ABSTRACT
OBJECTIVES: Direct haptic (force or tactile) feedback is not yet available in commercial robotic surgical systems. Previous work by our group and others suggests that haptic feedback might significantly enhance the execution of surgical tasks requiring fine suture manipulation, specifically those encountered in cardiothoracic surgery. We studied the effects of substituting direct haptic feedback with visual and auditory cues to provide the operating surgeon with a representation of the forces he or she is applying with robotic telemanipulators. METHODS: Using the robotic da Vinci surgical system (Intuitive Surgical, Inc, Sunnyvale, Calif), we compared applied forces during a standardized surgical knot-tying task under 4 different sensory-substitution scenarios: no feedback, auditory feedback, visual feedback, and combined auditory-visual feedback. RESULTS: The forces applied with these sensory-substitution modes more closely approximate suture tensions achieved under ideal haptic conditions (ie, hand ties) than forces applied without such sensory feedback. The consistency of applied forces during robot-assisted suture tying aided by visual feedback or combined auditory-visual feedback sensory substitution is superior to that achieved with hand ties. Robot-assisted ties aided with auditory feedback revealed levels of consistency that were generally equivalent or superior to those attained with hand ties. Visual feedback and auditory feedback improve the consistency of robotically applied forces. CONCLUSIONS: Sensory substitution, in the form of visual feedback, auditory feedback, or both, confers quantifiable advantages in applied force accuracy and consistency during the performance of a simple surgical task.
Subject(s)
Anastomosis, Surgical/instrumentation , Robotics , Surgery, Computer-Assisted , Suture Techniques/instrumentation , Anastomosis, Surgical/methods , Cardiac Surgical Procedures/instrumentation , Cardiac Surgical Procedures/methods , Confidence Intervals , Feedback , Humans , Man-Machine Systems , Probability , Risk Factors , Sensitivity and Specificity , Tensile Strength , TouchABSTRACT
Bilateral telemanipulation, which applies haptic feedback to the operator, is not yet available in most commercial robot-assisted surgical systems. We have shown in previous work that the lack of haptic (force or tactile) feedback is detrimental in applications requiring fine suture manipulation. In this paper, we study the effect of substituting direct haptic feedback with visual and auditory cues. Using the da Vinci robot from Intuitive Surgical, we observed the difference between applied forces during a knot tying procedure for four different sensory feedback substitution scenarios: no feedback, auditory feedback, visual feedback, and a combination of auditory and visual feedback. Our results indicate that visual feedback, which provides continuous force information, would improve robot-assisted performance during complex surgical tasks such as knot tying with fine sutures. Discrete auditory feedback gives additional useful support to the surgeon.
Subject(s)
Surgical Procedures, Operative , Sutures , Telemedicine , User-Computer Interface , Feedback , Robotics , United StatesABSTRACT
Robotic surgical systems have greatly contributed to the advancement of minimally invasive endoscopic surgery. However, current robotic systems do not provide tactile or haptic feedback to the operating surgeon. Under certain circumstances, particularly with the manipulation of delicate tissues and suture materials, this may prove to be a significant irritation. We hypothesize that haptic feedback, in the form of sensory substitution, facilitates the performance of surgical knot tying. This preliminary study describes evidence that visual sensory substitution permits the surgeon to apply more consistent, precise, and greater tensions to fine suture materials without breakage during robot-assisted knot tying.
