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von Bechtolsheim F, Franz A, Schmidt S, Schneider A, La Rosée F, Radulova-Mauersberger O, Krause-Jüttler G, Hümpel A, Bodenstedt S, Speidel S, Weitz J, Distler M, Oehme F. The development of tissue handling skills is sufficient and comparable after training in virtual reality or on a surgical robotic system: a prospective randomized trial. Surg Endosc 2024; 38:2900-2910. [PMID: 38632120 PMCID: PMC11078795 DOI: 10.1007/s00464-024-10842-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 04/02/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Virtual reality is a frequently chosen method for learning the basics of robotic surgery. However, it is unclear whether tissue handling is adequately trained in VR training compared to training on a real robotic system. METHODS In this randomized controlled trial, participants were split into two groups for "Fundamentals of Robotic Surgery (FRS)" training on either a DaVinci VR simulator (VR group) or a DaVinci robotic system (Robot group). All participants completed four tasks on the DaVinci robotic system before training (Baseline test), after proficiency in three FRS tasks (Midterm test), and after proficiency in all FRS tasks (Final test). Primary endpoints were forces applied across tests. RESULTS This trial included 87 robotic novices, of which 43 and 44 participants received FRS training in VR group and Robot group, respectively. The Baseline test showed no significant differences in force application between the groups indicating a sufficient randomization. In the Midterm and Final test, the force application was not different between groups. Both groups displayed sufficient learning curves with significant improvement of force application. However, the Robot group needed significantly less repetitions in the three FRS tasks Ring tower (Robot: 2.48 vs. VR: 5.45; p < 0.001), Knot Tying (Robot: 5.34 vs. VR: 8.13; p = 0.006), and Vessel Energy Dissection (Robot: 2 vs. VR: 2.38; p = 0.001) until reaching proficiency. CONCLUSION Robotic tissue handling skills improve significantly and comparably after both VR training and training on a real robotic system, but training on a VR simulator might be less efficient.
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Affiliation(s)
- Felix von Bechtolsheim
- Department of Visceral, Thoracic, and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany.
- Centre for Tactile Internet with Human-in-the-Loop (CeTI), Technische Universität Dresden, Dresden, Germany.
| | - Andreas Franz
- Department of Visceral, Thoracic, and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany
| | - Sofia Schmidt
- Department of Visceral, Thoracic, and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany
| | - Alfred Schneider
- Department of Visceral, Thoracic, and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany
| | - Felicitas La Rosée
- Department of Visceral, Thoracic, and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany
| | - Olga Radulova-Mauersberger
- Department of Visceral, Thoracic, and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany
| | - Grit Krause-Jüttler
- Department of Visceral, Thoracic, and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany
- Centre for Tactile Internet with Human-in-the-Loop (CeTI), Technische Universität Dresden, Dresden, Germany
| | - Anja Hümpel
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
| | - Sebastian Bodenstedt
- Department of Translational Surgical Oncology, National Center for Tumor Diseases (NCT/UCC Dresden), Dresden, Germany
| | - Stefanie Speidel
- Department of Translational Surgical Oncology, National Center for Tumor Diseases (NCT/UCC Dresden), Dresden, Germany
| | - Jürgen Weitz
- Department of Visceral, Thoracic, and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany
- Centre for Tactile Internet with Human-in-the-Loop (CeTI), Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
| | - Marius Distler
- Department of Visceral, Thoracic, and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany
- Centre for Tactile Internet with Human-in-the-Loop (CeTI), Technische Universität Dresden, Dresden, Germany
| | - Florian Oehme
- Department of Visceral, Thoracic, and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany
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Wang Y, Cao D, Chen SL, Li YM, Zheng YW, Ohkohchi N. Current trends in three-dimensional visualization and real-time navigation as well as robot-assisted technologies in hepatobiliary surgery. World J Gastrointest Surg 2021; 13:904-922. [PMID: 34621469 PMCID: PMC8462083 DOI: 10.4240/wjgs.v13.i9.904] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 04/19/2021] [Accepted: 08/02/2021] [Indexed: 02/06/2023] Open
Abstract
With the continuous development of digital medicine, minimally invasive precision and safety have become the primary development trends in hepatobiliary surgery. Due to the specificity and complexity of hepatobiliary surgery, traditional preoperative imaging techniques such as computed tomography and magnetic resonance imaging cannot meet the need for identification of fine anatomical regions. Imaging-based three-dimensional (3D) reconstruction, virtual simulation of surgery and 3D printing optimize the surgical plan through preoperative assessment, improving the controllability and safety of intraoperative operations, and in difficult-to-reach areas of the posterior and superior liver, assistive robots reproduce the surgeon’s natural movements with stable cameras, reducing natural vibrations. Electromagnetic navigation in abdominal surgery solves the problem of conventional surgery still relying on direct visual observation or preoperative image assessment. We summarize and compare these recent trends in digital medical solutions for the future development and refinement of digital medicine in hepatobiliary surgery.
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Affiliation(s)
- Yun Wang
- Institute of Regenerative Medicine, and Affiliated Hospital of Jiangsu University, Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
| | - Di Cao
- Institute of Regenerative Medicine, and Affiliated Hospital of Jiangsu University, Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
| | - Si-Lin Chen
- Institute of Regenerative Medicine, and Affiliated Hospital of Jiangsu University, Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
| | - Yu-Mei Li
- Institute of Regenerative Medicine, and Affiliated Hospital of Jiangsu University, Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
| | - Yun-Wen Zheng
- Institute of Regenerative Medicine, and Affiliated Hospital of Jiangsu University, Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Ibaraki, Japan
- Guangdong Provincial Key Laboratory of Large Animal Models for Biomedicine, and School of Biotechnology and Heath Sciences, Wuyi University, Jiangmen 529020, Guangdong Province, China
- School of Medicine, Yokohama City University, Yokohama 234-0006, Kanagawa, Japan
| | - Nobuhiro Ohkohchi
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Ibaraki, Japan
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Braun D, Weik D, Elsner S, Hunger S, Werner M, Drossel WG. Position Control and Force Estimation Method for Surgical Forceps Using SMA Actuators and Sensors. Materials (Basel) 2021; 14:ma14175111. [PMID: 34501197 PMCID: PMC8434184 DOI: 10.3390/ma14175111] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/11/2021] [Accepted: 08/20/2021] [Indexed: 11/16/2022]
Abstract
Minimally invasive surgery is increasingly used in many medical operations because of the benefits for the patients. However, for the surgeons, accessing the situs through a small incision or natural orifice comes with a reduction of the degrees of freedom of the instrument. Due to friction of the mechanical coupling, the haptic feedback lacks sensitivity that could lead to damage of the tissue. The approach of this work to overcome these problems is to develop a control concept for position control and force estimation with shape memory alloys (SMA) which could offer haptic feedback in a novel handheld instrument. The concept aims to bridge the gap between manually actuated laparoscopic instruments and surgical robots. Nickel-titanium shape memory alloys are used for actuation because of their high specific energy density. The work includes the manufacturing of a functional model as a proof of concept comprising the development of a suitable forceps mechanism and electronic circuit for position control and gripping force measurement, as well as designing an ergonomic user interface with haptic force feedback.
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Affiliation(s)
- Dennis Braun
- Fraunhofer Institute for Machine Tools and Forming Technology, Department of Medical Engineering, Nöthnitzer Str. 44, 01187 Dresden, Germany; (D.W.); (S.E.); (S.H.); (M.W.); (W.-G.D.)
- Correspondence:
| | - David Weik
- Fraunhofer Institute for Machine Tools and Forming Technology, Department of Medical Engineering, Nöthnitzer Str. 44, 01187 Dresden, Germany; (D.W.); (S.E.); (S.H.); (M.W.); (W.-G.D.)
| | - Sophia Elsner
- Fraunhofer Institute for Machine Tools and Forming Technology, Department of Medical Engineering, Nöthnitzer Str. 44, 01187 Dresden, Germany; (D.W.); (S.E.); (S.H.); (M.W.); (W.-G.D.)
| | - Sandra Hunger
- Fraunhofer Institute for Machine Tools and Forming Technology, Department of Medical Engineering, Nöthnitzer Str. 44, 01187 Dresden, Germany; (D.W.); (S.E.); (S.H.); (M.W.); (W.-G.D.)
| | - Michael Werner
- Fraunhofer Institute for Machine Tools and Forming Technology, Department of Medical Engineering, Nöthnitzer Str. 44, 01187 Dresden, Germany; (D.W.); (S.E.); (S.H.); (M.W.); (W.-G.D.)
| | - Welf-Guntram Drossel
- Fraunhofer Institute for Machine Tools and Forming Technology, Department of Medical Engineering, Nöthnitzer Str. 44, 01187 Dresden, Germany; (D.W.); (S.E.); (S.H.); (M.W.); (W.-G.D.)
- Professorship for Adaptronics and Lightweight Design in Production, Chemnitz University of Technology, Straße der Nationen 62, 09111 Chemnitz, Germany
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Yatabe K, Ozawa S, Oguma J, Hiraiwa S, Tomita S, Matsunaga T, Togashi N, Yokoyama M, Shimono T, Ohnishi K. A study on safe forceps grip force for the intestinal tract using haptic technology. MINIM INVASIV THER 2021; 31:573-579. [PMID: 33463376 DOI: 10.1080/13645706.2020.1870500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE The present study used haptic technology to determine the safe forceps grip force for preventing organ damage when handling the intestinal tract. MATERIAL AND METHODS The small intestines of ten male beagle dogs (weighing 9.5-10 kg) were grasped with the entire forceps for one minute; the small intestines were then pulled out of the forceps and evaluated for damage. The force at which the shaft inside the forceps was pulled to close the tip of the forceps was defined as the grip force. Small intestine damage was classified into macroscopic (serosal defects, hemorrhage, hematomas, grip marks) and microscopic (damage layer to the mucosa, submucosa/muscularis mucosa, inner orbicularis muscle, external longitudinal muscle, serosa/subserosa). Grip marks and damage layer to the serosa/subserosa have been considered as acceptable safety margins when grasping the small intestines of beagle dogs. RESULTS The macroscopic findings showed that the maximum grip force that produced a 0% incidence of hemorrhage and hematoma was 15 N. At the microscopic level, the maximum grip force that produced a 0% incidence of external longitudinal muscle injury was 15 N, respectively. CONCLUSIONS A grip force of 15 N does not damage the small intestines of beagle dogs.
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Affiliation(s)
- Kentaro Yatabe
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Soji Ozawa
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Junya Oguma
- Department of Esophageal Surgery, National Cancer Center, Tokyo, Japan
| | - Shinichiro Hiraiwa
- Department of Pathology, Tokai University School of Medicine, Kanagawa, Japan
| | - Sakura Tomita
- Department of Pathology, Tokai University School of Medicine, Kanagawa, Japan
| | - Takuya Matsunaga
- Kanagawa Institute of Industrial Science and Technology, Kanagawa, Japan
| | - Nobuyuki Togashi
- Kanagawa Institute of Industrial Science and Technology, Kanagawa, Japan
| | - Minoru Yokoyama
- Graduate School of Engineering, Yokohama National University, Kanagawa, Japan
| | - Tomoyuki Shimono
- Faculty of Engineering, Yokohama National University, Kanagawa, Japan
| | - Kouhei Ohnishi
- Haptics Research Center, Keio University, Kanagawa, Japan
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