Impact of haptic feedback on applied intracorporeal forces using a novel surgical robotic system—a randomized cross-over study with novices in an experimental setup

Abstract

Background Most currently used surgical robots have no force feedback; the next generation displays forces visually. A novel single-port robotic surgical system called FLEXMIN has been developed. Through an outer diameter of 38 mm, two instruments are teleoperated from a surgeon’s control console including true haptic force feedback. One additional channel incorporates a telescope, another is free for special instrument functions. Methods This randomized cross-over study analyzed the effect of haptic feedback on the application of intracorporeal forces. In a standardized experiment setup, the subjects had to draw circles with the surgical robot as gently as possible. The applied forces, the required time spans, and predefined error rates were measured. Results Without haptic feedback, the maximum forces (median/IQR) were 6.43 N/2.96 N. With haptic feedback, the maximum forces were lower (3.57 N/1.94 N, p < 0.001). Also, the arithmetic means of the force progression (p < 0.001) and their standard deviations (p < 0.001) were lower. Not significant were the shorter durations and lower error rates. No sequence effect of force or duration was detected. No characteristic learning or fatigue curve was observed. Conclusions In the experiment setup, the true haptic force feedback can reduce the applied intracorporeal robotic force to one-half when considering the aspects maximum, means, and standard deviation. Other test tasks are needed to validate the influence of force feedback on surgical efficiency and safety.

Crossover-effects in technical skills between laparoscopy and robot-assisted surgery

“…This is caused by the loss of tactile and haptic feedback. Although RAS has the advantage in accuracy and more precise handling of instruments, the sensory feedback [6][7][8], which results in dangerously high force application on the tissues. Haptic force feedback during training has the potential to limit the applied intracorporeal forces, with a decrease up to 44% [8].…”

“…Utilizing a robotic system does impact the posture of the surgeon leading to different muscle stress locations and differences in fatigue progression [4,5]. Moreover, RAS gives a different touch and feel of the instruments, the tissues and its environment due to the absence of tactile and haptic feedback [6][7][8].…”

Evaluation of different setting configurations with a new developed telemedical interface of a parallel kinematic robotic system – An experimental development study

“…The manual input device consisted of a pen-tweezers hybrid, which allows movement in 3 directions, the X, Y, and Z axis, with additional rotational capability, which is achieved via suspension through 2 universal joints (Figure 2). 27,28 Two tweezer-like feelers achieve precise control of the gripping movement of the end effectors. In addition, concerning the literature research, attention was paid to the highest possible adaptability in height and spatial orientation of the individual components of the MU.…”

An Introduction to Robotically Assisted Surgical Systems: Current Developments and Focus Areas of Research

“…to classify tissue by palpation or in vascular surgery to palpate for bifurcations by tactile impressions when advancing a guide wire. While several studies indicated potential benefits of haptic feedback [75][76][77], the development of suitable costeffective, sterilizable or disposable miniaturized sensors for the integration into robotic instruments still remains a technological challenge [78][79][80]. However, some interesting concepts for a novel force-sensing laparoscopic instrument and the integration of force sensing capabilities into the trocar have been developed recently [81,82].…”