Novel force feedback technology improves suturing in robotic-assisted surgery: a pre-clinical study

Introduction: The inability to sense force applied to tissue is suggested as a limitation to robotic-assisted surgery (RAS). This pre-clinical study evaluated the impact of a novel force feedback (FFB) technology, integrated on a next-generation robotic system that allows surgeons to sense forces exerted at the instrument tips, on suturing performance by novice surgeons during RAS.

Methods: Twenty-nine novice surgeons (< 50 RAS cases in the last 5 years) were randomized into two groups with (n = 15) or without (n = 14) FFB sensing. Participants performed interrupted stitches on ex vivo porcine bladder and running stitches on porcine aorta (Fig. 1A) over four runs. Average forces applied, number of errors, time for exercise completion, and Robotic Anastomosis Competence Evaluation (RACE) technical skill ratings were compared using a three-way mixed-model ANOVA and applicable post hoc tests. Fig. 1 A View from surgeon console of participant performing suturing tasks using Kotobuki dry model (Exercise 1 to 3), Foam dry model (Exercise 4 and 5), Urinary Bladder ex vivo tissue (Exercise 6), and Aorta ex vivo tissue (Exercise 7). B Description of 7 suturing exercises and anatomical models used for each exercise RESULTS: FFB sensing significantly lowered the mean force applied (bladder, 1.71 N vs 2.40 N, p < 0.006; aorta, 1.80 N vs 2.53 N, p < 0.006), average number of errors (bladder, 0.59 vs 1.76, p < 0.001; aorta, 0.38 vs 1.14, p < 0.001), and the time to completion (bladder, 659 s vs 781 s, p = 0.002; aorta, 460 s vs 570 s, p = 0.001) (Fig. 1C). The FFB group applied less tissue trauma with a higher RACE skill score (3.75 vs 3.03, p = 0.012).

Conclusion: This study showed that novice surgeons using FFB-enabled instruments completed suturing tasks using less force, with fewer errors, taking less time, and less tissue trauma during RAS. Future studies are required to better understand the impact of FFB technology on surgical performance and potential patient benefits.