Laparoscopic Forceps with Force Feedback
There are two main aspects of safety and effectiveness in laparoscopic surgery. The first is ensuring an appropriate operation field and maintaining this throughout the procedure. The second is finding the correct tissue plane and applying appropriate traction and counter-traction. To accomplish these requirements, surgeons must know the appropriate pressure to apply to the target organ or tissue. For example, weak operation of the forceps in the left hand during laparoscopic surgery leads to poor visibility owing to a small operational field. Furthermore, poor traction at the point of incision on the dissected plane decreases the dissection efficiency. In contrast, when excessive force is applied, there is an increased risk of organ injury or bleeding from capillary vessels during traction; this is clearly detrimental to the overall safety of the procedure. It is difficult for surgeons to master a feeling for the appropriate pressure to apply. Imitating the techniques of skilled surgeons is essential; however, surgical techniques cannot be imitated on first sight. With the aim of assisting this learning process, we developed Forceps Guiding Correct Operation (FOGCOP), new laparoscopic forceps with sensors. Although they are the same shape as Maryland dissecting forceps, FOGCOP can measure the pressure applied on the shaft of the forceps in three axis directions (X, Y, and Z) and on the jaw. The measured pressures are displayed in real time. Surgeons can insert this device into a 5-mm trocar in the same manner as normal forceps. We conducted experiments to verify the effectiveness of the device. 30 students with no experience of laparoscopic surgery participated in this study. Using a training box, students performed a task to press and pull a rubber plate. We compared the performance of a group of students using FOGCOP (group 1, n = 10) with that of a group using conventional forceps (group 2, n = 10). The results suggest that the feedback provided by FOGCOP may be useful for understanding the force delivered by forceps. To verify the usefulness of the device, FOGCOP was also used in laparoscopic nephrectomy of a pig, a procedure that is part of the training course for laparoscopic surgery. It was possible to dissect a tissue plane in the same manner as with conventional forceps. However, the wire from the sensor sometimes interfered with operation. In future, we intend to upgrade FOGCOP by including a wireless sensor, to improve operability to be closer to that of normal forceps, and to allow this device to be used as an educational tool.
KeywordsLaparoscopic surgery Force feedback Education
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