An evaluation of the benefits of tactile feedback in robotic surgery

描述（由申请人提供）：腹腔镜微创手术（MIS）彻底改变了手术护理，减少了患者创伤，减少了药物需求，缩短了恢复时间。机器人微创手术提供了优于传统腹腔镜技术的优势，例如改进的腕部可操作性、立体视频显示以及手术手势的缩放以提高精度。尽管有这些优点，机器人手术的应用不成比例地局限于泌尿外科手术。触觉反馈的增加将使外科医生能够以较小的夹持力操纵组织，显著降低在较长手术中可能发生的组织损伤和疲劳的可能性，并加速其扩展到其他微创专业。在过去的四年中，我们在加州大学洛杉矶分校先进外科和介入技术中心（CASIT）的团队开发了一个完整的触觉反馈系统1，包括一个基于气球的触觉显示器，气动和电子控制系统，以及一个修改为阵列配置的商用力传感器。该系统测量腹腔镜抓钳尖端的力，并向手术外科医生的指尖提供成比例的力。该系统与da芬奇手术系统集成，我们的团队首次发现，触觉反馈在腹腔镜手术（FLS）训练任务的基础上显著降低了握力，而不会改变性能。握力从已知的组织损伤范围降低到组织安全范围。2 NIH R21提案的目的是通过在猪模型中进行关于握力和训练的研究，评估触觉反馈在体内环境中的益处。据推测，这种触觉反馈系统的成功应用将导致在手术操作期间减少夹持力并提高精度和控制，从而减少组织损伤并更快地完成任务。[补充：该提案的结果将为下一代尖端安装式触觉传感器的设计提供必要的信息，这对传感器系统的未来改进至关重要。 公共卫生相关性：机器人手术已被用于许多外科手术。人们普遍认为，与机器人手术相关的最重要的技术缺点之一是完全缺乏触觉反馈。将触觉反馈添加到机器人手术系统具有提高现有机器人手术系统的精度和控制的潜力。 手术过程，以减少组织损伤的发生，并减少与较长手术相关的疲劳。改进的控制还可以减少与机器人手术相关联的学习曲线，并促进其扩展到更广泛的程序。

DESCRIPTION (provided by applicant): Laparoscopic minimally invasive surgery (MIS) has revolutionized surgical care, reducing trauma to the patient, decreasing the need for medication, and shortening recovery times. Robotic minimally invasive surgery offers advantages over traditional laparoscopic techniques, such as improved wrist-like maneuverability, stereoscopic video displays, and scaling of surgical gestures to increase precision. Despite these advantages, the application of robotic surgery is disproportionately limited to urologic procedures. The addition of tactile feedback will allow surgeons to manipulate tissue with reduced grip force, significantly reducing the probability of causing tissue damage and the fatigue that may occur in longer procedures, and accelerating its expansion into other minimally invasive specialties. Over the previous four years, our group at the UCLA Center for Advanced Surgical and Interventional Technology (CASIT) has developed a complete tactile feedback system1, including a balloon-based tactile display, pneumatic and electronic control systems, and a commercial force sensor modified into an array configuration. The system measures forces at the tips of a laparoscopic grasper and provides proportional forces to the fingertips of the operating surgeon. The system was integrated with the da Vinci Surgical system, and our group discovered for the first time that tactile feedback produced a significant reduction in grip forces during Fundamentals of Laparoscopic Surgery (FLS) training tasks without altering performance. The reduction in grip forces was from a known tissue-damaging range into a tissue-safe range.2 the objective of this NIH R21 proposal is to evaluate the benefit of tactile feedback in an in-vivo environment, by performing studies concerning grip force and training in a porcine model. It is hypothesized that the successful application of this tactile feedback system will result in reduced grip force and improved precision and control during surgical manipulation, thus resulting in reduced tissue damage and quicker task completion. [Added: Results from this proposal will provide information that is essential for design of the next generation of tip-mounted tactile sensors, which is critical for future improvements in sensor systems.] PUBLIC HEALTH RELEVANCE: Robotic surgery has been adopted for numerous surgical procedures. It is widely cited that one of the most significant technical disadvantages associated with robotic surgery is the complete lack of haptic feedback. The addition of tactile feedback to robotic surgical systems has the potential to improve the precision and control of existing robotic surgery procedures, to reduce the occurrence of tissue damage, and to reduce the fatigue associated with longer procedures. The improved control may also reduce the learning curve associated with robotic surgery, and facilitate its expansion to a wider range of procedures.