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Reducing retraction forces with tactile feedback during robotic total mesorectal excision in a porcine model

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Abstract

Excessive tissue–instrument interaction forces during robotic surgery have the potential for causing iatrogenic tissue damages. The current in vivo study seeks to assess whether tactile feedback could reduce intraoperative tissue–instrument interaction forces during robotic-assisted total mesorectal excision. Five subjects, including three experts and two novices, used the da Vinci robot to perform total mesorectum excision in four pigs. The grip force in the left arm, used for retraction, and the pushing force in the right arm, used for blunt pelvic dissection around the rectum, were recorded. Tissue–instrument interaction forces were compared between trials done with and without tactile feedback. The mean force exerted on the tissue was consistently higher in the retracting arm than the dissecting arm (3.72 ± 1.19 vs 0.32 ± 0.36 N, p < 0.01). Tactile feedback brought about significant reductions in average retraction forces (3.69 ± 1.08 N vs 4.16 ± 1.12 N, p = 0.02), but dissection forces appeared unaffected (0.43 ± 0.42 vs 0.37 ± 0.28 N, p = 0.71). No significant differences were found between retraction and dissection forces exerted by novice and expert robotic surgeons. This in vivo animal study demonstrated the efficacy of tactile feedback in reducing retraction forces during total mesorectal excision. Further research is required to quantify the clinical impact of such force reduction.

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Availability of data and materials

The current bioengineering force data are only available to UCLA investigators listed on the original IRB protocol.

Code availability

The program codes for the UCLA haptic feedback system are only available to UCLA investigators listed on the original IRB protocol.

References

  1. van der Meijden OAJ, Schijven MP (2009) The value of haptic feedback in conventional and robot-assisted minimal invasive surgery and virtual reality training: a current review. Surg Endosc 23(6):1180–1190. https://doi.org/10.1007/s00464-008-0298-x

    Article  PubMed  PubMed Central  Google Scholar 

  2. Amirabdollahian F, Livatino S, Vahedi B, Gudipati R, Sheen P, Gawrie-Mohan S et al (2018) Prevalence of haptic feedback in robot-mediated surgery: a systematic review of literature. J Robot Surg 12(1):11–25. https://doi.org/10.1007/s11701-017-0763-4

    Article  PubMed  Google Scholar 

  3. Meli L, Pacchierotti C, Prattichizzo D (2017) Experimental evaluation of magnified haptic feedback for robot-assisted needle insertion and palpation. Int J Med Robot Comput Assist Surg [Internet] 13(4):e1809. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28218455. Accessed 3 Jun 2018

  4. Koehn JK, Kuchenbecker KJ (2015) Surgeons and non-surgeons prefer haptic feedback of instrument vibrations during robotic surgery. Surg Endosc 29(10):2970–2983. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25539693. Accessed 03 Jun 2018

  5. Wottawa CR, Genovese B, Nowroozi BN, Hart SD, Bisley JW, Grundfest WS, et al (2016) Evaluating tactile feedback in robotic surgery for potential clinical application using an animal model. Surg Endosc 30(8):3198–3209. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26514132. Accessed 03 Jun 2016

  6. Abiri A, Tao A, LaRocca M, Guan X, Askari SJ, Bisley JW, et al (2017) Visual–perceptual mismatch in robotic surgery. Surg Endosc 31(8):3271–3278. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27924387. Accessed 03 Jun 2018

  7. Juo YY, Mantha A, Abiri A, Lin A, Dutson E (2018) Diffusion of robotic-assisted laparoscopic technology across specialties: a national study from 2008 to 2013. Surg Endosc 32(3):1405–1413

    Article  Google Scholar 

  8. Park S, Kim NK (2015) The role of robotic surgery for rectal cancer: overcoming technical challenges in laparoscopic surgery by advanced techniques. J Korean Med Sci 30(7):837. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26130943. Accessed 18 Jun 2018

  9. Chew M-H, Yeh Y-T, Lim E, Seow-Choen F (2016) Pelvic autonomic nerve preservation in radical rectal cancer surgery: changes in the past 3 decades. Gastroenterol Rep 4(3):173–85. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27478196. Accessed 18 Jun 2018

  10. Douissard J, Ris F, Morel P, Buchs NC (2018) Current strategies to prevent iatrogenic ureteral injury during colorectal surgery. Surg Technol Int 32:119–24. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29791695. Accessed 18 Jun 2018

  11. Chih-Hung King C-H, Culjat MO, Franco ML, Bisley JW, Dutson E, Grundfest WS (2008) Optimization of a pneumatic balloon tactile display for robot-assisted surgery based on human perception. IEEE Trans Biomed Eng 55(11):2593–2600. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18990629. Accessed 18 Jun 2018

  12. Franco ML, King C-H, Culjat MO, Lewis CE, Bisley JW, Holmes EC et al (2009) An integrated pneumatic tactile feedback actuator array for robotic surgery. Int J Med Robot 5(1):13–19. https://doi.org/10.1002/rcs.224

    Article  PubMed  Google Scholar 

  13. King C-H, Higa AT, Culjat MO, Han SH, Bisley JW, Carman GP, et al (2007) A pneumatic haptic feedback actuator array for robotic surgery or simulation. Stud Health Technol Inform 125:217–222. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17377270. Accessed 3 Jun 2018

  14. King C-H, Culjat MO, Franco ML, Lewis CE, Dutson EP, Grundfest WS, et al (2009) Tactile feedback induces reduced gras** force in robot-assisted surgery. IEEE Trans Haptics [Internet] 2(2):103–110. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27788101. Accessed 6 Jun 2018

  15. Reiley CE, Akinbiyi T, Burschka D, Chang DC, Okamura AM, Yuh DD (2008) Effects of visual force feedback on robot-assisted surgical task performance. J Thorac Cardiovasc Surg 135(1):196–202. Available from: http://linkinghub.elsevier.com/retrieve/pii/S002252230701536X. Accessed 06 Jun 2018

  16. Juo Y-Y, Abiri A, Tao A, Pensa J, Hanna C, Askari S, et al (2017) Artificial palpation with da vinci surgical robot using a novel haptic feedback system. In: Society of American Gastrointestinal and Endoscopic Surgeons 2017 Annual Conference

  17. Kim NK, Kim YW, Cho MS (2015) Total mesorectal excision for rectal cancer with emphasis on pelvic autonomic nerve preservation: Expert technical tips for robotic surgery. Surg Oncol 24(3):172–180. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26141555. Accessed 18 Jun 2018

  18. Casal Núñez JE, Vigorita V, Ruano Poblador A, Gay Fernández AM, Toscano Novella MÁ, Cáceres Alvarado N, et al (2017) Presacral venous bleeding during mobilization in rectal cancer. World J Gastroenterol 23(9):1712. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28321171. Accessed 18 Aug 2018

  19. Ladwa N, Sajid MS, Pankhania NK, Sains P, Baig MK (2013) Retraction techniques in laparoscopic colorectal surgery: a literature-based review. Color Dis 15(8):936–943. https://doi.org/10.1111/codi.12190

    Article  CAS  Google Scholar 

  20. Lee SW, Sonoda T, Milsom JW (2007) Expediting of laparoscopic rectal dissection using a hand-access device. Available from: https://www.semanticscholar.org/paper/Expediting-of-laparoscopic-rectal-dissection-using-Lee-Sonoda/98bf41faa801b94a1190ee5b0d1886b48d8a8347. Accessed 18 Aug 2018

  21. Mucksavage P, Kerbl DC, Pick DL, Lee JY, McDougall EM, Louie MK (2011) Differences in grip forces among various robotic instruments and da vinci surgical platforms. J Endourol [Internet] 25(3):523–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21235410. Accessed 18 Aug 2018

  22. Lee C, Park YH, Yoon C, Noh S, Lee C, Kim Y, et al (2015) A grip force model for the da Vinci end-effector to predict a compensation force. Med Biol Eng Comput 53(3):253–61. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25432526. Accessed 18 Aug 2018

  23. Abiri A, Paydar O, Tao A, LaRocca M, Liu K, Genovese B, et al (2017) Tensile strength and failure load of sutures for robotic surgery. Surg Endosc 31(8):3258–3270. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27928670. Accessed 3 Jun 2018

  24. Paydar OH, Wottawa CR, Fan RE, Dutson EP, Grundfest WS, Culjat MO, et al (2012) Fabrication of a thin-film capacitive force sensor array for tactile feedback in robotic surgery. In: 2012 Annual International Conference of the IEEE Engineering in Medicine and Biology Society [Internet]. IEEE: 2355–2358. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23366397. Accessed 3 Jun 2018

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Funding

The current study is supported by the American Society of Colon and Rectal Surgeons Robotic Research Grant RRTG-002.

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Authors and Affiliations

  1. Center for Health Sciences (CHS), Department of Surgery, University of California Los Angeles (UCLA), 72-247, Box 956904, Los Angeles, CA, 90095, USA

    Yen-Yi Juo, Yas Sanaiha, Ahmad Abiri, Kevork Kazanjian, Erik Dutson, Warren Grundfest & Anne Lin

  2. UCLA Henry Samueli School of Engineering and Applied Science, University of California Los Angeles (UCLA), Los Angeles, CA, USA

    Jake Pensa, Ahmad Abiri, Song** Sun, Anna Tao & Warren Grundfest

  3. Division of Laboratory Animal Medicine, David Geffen School of Medicine, Los Angeles, CA, USA

    Sandra Duarte Vogel

Authors
  1. Yen-Yi Juo
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  2. Jake Pensa
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  3. Yas Sanaiha
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  4. Ahmad Abiri
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  5. Song** Sun
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  6. Anna Tao
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  8. Kevork Kazanjian
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  9. Erik Dutson
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  11. Anne Lin
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Contributions

All authors contributed to the study conception and design. Material preparation was performed by Y-YJ, JP, YS, AA, SS, AT and SDV. Data collection and analysis were performed by JP, AA, AT and SS. Funding acquisition was performed by Y-YJ, ED, AA and AL. The first draft of the manuscript was written by Y-YJ and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yen-Yi Juo.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose. The authors have no conflicts of interest to declare that are relevant to the content of this article. All authors certifu that they have no affiliations with or involvement in any organization or entity with any financial interest of non-financial interest in the subject matter or materials discussed in this manuscript. The authors have no financial or proprietary interests in any material discussed in this article.

Ethics approval

The current study was approved by the Animal Research Committee (ARC) under protocol number #2016-075-02.

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Not applicable (no human subjects involved in this study).

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Not applicable (no human subjects involved in this study).

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Juo, YY., Pensa, J., Sanaiha, Y. et al. Reducing retraction forces with tactile feedback during robotic total mesorectal excision in a porcine model. J Robotic Surg 16, 1083–1090 (2022). https://doi.org/10.1007/s11701-021-01338-w

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  • DOI: https://doi.org/10.1007/s11701-021-01338-w

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