11-04-2012, 02:56 PM
Haptics in minimally invasive surgery
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Introduction
Minimally invasive surgery (MIS), which is surgery
performed with long thin instruments through small
incisions, has been used for more than 25 years. The
main reason for the rapid developments in MIS are
the benefits for the patient, such as less trauma,
shorter hospital stay, and reduced recovery time (1–
5). However, this technique brings severe difficulties
for the surgeon (6), which in turn can lead to a
higher number of errors and complications (7).
Interference components of haptic sensation
Items, attributes and techniques establish the link
between the surgeon’s hands and the treated tissue,
thereby interfering with the desired haptic perception
(see Figure 1). These interference factors
consist of the following components (see Figure 2
for an overview of the interference factors in
conventional MIS).
Results
Haptic sensation in conventional minimally invasive surgery (MIS)
In theory, a surgeon wants to feel the forces, position
and tactile information generated by the instruments
applied on the tissue in order to control them. The
ability to feel texture, shape, size and consistency of
tissue using MIS graspers has been studied (25–29).
These studies show that haptics are considerably
reduced compared to bare hands, except for texture
discrimination, although one is able to distinguish
shape, size and consistency of tissue. Unfortunately,
all these studies used artificial tissue like sandpaper
and plastic cubes and cones.
Haptic sensation in minimally invasive roboticsurgery (MIRS)
In MIRS the instrument (slave) and handgrip
(master) are physically disconnected, called a master-
slave system (Figure 3). The master is held by
the surgeon and dictates movements to the slave that
controls the instrument via an electromechanical
device. The advantage of this system is that it
compensates for some of the interference factors
described earlier. An example is the simplicity to
neutralize the mirroring effect by software.
Conclusion
Augmented force information can aid performance in
all fields of minimally invasive surgery, and surgeons
benefit from the additional feedback of force information.
This information should be presented by a haptic
display because of its intuitive nature, but a multisensory
display might be preferable. In general, little
research has been done in the field of augmented
haptics during MIS. Especially when it comes to
grasping forces and the perception of slips, little is
known about the advantages additional haptic information
can give to prevent tissue trauma during
manipulation. Improvement of haptic perception by
means of augmenting haptic information feedback to
MIS might be promising for patient safety.