Evaluation of Haptic Feedback on Bimanually Teleoperated Laparoscopy for Endometriosis Surgery

Robotic minimal invasive surgery is gaining acceptance in surgical care. In contrast with the appreciated 3D vision and enhanced dexterity, haptic feedback is not offered. For this reason robotics is not considered beneficial for delicate interventions such the endometriosis. Overall, haptic feedback remains debatable and yet unproven except for some simple scenarios such as Fundamentals of Laparoscopic Surgery exercises. OBJECTIVE: The present work investigates the benefits of haptic feedback on more complex surgical gestures, manipulating delicate tissue through coordination between multiple instruments. Methods: A new training exercise, “Endometriosis Surgery Exercise” (ESE) has been devised approximating the setting for monocular robotic endometriosis treatment. A bimanual bilateral teleoperation setup was designed for laparoscopic laser surgery. Haptic guidance and haptic feedback are respectively offered to the operator. User experiments have been conducted to i) assess the validity of ESE and to ii) examine possible advantages of haptic technology during execution of bimanual surgery. RESULTS: i) Content and face validity of ESE was established by participating surgeons. Surgeons suggested ESE also as a means to train lasering skills, ii) interaction forces on endometriotic tissue were found to be significantly lower when a bilateral controller is used. Collisions between instruments and the environment were less frequent and so were situations marked as potentially dangerous. CONCLUSION: This study provides some promising results suggesting that haptics may offer a distinct advantage in complex robotic interventions were fragile tissue is manipulated. SIGNIFICANCE: Patients need to know whether it should be incorporated. Improved understanding of the value of haptics is important as current commercial surgical robots are widely used but do not offer haptics

The benefits of haptic feedback in robot assisted surgery and their moderators: a metaanalysis

Robot assisted surgery (RAS) provides medical practitioners with valuable tools, decreasing strain during surgery and leading to better patient outcomes. While the loss of haptic sensation is a commonly cited disadvantage of RAS, new systems aim to address this problem by providing artificial haptic feedback. N = 56 papers that compared robotic surgery systems with and without haptic feedback were analyzed to quantify the performance benefits of restoring the haptic modality. Additionally, this study identifies factors moderating the effect of restoring haptic sensation. Overall results showed haptic feedback was effective in reducing average forces (Hedges' g = 0.83) and peak forces (Hedges' g = 0.69) applied during surgery, as well as reducing the completion time (Hedges' g = 0.83). Haptic feedback has also been found to lead to higher accuracy (Hedges' g = 1.50) and success rates (Hedges' g = 0.80) during surgical tasks. Effect sizes on several measures varied between tasks, the type of provided feedback, and the subjects' levels of surgical expertise, with higher levels of expertise generally associated with smaller effect sizes. No significant differences were found between virtual fixtures and rendering contact forces. Implications for future research are discussed

Evaluation of Haptic Feedback on Bimanually Teleoperated Laparoscopy for Endometriosis Surgery.

Robotic minimal invasive surgery is gaining acceptance in surgical care. In contrast with the appreciated 3D vision and enhanced dexterity, haptic feedback is not offered. For this reason robotics is not considered beneficial for delicate interventions such the endometriosis. Overall, haptic feedback remains debatable and yet unproven except for some simple scenarios such as Fundamentals of Laparoscopic Surgery exercises. OBJECTIVE: The present work investigates the benefits of haptic feedback on more complex surgical gestures, manipulating delicate tissue through coordination between multiple instruments. METHODS: A new training exercise, "Endometriosis Surgery Exercise" (ESE) has been devised approximating the setting for monocular robotic endometriosis treatment. A bimanual bilateral teleoperation setup was designed for laparoscopic laser surgery. Haptic guidance and haptic feedback are respectively offered to the operator. User experiments have been conducted to i) assess the validity of ESE and to ii) examine possible advantages of haptic technology during execution of bimanual surgery. RESULTS: i) Content and face validity of ESE was established by participating surgeons. Surgeons suggested ESE also as a means to train lasering skills, ii) interaction forces on endometriotic tissue were found to be significantly lower when a bilateral controller is used. Collisions between instruments and the environment were less frequent and so were situations marked as potentially dangerous. CONCLUSION: This study provides some promising results suggesting that haptics may offer a distinct advantage in complex robotic interventions were fragile tissue is manipulated. SIGNIFICANCE: Patients need to know whether it should be incorporated. Improved understanding of the value of haptics is important as current commercial surgical robots are widely used but do not offer haptics.status: publishe