The effect of indentation force and displacement on visual perception of compliance

This paper investigates the effect of maximum indentation force and depth on people's ability to accurately discriminate compliance using indirect visual information only. Participants took part in two psychophysical experiments in which they were asked to choose the 'softest' sample out of a series of presented sample pairs. In the experiments, participants observed a computer-actuated tip indent the sample pairs to one of two conditions; maximum depth (10mm) or maximum force (4N). This indentation process simulates tool operated palpation in laparoscopic surgery. Results were used to plot psychometric functions as a measure of accuracy of compliance discriminability. A comparison indicated that participants performed best in the task where they judged samples being indented to a pre-set maximum force relying solely on visual cues, which demonstrates the effect of visual information on compliance discrimination. Results also show that indentation cues such as force and deformation depth have different effects on our ability to visually discriminate compliance. These findings will inform future work on designing a haptic feedback system capable of augmenting visual and haptic information independently for optimal compliance discrimination performance

A soft multi-axial force sensor to assess tissue properties in RealTime

Objective: This work presents a method for the use of a soft multi-axis force sensor to determine tissue trauma in Minimally Invasive Surgery. Despite recent developments, there is a lack of effective haptic sensing technology employed in instruments for Minimally Invasive Surgery (MIS). There is thus a clear clinical need to increase the provision of haptic feedback and to perform real-time analysis of haptic data to inform the surgical operator. This paper establishes a methodology for the capture of real-time data through use of an inexpensive prototype grasper. Fabricated using soft silicone and 3D printing, the sensor is able to precisely detect compressive and shear forces applied to the grasper face. The sensor is based upon a magnetic soft tactile sensor, using variations in the local magnetic field to determine force. The performance of the sensing element is assessed and a linear response was observed, with a max hysteresis error of 4.1% of the maximum range of the sensor. To assess the potential of the sensor for surgical sensing, a simulated grasping study was conducted using ex vivo porcine tissue. Two previously established metrics for prediction of tissue trauma were obtained and compared from recorded data. The normalized stress rate (kPa.mm⁻¹) of compression and the normalized stress relaxation (ΔσR) were analyzed across repeated grasps. The sensor was able to obtain measures in agreement with previous research, demonstrating future potential for this approach. In summary this work demonstrates that inexpensive soft sensing systems can be used to instrument surgical tools and thus assess properties such as tissue health. This could help reduce surgical error and thus benefit patients

A novel multiple electrode direct current technique for characterisation of tissue resistance during surgery

Electrochemical and electrical characteristics have the potential to help differentiate between, and assess the health state of, different biological tissues. However, measurement and interpretation of these characteristics is non-trivial. We propose a new DC galvanostatic sensing method for application to laparoscopic cancer surgery. This presents a simple and cost-effective measurement coupled with straightforward data interpretation. This paper describes the electrochemical and electrical theory underpinning the technique. Additionally, we describe a measurement system employing this technique and present an investigation into the feasibility of using it for measuring the resistance of different tissue types. Measurements were performed on ex vivo porcine liver, colon and rectum tissues. Outputs were consistent with theory and showed a significant difference between the resistance of the different tissue types, (one-way ANOVA, F(2, 28) = 1369, p < 0.01). These findings indicate that this novel technique may be viable as a low cost method for the discrimination and health assessment of tissues in clinical scenarios

A physical simulation to investigate the effect of anorectal angle on continence

This paper investigates the effect of the anorectal angle on continence using a physical model of the anatomical system. A method to fabricate, measure and control a physical model for the simulation of human faecal continence is presented. A model rectum and associated soft tissues, based on geometry from an anonymised CT dataset, was fabricated from silicone and showed behavioural realism to ex vivo tissue. Simulated stool matter with similar rheological properties to human faeces was developed. Instrumentation and control hardware are used to regulate injection of simulated stool into the system, define the anorectal angle and monitor stool flow rate, intra-rectal pressure and puborectalis force. A study was then conducted in which simulated stool was introduced to the system for anorectal angles between 80° and 100°. Results obtained from the study give insight into the effect of the anorectal angle on continence. Stool leakage was reduced as the angle became more acute. Conversely, intra-rectal pressure increased. These data demonstrate that the anorectal angle is fundamental in maintaining continence. This work is valuable in helping improve our understanding of the physical behaviour of the faecal system. It has particular relevance facilitating improved technologies to treat or manage severe faecal incontinence

Hybrid Position and Orientation Tracking for a Passive Rehabilitation Table-Top Robot

This paper presents a real time hybrid 2D position and orientation tracking system developed for an upper limb rehabilitation robot. Designed to work on a table-top, the robot is to enable home-based upper-limb rehabilitative exercise for stroke patients. Estimates of the robot's position are computed by fusing data from two tracking systems, each utilizing a different sensor type: laser optical sensors and a webcam. Two laser optical sensors are mounted on the underside of the robot and track the relative motion of the robot with respect to the surface on which it is placed. The webcam is positioned directly above the workspace, mounted on a fixed stand, and tracks the robot's position with respect to a fixed coordinate system. The optical sensors sample the position data at a higher frequency than the webcam, and a position and orientation fusion scheme is proposed to fuse the data from the two tracking systems. The proposed fusion scheme is validated through an experimental set-up whereby the rehabilitation robot is moved by a humanoid robotic arm replicating previously recorded movements of a stroke patient. The results prove that the presented hybrid position tracking system can track the position and orientation with greater accuracy than the webcam or optical sensors alone. The results also confirm that the developed system is capable of tracking recovery trends during rehabilitation therapy

Kinematic Measures of Imitation Fidelity in Primary School Children

We sought to develop a method for measuring imitation accuracy objectively in primary school children. Children imitated a model drawing shapes on the same computer-tablet interface they saw used in video clips, allowing kinematics of model and observers' actions to be directly compared. Imitation accuracy was reported as a correlation reflecting the statistical dependency between values of the model's and participant's sets of actions, or as a mean absolute difference between them. Children showed consistent improvement in imitation accuracy across middle childhood. They appeared to rationalize the demands of the task by remembering duration and size of action, which enabled them to reenact speed through motor-planning mechanisms. Kinematic measures may provide a window into the cognitive mechanisms involved in imitation

Macro-Scale Tread Patterns for Traction in the Intestine

Goal: Tread patterns are widely used to increase traction on different substrates, with the tread scale, geometry and material being tailored to the application. This work explores the efficacy of using macro-scale tread patterns for a medical application involving a colon substrate - renowned for its low friction characteristics. Methods: Current literature was first summarized before an experimental approach was used, based on a custom test rig with ex vivo porcine colon, to assess different macro-scale tread patterns. Performance was based on increasing traction while avoiding significant trauma. Repeated testing (n = 16) was used to obtain robust results. Results: A macro-scale tread pattern can increase the traction coefficient significantly, with a static traction coefficient of 0.74 ± 0.22 and a dynamic traction coefficient of 0.35 ± 0.04 compared to a smooth (on the macro-scale) Control (0.132 ± 0.055 and 0.054 ± 0.015, respectively). Decreasing the scale and spacing between the tread features reduced apparent trauma but also reduced the traction coefficient. Conclusion: Significant traction can be achieved on colon tissue using a macro-scale tread but a compromise between traction (large feature sizes) and trauma (small feature sizes) may have to be made. Significance: This work provides greater insight into the complex frictional mechanisms of the intestine and gives suggestions for developing functional tread surfaces for a wide range of clinical applications

An in vivo analysis of safe laparoscopic grasping thresholds for colorectal surgery

Background Analysis of safe laparoscopic grasping thresholds for the colon has not been performed. This study aimed to analyse tissue damage thresholds when the colon is grasped laparoscopically, correlating histological changes to mechanical compressive forces. Methods An instrumented laparoscopic grasper was used to measure the forces applied to porcine colon, with data captured and plotted as a force–time (f–t) curve. Haematoxylin and eosin histochemistry of tissue subjected to 10, 20, 40, 50 and 70 N for 5, 30 and 60 s was performed, and the area of colonic circular and longitudinal muscle was compared in grasped and un-grasped regions. The area under the f–t curve was calculated as a measure of the accumulated force applied, known as the force–time product (FTP). Results FTP ranged from 55.7 to 3793 N.s. Significant differences were observed between the muscle area of the grasped and un-grasped regions in both longitudinal and circular muscle at 50 N and above for all grasping times. For the longitudinal muscle, significant differences were observed between grasped and un-grasped areas at 20 N force for 30 s (mean difference = 59 mm2, 95% CI 41–77 mm2, P = 0.04), 20 N force for 60 s (mean difference = 31 mm2, 95% CI 21.5–40.5 mm2, P = 0.006) and 40 N force for 30 s (mean difference 37 mm2, 95% CI 27–47 mm2, P = 0.006). Changes in histology correlated with mechanical forces applied to the longitudinal muscle at a FTP over 300 N s. Conclusions This study characterizes the grasping forces that result in histological changes to the colon and correlates these with a mechanical measurement of the applied force. The findings will contribute to the development of smart laparoscopic graspers with active constraints to prevent excessive grasping and tissue injury

Can Virtual Reality Trainers Improve the Compliance Discrimination Abilities of Trainee Surgeons?

The assessment of tissue compliance using a handheld tool is an important skill in medical areas such as laparoscopic and dental surgery. The increasing prevalence of virtual reality devices raises the question of whether we can exploit these systems to accelerate the training of compliance discrimination in trainee surgeons. We used a haptic feedback device and stylus to assess the abilities of naïve participants to detect compliance differences with and without knowledge of results (KR) (groups 1 and 2), as well as the abilities of participants who had undergone repetitive training over several days (group 3). Kinematic analyses were carried out to objectively measure the probing action. Untrained participants had poor detection thresholds (mean just noticeable difference, JND = 33%), and we found no effect of KR (provided after each trial) on performance (mean JND = 35%). Intensive training dramatically improved group performance (mean JND = 12%). Probing action (in particular, slower movement execution) was associated with better detection thresholds, but training did not lead to systematic changes in probing behaviour. These findings set a benchmark for training systems that act to increase perceptual sensitivity and guide the learner toward optimal movement strategies to improve discrimination

An Instrumented Walking-Aid to Assess and Retrain Gait

An instrumented walking-aid, the iWA system, has been developed to measure kinematic and kinetic properties of walking aid (WA) use and deliver feedback to improve gait. The clinical requirements, technical specification and design of the system are developed through clinical collaboration. The development of the system is described, including hardware components and data analysis used to process the measured data for assessment. The system measurements are validated under controlled laboratory conditions. The iWA system is evaluated in a typical UK clinical environment by a participant in a rehabilitation session. The resultant data successfully capture the quality of the participant’s walking aid use and agree with clinical opinion, supporting the efficacy of this approach