Impact of the force feedback feature on transoral robotic surgery

Transoral robotic surgery (TORS) has become an established minimally invasive approach for treating head and neck cancer. However, the absence of haptic feedback constrains surgeons to rely almost exclusively on visual cues, which may compromise tissue handling and resection accuracy. This study evaluated the effect of force feedback on surgical performance using a robotic system equipped with haptic feedback in a simulated TORS model. Fifteen head and neck surgeons, categorized as experienced or trainees, performed simulated transoral tumor resection using a plant-derived soft tissue phantom. Contact and grasping forces, resection accuracy, and tissue effects were compared between force-feedback-on and force-feedback-off conditions. Across all surgeons, all contact force measures and mean and maximal grasping forces were significantly lower under the feedback-on condition. Mean contact force was 1.59 ± 0.25 N with feedback on versus 2.11 ± 0.29 N with feedback off (P < 0.001), and maximal contact force was 4.32 ± 1.11 N versus 5.86 ± 2.40 N (P = 0.003). A significant feedback-by-experience interaction was observed for maximal contact force (P = 0.021), with a greater reduction among trainees. Force feedback also significantly reduced horizontal and deep margin deviations and tissue charring. Operative time was not significantly affected. Force feedback improved force control and procedural precision overall, with a particularly pronounced effect on limiting excessive peak contact forces among training surgeons. These findings support the potential value of force feedback for more precise and controlled robotic surgery.