Dynamic analysis of surgical incision in head and neck surgery by using force sensing knife

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1. Objectives of the studyIn surgery, making the skin incision is a basic technique. However, the quality, methods, techniques, and depth of incision are usually evaluated empirically. There has been little scientific analysis of the force applied to the knife during incision and its dynamic effect on the tissues and organs. Before performing a dynamic analysis of the process of surgical incision, we prepared 1) a knife with a biaxial force sensor that measured the force in two directions and 2) a biaxial tension measurement system that could assess the tension applied to the skin during incision. We then carried out a dynamic analysis of surgical incision using the sensor knife.2. Preparation of the biaxial sensor knife and biaxial skin tension sensorThe sensor knife and the skin tension sensor were prepared utilizing the principle that a parallel metal plate subjected to mechanical force converts the stress to electric current, enabling detection of the force. We attached such a sensor to a knife and tension meter.3. Results1) Incision was performed in a shank of beef using the sensor knife and tension sensor. One incision was made parallel to the muscle fibers and one was made perpendicular to the fibers. It was found that the parallel incision required less force than the perpendicular incision.2) When tension was applied across the incision, less force was needed for cutting than without tension.3) When starting the incision, vertical force was applied. As the incision proceeded, horizontal force was applied that was almost equivalent to the vertical force.4) For clinical skin incision during head and neck surgery, the results of this study suggest that the tension applied to the skin via the thumb and index finger should be almost equal.5) When making an incision, the initial vertical force on the knife was increased and then the horizontal force was increased. It was found that the incision force was greater for the skin than for adipose tissue.