Stiffness Assessment and Lump Detection in Minimally Invasive Surgery Using In-House Developed Smart Laparoscopic Forceps

Abstract

Minimally invasive surgery (MIS) incorporates surgical instruments through small incisions to perform procedures. Despite the potential advantages of MIS, the lack of tactile sensation and haptic feedback due to the indirect contact between the surgeon’s hands and the tissues restricts sensing the strength of applied forces or obtaining information about the biomechanical properties of tissues under operation. Accordingly, there is a crucial need for intelligent systems to provide an artificial tactile sensation to MIS surgeons and trainees. This study evaluates the potential of our proposed real-time grasping forces and deformation angles feedback to assist surgeons in detecting tissues’ stiffness. A prototype was developed using a standard laparoscopic grasper integrated with a force-sensitive resistor on one grasping jaw and a tunneling magneto-resistor on the handle’s joint to measure the grasping force and the jaws’ opening angle, respectively. The sensors’ data are analyzed using a microcontroller, and the output is displayed on a small screen and saved to a log file. This integrated system was evaluated by running multiple grasp-release tests using both elastomeric and biological tissue samples, in which the average force-to-angle-change ratio precisely resembled the stiffness of grasped samples. Another feature is the detection of hidden lumps by palpation, looking for sudden variations in the measured stiffness. In experiments, the real-time grasping feedback helped enhance the surgeons’ sorting accuracy of testing models based on their stiffness. The developed tool demonstrated a great potential for low-cost tactile sensing in MIS procedures, with room for future improvements. Significance: The proposed method can contribute to MIS by assessing stiffness, detecting hidden lumps, preventing excessive forces during operation, and reducing the learning curve for trainees.

An intelligent grasper to provide real-time force feedback to shorten the learning curve in laparoscopic training

“…In the past few decades, Minimally Invasive Surgery (MIS) has changed the surgical process [ 1 – 3 ], greatly improving the implementation of MIS in general surgery, gynecology, cardiothoracic surgery, colorectal surgery and urological surgery [ 4 – 7 ]. MIS has many advantages, such as small wound, quickly recovery, etc [ 1 , 8 ]. However, the lack of force feedback, even completely lose in Robot-assisted minimally invasive surgery (RMIS), during operation restricts its development [ 9 ] and affects the training of novices’ operating during MIS to some extent.…”

Research on force and position control performance of the tendon sheath system with time‐varying parameters and flexible robotic arms

“…Laparoscopic surgery is a high‐tech method with great potential to treat patients with abdominal diseases 1 . The surgeons uses an endoscope and two or three flexible manipulators to complete a series of surgical tasks such as in vivo examination, suturing, and knot‐tying through a small abdominal incision.…”

‘Now you can see me, now you don’t’: seeking the invisible lung nodule

“…However, VATS is definitely not a panacea and it actually has a number of technical drawbacks [ 1 , 2 , 4 ]. One of the main ones is the loss of 3D vision [ 2 , 4 ].…”

“…However, VATS is definitely not a panacea and it actually has a number of technical drawbacks [ 1 , 2 , 4 ]. One of the main ones is the loss of 3D vision [ 2 , 4 ]. The image the surgeon sees to operate by is captured, transmitted and projected onto a 2D monitor resulting in the loss of depth judgement and a reduced visual field [ 4 ].…”

“…Another significant limitation of MIS is the lack of tactile sense during tool—tissue interaction that severely impairs the surgeon’s ability to control the applied forces—and thus can cause unintentional damage or additional trauma to healthy tissues [ 1 ]. Tactile sensation is crucial not only for safely manipulating organs, structures, tissues and sutures but also for getting reliable information about the thickness, stiffness and texture of tissues through palpation, which is crucial for tumour detection [ 2 ].…”