Tensile strength and failure load of sutures for robotic surgery.
Tensile strength and failure load of sutures for robotic surgery.
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DOI：
10.1007/s00464-016-5356-1
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发表时间：
2017-08
期刊：
影响因子：
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通讯作者：
Dutson EP
中科院分区：
文献类型：
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作者：
Abiri A;Paydar O;Tao A;LaRocca M;Liu K;Genovese B;Candler R;Grundfest WS;Dutson EP
机器人手术平台在微创胃肠外科医生中的使用越来越多。然而，这些系统仍然缺乏触觉反馈，导致过度用力，经常导致缝合失败。这项工作对常用缝合线的抗张强度和破坏载荷进行了分类，以努力防止机器人操作台超过确定的阈值。因此，在不同材料类型、规格大小、拉力速率和施力方法的常见缝合线上进行了试验。使用商用机械测试系统，将聚二氧六环、丝绸、维克瑞基和普鲁兰，量规5-0到1-0拉至失效。在50 mm/min、200 mm/min和400 mm/min的速率下，进一步测试2-0和3-0缝合对破坏载荷的影响。使用达芬奇机器人手术系统，在无环、有环和针体布置下，也将3-0线拉至失败。一般来说，Vicryl和PDS缝线的机械强度最高(47~179 kN/cm2)，Silk最低(40~106 kN/cm2)。更大直径的缝合线可以承受更大的总力，但更细的缝合线始终显示出更高的单位面积力。随着直径的减小，材料类型之间的差异变得越来越明显。相同的缝合材料和压力计的比较表明，抗拉强度比1985年的数据提高了27-50%。在不同的拉线速度下，没有观察到明显的差异。缝合强度的降低似乎受到缝合操作技术的强烈影响。缝合拉伸强度和失败负荷数据的可用性将有助于定义软件安全协议，以便在机器人手术过程中缝合失败之前向外科医生发出警报。意识到直接操作器械会削弱缝线强度，可能会导致更好的技术的发展，以进一步减少术中缝线断裂。
Robotic surgical platforms have seen increased use amongst minimally invasive gastrointestinal surgeons. However, these systems still suffer from lack of haptic feedback, which results in exertion of excessive force, often leading to suture failures. This work catalogs tensile strength and failure load amongst commonly used sutures in an effort to prevent robotic surgical consoles from exceeding identified thresholds. Trials were thus conducted on common sutures varying in material type, gauge size, rate of pulling force, and method of applied force. Polydioxane, Silk, Vicryl, and Prolene, gauges 5-0 to 1-0, were pulled till failure using a commercial mechanical testing system. 2-0 and 3-0 sutures were further tested for the effect of pullrate on failure load at rates of 50 mm/min, 200 mm/min, and 400 mm/min. 3-0 sutures were also pulled till failure using a da Vinci robotic surgical system in un-looped, looped, and at the needle body arrangements. Generally, Vicryl and PDS sutures had the highest mechanical strength (47 to 179 kN/cm2), while Silk had the lowest (40 to 106 kN/cm2). Larger diameter sutures withstand higher total force, but finer gauges consistently show higher force per unit area. The difference between material types becomes increasingly significant as the diameters decrease. Comparisons of identical suture materials and gauges show 27–50% improvement in the tensile strength over data obtained in 1985. No significant differences were observed when sutures were pulled at different rates. Reduction of suture strength appeared to be strongly affected by the technique used to manipulate the suture. Availability of suture tensile strength and failure load data will help define software safety protocols for alerting a surgeon prior to suture failure during robotic surgery. Awareness of suture strength weakening with direct instrument manipulation may lead to development of better techniques to further reduce intraoperative suture breakage.