Abstract
BackgroundExcessive tool-tissue interaction forces often result in tissue damage and intraoperative complications, while insufficient forces prevent the completion of the task. This review sought to explore the tool-tissue interaction forces exerted by instruments during surgery across different specialities, tissues, manoeuvres and experience levels. Materials & methodsA PRISMA-guided systematic review was carried out using Embase, Medline and Web of Science databases. ResultsOf 462 articles screened, 45 studies discussing surgical tool-tissue forces were included. The studies were categorized into 9 different specialities with the mean of average forces lowest for ophthalmology (0.04N) and highest for orthopaedic surgery (210N). Nervous tissue required the least amount of force to manipulate (mean of average: 0.4N), whilst connective tissue (including bone) required the most (mean of average: 45.8). For manoeuvres, drilling recorded the highest forces (mean of average: 14N), whilst sharp dissection recorded the lowest (mean of average: 0.03N). When comparing differences in the mean of average forces between groups, novices exerted 22.7% more force than experts, and presence of a feedback mechanism (e.g. audio) reduced exerted forces by 47.9%. ConclusionsThe measurement of tool-tissue forces is a novel but rapidly expanding field. The range of forces applied varies according to surgical speciality, tissue, manoeuvre, operator experience and feedback provided. Knowledge of the safe range of surgical forces will improve surgical safety whilst maintaining effectiveness. Measuring forces during surgery 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]
A systematic review of the literature was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (Assessing the methodological quality of systematic reviews) guidelines
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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