Characterization of Applied Forces and Torques During Rigid Bronchoscopy Intubation

Area of Science:

• Medical Engineering
• Pulmonology
• Surgical Simulation

Background:

• Rigid bronchoscopy intubation carries risks of mechanical trauma.
• Precision in surgical force application is crucial but unquantified in this procedure.
• Existing training methods' fidelity to real-world forces is unknown.

Purpose of the Study:

• To quantify forces and torques during rigid bronchoscopy intubation.
• To compare forces and torques in manikin training versus patient procedures.
• To assess the accuracy of current training modalities in replicating clinical forces.

Main Methods:

• A 6-axis load sensor was integrated into a bronchoscope.
• Forces and torques were measured during intubation in low-fidelity manikins.
• Measurements were also taken during patient intubations by interventional pulmonologists.

Main Results:

• Manikin trials showed significantly higher axial (51.6%) and lateral (92.6%) forces than patient trials.
• Axial torque was 40% lower in manikin trials (78.3 N-mm) compared to human trials (130.5 N-mm).
• Manikin lateral torque exhibited greater variability and standard deviation than in human trials.

Conclusions:

• This study is the first to measure forces at the rigid bronchoscope handle.
• Significant discrepancies exist between manikin training and patient intubation forces/torques.
• Novel haptic training modalities may be needed to bridge the gap and improve atraumatic intubations.