Abstract
STRAS (Single access Transluminal Robotic Assistant for Surgeons) is a new robotic system based on the Anubis® platform of Karl Storz for application to intra-luminal surgical procedures. Pre-clinical testing of STRAS has recently permitted to demonstrate major advantages of the system in comparison with classic procedures. Benchmark methods permitting to establish objective criteria for ‘expertise’ need to be worked out now to effectively train surgeons on this new system in the near future. STRAS consists of three cable-driven sub-systems, one endoscope serving as guide, and two flexible instruments. The flexible instruments have three degrees of freedom and can be teleoperated by a single user via two specially designed master interfaces. In this study, small force sensors sewn into a wearable glove to ergonomically fit the master handles of the robotic system were employed for monitoring the forces applied by an expert and a trainee (complete novice) during all the steps of surgical task execution in a simulator task (4-step-pick-and-drop). Analysis of grip-force profiles is performed sensor by sensor to bring to the fore specific differences in handgrip force profiles in specific sensor locations on anatomically relevant parts of the fingers and hand controlling the master/slave system.
Highlights
Flexible systems such as endoscopes are widely used for performing minimally invasive surgical interventions, as in intraluminal procedures or single port laparoscopy
Surgical platforms have been developed by companies and by laboratories to improve the capabilities of these flexible systems, for instance by providing additional degrees of freedom (DoF) to the instruments or triangulation configurations [1,2]
S12 produced markedly different grip force data across the two individuals in all the sessions and across hand conditions. These differences in grip-force profiles are explained by the fact that the corresponding finger or hand regions were not used in the same way, for either general grip force control or strategic grip force deployment in the manipulation of the robotic system, by the expert and the novice, who was an absolute beginner and had no experience at all with the system. These findings show promising differences that could be exploited in future studies on larger study populations, where the expert grip force profiles for strategically selected sensor locations may serve as benchmarks for assessing the skill status or evolution of novices and/or absolute beginners from different sample populations
Summary
Flexible systems such as endoscopes are widely used for performing minimally invasive surgical interventions, as in intraluminal procedures or single port laparoscopy. The high number of DoF to be controlled represents a constraint, where several expert technicians, including the surgeon, have to work together in a complex environment. Robot assistance has been identified as a solution to this problem relative to the use of flexible systems in minimally invasive surgery [3], which explains the motivation for developing the new, teleoperated robotic system put to work in this study here. The goal of STRAS is to optimally assist the expert surgeon in minimally invasive procedures [4], and the design is based on the Anubis® platform developed by Karl Storz and the IRCAD [5].
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