In vivo soft tissue damage assessment for applications in surgery

In robotic and conventional minimally invasive surgery the risk of complications caused by collateral tissue damage remains high. This paper studies the concept of imposing damage thresholds on surgical instruments to avoid tissue overload. More specifically, the correlation between mechanical loading and damage in case of vascular clamping is investigated. With a computer controlled device, a high and a low clamping load were applied in vivo on the abdominal aorta of 43 rats. Samples of both loading levels were compared with zero load control samples and with samples clamped by a mosquito clamp w.r.t. functionality and histological integrity. Analysis of the samples shows that high clamping forces result in endothelial and smooth muscle cell destruction. Clamping with a mosquito clamp will cause even more damage to the elastic lamellae. Samples loaded at the lower load showed significantly less smooth muscle cell damage and a lower degree of endothelial damage. This paper is the first to statistically quantify the correlation between the degree of mechanical loading and the degree of tissue damage, thus setting the first steps towards tissue overload prevention during surgery. Future experiments will also include the effects of loading duration, recovery and patient-specificity.