The use of a vibrotactile sensor as an artificial sense of touch for tissues of the head and neck

Design and analysis of an ultrasonic tactile sensor using electro-mechanical analogy

This paper proposed a hybrid design approach of a vibro-concentrator, a vital component of an ultrasonic tactile sensor, by using electro-mechanical analogy. Lab experiments on soft materials with elastic modulus from 14 kPa to 150 kPa were conducted using the tactile sensor installed with the vibro-concentrator to verify the performance of the design. Various mechanical and electrical parameters, such as resonance frequency shift and equivalent conductance, were discussed, focusing on their feasibility as new stiffness indicators. As a variant of tactile sensors, ultrasonic tactile sensors have the advantage of high sensitivity and minimal contact with the object over traditional tactile sensors based on force-displacement principle. They detect the changes in mechanical vibration characteristics, mostly resonance frequency shift of the sensor, as an indicator of the mechanical properties of the object. A vibro-concentrator has been frequently adopted to improve the performance an ultrasonic tactile sensor, but its design has yet been systematically considered. We propose a hybrid design approach based on electro-mechanical analogy for both mechanical and electrical analyses. Mechanically, impedance analogy was adopted to design an ultrasonic vibration concentrator for the sensor to localize the contact and reinforce the vibration behavior at ~40 kHz. Electrically, we used mobility analogy to derive electrical parameters from the tactile sensing tests in lab environment. The competence of the design was demonstrated by mechanical and electrical characteristic tests. By investigating various electrical parameters from tactile sensing tests, the equivalent conductance determined by the electro-mechanical analysis was found to have almost perfectly linear relationship (R² = 0.9998) with the samples' elastic modulus ranging from 10 kPa to 70 kPa, and showed its potential as a new stiffness indicator for soft materials. Further analyses suggested that the electrically determined series resonance frequency shift, parallel resonance frequency shift, and maximum phase angle frequency shift also had excellent linearities (R² = 0.9947, 0.9842, and 0.9935, respectively) with sample's modulus and can be considered as indicator candidates.

Friction characteristics of trocars in laparoscopic surgery

This article investigates the friction characteristics of the instrument-trocar interface in laparoscopic surgery for varying linear instrument velocities, trocar seal design and material, and trocar tilt. Furthermore, the effect of applying lubrication at the instrument-trocar seal interface on friction was studied. A friction testing apparatus was designed and built to characterise the resistance force at the instrument-trocar interface as a function of the instrument's linear movement in the 12-mm trocar (at constant velocity) for different design, seal material, and angle of tilt. The resistance force depended on the trocar seal design and material properties, specifically surface roughness, elasticity, hardness, the direction of movement, and the instrument linear velocity, and varied between 0.25 and 8 N. Lubricating the shaft with silicone oil reduced the peak resistance force by 75% for all trocars and eliminated the stick-slip phenomenon evident in non-lubricated cases. The magnitude of fluctuation in resistance force depends on the trocar design and is attributed to stick-slip of the sealing mechanism and is generally higher during retraction in comparison to insertion. Trocars that have an inlet seal made of rubber/polyurethane showed higher resistance forces during retraction. Use of a lubricant significantly reduced frictional effects. Comparisons of the investigated trocars indicate that a low friction port, providing the surgeon with improved haptic feedback, can be designed by improving the tribological properties of the trocar seal interface.

Artificial tactile sensing in minimally invasive surgery – a new technical approach

The loss of tactile sensation is a commonly known drawback of minimally invasive surgery (MIS). Since the advent of MIS, research activities in providing tactile information to the surgeon are still ongoing, in order to improve patient safety and to extend the indications for MIS. We have designed a tactile sensor system comprising a tactile laparoscopic grasper for surgical palpation. For this purpose, we developed a novel tactile sensor technology which allows the manufacturing of an integrated sensor array within an acceptable price range. The array was integrated into the jaws of a 10mm laparoscopic grasper. The tactile data are transferred wirelessly via Bluetooth and are presented visually to the surgeon. The goal was to be able to obtain information about the shape and consistency of tissue structures by gently compressing the tissue between the jaws of the tactile instrument and thus to be able to recognize and assess anatomical or pathological structures, even if they are hidden in the tissue. With a prototype of the tactile sensor system we have conducted bench-tests as well as in-vitro and in-vivo experiments. The system proved feasibility in an experimental environment, it was easy to use, and the novel tactile sensor array was applicable for both palpation and grasping manoeuvres with forces of up to 60N. The tactile data turned out to be a useful supplement to the minimal amount of haptic feedback that is provided by current endoscopic instruments and the endoscopic image under certain conditions.

Vibrotactile characteristics of different tissues in endoscopic otolaryngologic surgery - in vivo and ex vivo measurements

The measurement of mechanical tissue impedance by determining resonance frequency with the help of a tactile sensor is one method of compensating for sensory deficits in endoscopic surgery. In principle, this electromechanic vibrotactile sensor can be integrated into an operating instrument. The operator would thereby receive indirect feedback on the tactile properties of the tissue. We examined freshly resected tissues using the first prototype vibrotactile sensor. Measurements on resected carcinoma of the oropharynx demonstrated the possibility of differentiating between carcinoma, healthy mucosa and carcinomatous-infiltrated mucosa. Subsequent in vivo measurements in the oropharynx and oral-cavity regions of 20 patients confirmed these results. We found that, in the oral cavity, tumours of > 1 cm diameter could be distinguished from the surrounding mucosa. Tumours of the soft palate and tonsillary region could not be clearly delimited, because of stimulation of the surrounding tissue.

Effects of experience on force perception threshold in minimally invasive surgery

BACKGROUND

Distorted haptic feedback by the surgical instrumentation is a major problem in minimally invasive surgery (MIS). Friction force generated by the rubber seal in the trocars masks the haptic information needed to perceive the properties and structure of the target tissue, resulting in an increased haptic perception threshold in naïve subjects. This can lead to over application of forces in surgery.

OBJECTIVE

This paper examines the effect of surgical experience on the psychophysics of force perception and force application efficiency in MIS.

METHOD

A controlled experiment was conducted using a mixed design, with friction and vision as independent within-subjects factors, experience as a between-subjects factor, and applied force and detection time as dependent measures. Fourteen subjects (eight novices and six experienced surgeons) performed a simulated tissue probing task. Performance data were recorded by a custom-built force-sensing system.

RESULTS

When friction was present, higher thresholds and longer detection times were observed for both experienced and inexperienced subjects. In all cases, experienced surgeons applied a greater force than novices, but were quicker to detect contact with tissue, resulting in higher force application efficiency.

CONCLUSION

Surgeons seem to have adapted to the higher threshold in haptic perception by reacting faster, even while applying more force to the tissue, keeping within the limits of safety.

Manipulation in laparoscopic surgery: overview of impeding effects and supporting aids

Within a Dutch research program on minimally invasive surgery, a large literature survey has been carried out. This article describes the state of the art in research on manipulation in laparoscopy. It gives an overview of factors impeding the surgeon and technical developments designed to overcome these problems. Starting from the year 1991, a large number of journals, proceedings, patents, and books have been consulted. The survey was completed with a thorough MEDLINE search. The impeding effects have been subdivided into two groups: transformation of spatial and grasping movements of the hand. The article gives an overview of these effects and of supporting aids that have been developed. The studies show that many aids are based on a technology-driven rather than a clinically-driven approach. The development of simple instruments that can be used for a large range of tasks instead of only one is still a very important topic of research.

Tactile feedback is present during minimally invasive surgery

BACKGROUND

The applications of minimally invasive surgery (MIS) and laparoscopy are rapidly expanding. Despite this expansion, our understanding of the importance of haptic feedback during laparoscopic surgery is incomplete. Although many surgeons believe that the use of minimally invasive techniques eliminates force feedback and tactile sensation (haptics), the importance of haptics in MIS has not been fully evaluated. There is considerable interest in the development of simulators for MIS even though the importance of force feedback remains poorly understood. This study was designed to determine the ability of experienced surgeons to interpret haptic feedback with respect to texture, shape, and consistency of an object.

STUDY DESIGN

A randomized, single-blinded study was designed. Twenty surgeons were presented objects in a random order, with participants blinded as to their identity. Inspection by direct palpation, conventional instruments, and laparoscopic instruments was performed on all objects. Statistic analysis of the data was performed using chi-square analysis and, when appropriate, a Fischer exact probability test.

RESULTS

Direct palpation was associated with the highest accuracy for shape identification and was superior to both conventional instruments (p < 0.001) and laparoscopic instruments (p<0.001). Fine texture analysis with either a conventional instrument or a laparoscopic instrument was superior to direct palpation (p < 0.05). Finally, the three methods of analysis were comparable for consistency analysis.

CONCLUSIONS

These data indicate that laparoscopic instruments do, in fact, provide surgeons with haptic feedback. Interpretation of the texture, shape, and consistency of objects can be performed. In some situations, laparoscopic instruments appear to amplify the haptic information available. Our ongoing work is directed at further defining force interactions.