Abstract
Abstract Introduction Excessive tool-tissue interaction forces in surgery may result in tissue damage and intraoperative complications, while insufficient forces prevent the completion of the task. Method A systematic review of studies exploring tool-tissue forces applied during surgery was performed in accordance with PRISMA guidelines. Results 45 studies discussing tool-tissue forces during surgical procedures or tasks were included. Mean forces per speciality were as follows: ophthalmology (0.04N), vascular (0.7N), neurosurgery (0.68N), cardiothoracic surgery (1.5N), general surgery (4.7N), otorhinolaryngology (8.5N), obstetrics & gynaecology (mean 8.7N), urology (9.8N) and orthopaedic surgery (210N). Senior surgeons applied 25% less force than novice surgeons, and feedback (haptic, visual or audio) reduced force application by 40% - across specialities and tasks. Nervous tissue required the least amount of force to manipulate (0.4N, n = 17), followed by epithelial (3.8N, n = 18), muscle (4.1N, n = 4) and connective tissue (45.8, n = 10). For manoeuvres, retraction-with-grasping recorded the highest forces (3.65N, n = 13), whilst vessel clamping recorded the lowest (0.5N, n = 2). Conclusions The measurement of tool-tissue forces is a novel but rapidly expanding field. Knowledge of the safe range of surgical forces will improve surgical safety whilst maintaining effectiveness. Measuring surgical forces may provide an objective metric for training and assessment. Development of smart instruments, robotics and integrated feedback systems will facilitate this.
Highlights
The field of surgery is defined by the application of physical force in order to manipulate or incise tissue for the treatment of medical disor ders
Surgical forces must be applied judiciously, in a precise and controlled manner, in order to carry out procedures efficiently without causing unnecessary tissue injury [1,2,3]
Force measurement can provide a quantitative metric of surgical skills, potentially useful for surgical training and assessment [4,9,10]
Summary
The field of surgery is defined by the application of physical force in order to manipulate or incise tissue for the treatment of medical disor ders. Measurement allows the defini tion and characterization of a safe range of forces for specific manoeuvre [1,4]. These data can be used to generate surgical simulations for training [11] and develop devices (e.g. robotic platforms and smart in struments) with force feedback mechanisms [4,12,13,14,27]. This review sought to explore the tool-tissue interaction forces exerted by instruments during surgery across different specialities, tissues, manoeuvres and experience levels. The range of forces applied varies according to surgical speciality, tissue, manoeuvre, operator experience and feedback provided. Development of smart instruments, robotics and integrated feedback systems will facilitate this
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