ]. Ten studies (22.2%) involved robotic surgery platforms [ 1 , 14 , [17] , [18] ,…”

Haptic Intracorporeal Palpation Using a Cable-Driven Parallel Robot: A User Study

“…Improved accuracy [47] and decreased applied forces [48] have also been valued as haptic feedback benefits in other surgical tasks, such as dissection, suturing, and in more complex tasks, e.g. teleoperated laparoscopy for endometriosis surgery [49]. Other research has provided similar evidence using the direct force feedback approach for palpation [17].…”

Discrete Sliding Mode Control Design for Bilateral Teleoperation System via Adaptive Extended State Observer

“…A representative nonlinear bilateral teleoperation system consists of the following five parts: human operator, master robot, the network communication channel, slave robot, and remote environment. In recent years, the potential applications of teleoperation systems are in the various fields, i.e., the remote handling of hazardous materials [ 1 ], underwater maintenance and repairing tasks [ 2 ], space exploration [ 3 ], telemedicine [ 4 ], and so on. In all of these applications, the tasks occur in long-distance and/or hazardous environments.…”