Force sensing in natural orifice transluminal endoscopic surgery

Area of Science:

• Minimally invasive surgery
• Surgical instrumentation
• Surgical robotics

Background:

• Natural orifice transluminal endoscopic surgery (NOTES) is a promising frontier in minimally invasive surgery.
• Current limitations in NOTES feasibility are attributed to a lack of suitable instruments.
• Quantifying tissue manipulation forces is crucial for developing advanced NOTES instrumentation.

Purpose of the Study:

• To experimentally measure and compare the forces involved in tissue manipulation during transgastric and transperineal NOTES procedures.
• To provide essential data for the design and development of novel NOTES instruments and devices.

Main Methods:

• Utilized sensorized instruments to record forces at the instrument tip during NOTES procedures in a porcine model.
• Performed both transgastric and transperineal NOTES approaches.
• Analyzed and compared average and maximum forces encountered during tissue handling.

Main Results:

• Transgastric NOTES required significantly lower average forces (43% less) compared to the transperineal approach.
• Maximum forces reached approximately 8 N for transgastric and 16 N for transperineal approaches.
• Forces exceeding 5 N were recorded in 1.6% (transgastric) and 2.9% (transperineal) of measurements.

Conclusions:

• This study provides the first experimental measurements of tissue manipulation forces during NOTES procedures.
• The data is valuable for researchers developing NOTES instruments and devices.
• NOTES instruments should be engineered to accommodate forces up to 16 N.