In vivo validation of a system for haptic feedback of tool vibrations in robotic surgery

Abstract

Background

Robotic minimally invasive surgery (RMIS) lacks the haptic (kinesthetic and tactile) cues that surgeons are accustomed to receiving in open and laparoscopic surgery. We previously introduced a method for adding tactile and audio feedback of tool vibrations to RMIS systems, creating sensations similar to what one feels and hears when using a laparoscopic tool. Our prior work showed that surgeons performing box-trainer tasks significantly preferred having this feedback and believed that it helped them concentrate on the task, but we did not know how well our approach would work in a clinically relevant setting. This study constituted the first in vivo test of our system.

Methods

Accelerometers that measure tool vibrations were mounted to the patient-side manipulators of a da Vinci S surgical system. The measured vibrations were recorded and presented to the surgeon through vibrotactile and audio channels while two transperitoneal nephrectomies and two mid-ureteral dissections with uretero-ureterostomy were completed on a porcine model. We examined 30 minutes of resulting video to identify and tag manipulation events, aiming to determine whether our system can measure significant and meaningful tool vibrations during in vivo procedures.

Results

A total of 1,404 manipulation events were identified. Analysis of each event’s accelerations indicated that 82 % of these events resulted in significant vibrations. The magnitude of the accelerations measured for different manipulation events varied widely, with hard contact causing the largest cues.

Conclusions

This study demonstrates the feasibility of providing tool vibration feedback during in vivo RMIS. Significant tool vibrations were reliably measured for the majority of events during standard urological procedures on a porcine model, while real-time, naturalistic tactile and audio tool vibration feedback was provided to the surgeon. The feedback system’s modules were easily implemented outside the sterile field of the da Vinci S and did not interfere with the surgical procedure.

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Acknowledgments

The authors thank Aly Kozieja, April Laskow, and Thad Henninger for their assistance in completing the reported procedures. We also thank Paul Martin, Dorsey Standish, and Pierre J. Mendoza for their contributions to the development of the VerroTouch system. This research was supported by a Coulter Translational Research Award, the Pennsylvania Department of Health via Health Research Formula Funds, and the National Science Foundation via grant #IIS-0845670. The University of Pennsylvania institutional animal care and use committee approved this investigation via protocol #802129.

Disclosures

Karlin Bark, William McMahan, Austin Remington, Jamie Gewirtz, and Alexei Wedmid have no conflicts of interest or financial ties to disclose. Professor Katherine J. Kuchenbecker has lectured at Lankenau Hospital in Philadelphia, receiving financial compensation. Professor Kuchenbecker has no stock ownership, equity interests, patent-licensing arrangements, or the like that might pose a conflict of interest in connection with this work, nor have her disclosures influenced the scientific work. Dr. David I. Lee has served as meeting participant and lecturer at Intuitive Surgical, Ethicon, and Aureon, and participated in scientific studies and trials at Johnson and Johnson and Pfizer. Dr. Lee has no stock ownership, equity interests, patent-licensing arrangements, or the like that might pose a conflict of interest in connection with this work, nor have his disclosures influenced the scientific work.

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Correspondence to Katherine J. Kuchenbecker.

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Bark, K., McMahan, W., Remington, A. et al. In vivo validation of a system for haptic feedback of tool vibrations in robotic surgery. Surg Endosc 27, 656–664 (2013). https://doi.org/10.1007/s00464-012-2452-8

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Keywords

  • Touch
  • Technology assessment
  • Biomedical
  • Robotics/instrumentation
  • Feedback/sensory