An evaluation of the benefits of tactile feedback in robotic surgery

描述(申请人提供)：腹腔镜微创手术(MIS)彻底改变了外科护理，减少了对患者的创伤，减少了药物需求，并缩短了康复时间。机器人微创手术比传统的腹腔镜技术具有优势，例如改善了手腕状的可操作性，立体视频显示，以及通过缩放手术手势来提高精度。尽管有这些优势，机器人手术的应用还是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更小的握力操纵组织，显著降低导致组织损伤和在较长程序中可能发生的疲劳的可能性，并加快向其他微创专业的扩展。在过去的四年里，我们在加州大学洛杉矶分校高级外科和介入技术中心(CASIT)的团队开发了一套完整的触觉反馈系统1，包括基于气球的触觉显示器、气动和电子控制系统，以及改装成阵列配置的商用力传感器。该系统测量腹腔镜抓取器尖端的力，并向手术医生的指尖提供成比例的力。该系统与达芬奇外科系统集成在一起，我们的团队首次发现，在不改变性能的情况下，在腹腔镜手术(FLS)的基础训练任务中，触觉反馈可以显著降低握力。握力的减少是从已知的组织损伤范围进入组织安全范围2 NIH R21提案的目的是通过在猪模型中执行关于握力和训练的研究来评估在活体环境中触觉反馈的益处。据推测，这种触觉反馈系统的成功应用将减少握力，提高手术操作的精确度和控制力，从而减少组织损伤和更快地完成任务。[补充：这项提案的结果将提供对设计下一代尖端安装式触觉传感器至关重要的信息，这对传感器系统的未来改进至关重要。] 与公共卫生相关：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大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中有可能提高现有机器人的精度和控制 手术程序，以减少组织损伤的发生，并减少与较长程序相关的疲劳。改进的控制还可以减少与机器人手术相关的学习曲线，并促进其扩展到更广泛的程序范围。

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.