In VivoForce Sensing During Laparoscopic Sacrocolpopexy Vaginal Vault Manipulation

Abstract

Context [Formula: see text] During laparoscopic sacrocolpopexy, vaginal vault prolapse is repaired by restoring the anatomical state of the vagina with a surgical mesh. A vaginal manipulator is placed inside the vagina to provide proper exposure to the surgeon for fixation of the mesh on the vaginal surface and vault by laparoscopy. Vaginal vault manipulation is done manually by an assistant and long operation times lead to fatigue, inconsistent application of tensioning forces and possibly vaginal rupture. This work describes a novel force sensor designed to be integrated in a vaginal manipulator to measure interaction forces between the vaginal vault and the manipulator. Content [Formula: see text] The sensor is characterized and tested in lab-environment. After receiving ethics committee approval two first-in-woman studies have been conducted. Both the force and pose of the instrument were recorded. Conclusions [Formula: see text] The force sensor showed to be suited to measure vaginal vault interaction forces and will be embedded in a robotic system for vaginal vault manipulation. Up to now, no previous research has quantified these interaction forces. Quantifying these forces and providing feedback cues to the surgeon is of particular interest, especially as a means to avoid vaginal rupture due to over-tensioning. A total of 30 interventions will be recorded.