A "smart" force-limiting instrument for microsurgery: laboratory and in vivo validation

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Title: A "smart" force-limiting instrument for microsurgery: laboratory and in vivo validation
Author(s): Marcus, HJ
Payne, CJ
Kailaya-Vasa, A
Griffiths, S
Clark, J
Yang, GZ
Darzi, A
Nandi, D
Item Type: Journal Article
Abstract: Residents are required to learn a multitude of skills during their microsurgical training. One such skill is the judicious application of force when handling delicate tissue. An instrument has been developed that indicates to the surgeon when a force threshold has been exceeded by providing vibrotactile feedback. The objective of this study was to validate the use of this "smart" force-limiting instrument for microsurgery. A laboratory and an in vivo experiment were performed to evaluate the force-limiting instrument. In the laboratory experiment, twelve novice surgeons were randomly allocated to use either the force-limiting instrument or a standard instrument. Surgeons were then asked to perform microsurgical dissection in a model. In the in vivo experiment, an intermediate surgeon performed microsurgical dissection in a stepwise fashion, alternating every 30 seconds between use of the force-limiting instrument and a standard instrument. The primary outcomes were the forces exerted and the OSATS scores. In the laboratory experiment, the maximal forces exerted by novices using the force-limiting instrument were significantly less than using a standard instrument, and were comparable to intermediate and expert surgeons (0.637N versus 4.576N; p = 0.007). In the in vivo experiment, the maximal forces exerted with the force-limiting instrument were also significantly less than with a standard instrument (0.441N versus 0.742N; p <0.001). Notably, use of the force-limiting instrument did not significantly impede the surgical workflow as measured by the OSATS score (p >0.1). In conclusion, the development and use of this force-limiting instrument in a clinical setting may improve patient safety.
Publication Date: 13-Sep-2016
Date of Acceptance: 21-Aug-2016
URI: http://hdl.handle.net/10044/1/40249
DOI: https://dx.doi.org/10.1371/journal.pone.0162232
ISSN: 1932-6203
Publisher: Public Library of Science
Journal / Book Title: PLOS One
Volume: 11
Issue: 9
Copyright Statement: © 2016 Marcus et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Sponsor/Funder: Medical Research Council (MRC)
Imperial College Healthcare NHS Trust
University College London
Medtronic UK Ltd
National Institute for Health Research
Wellcome Trust
Royal College of Surgeons Edinburgh
Funder's Grant Number: G0701698
CLRN award for N Yousif
N/A
N/A
4070016166
100564/Z/12/Z
N/A
Keywords: General Science & Technology
MD Multidisciplinary
Publication Status: Published
Conference Place: United States
Article Number: ARTN e0162232
Open Access location: http://dx.doi.org/10.1371/journal.pone.0162232
Appears in Collections:Division of Surgery
Department of Medicine



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