Assisting control of forces in laparoscopy using tactile and visual sensory susbtitution Thomas HOWARD Jérôme SZEWCZYK Sorbonne Universités, UPMC Univ. Paris 06, ISIR, CNRS, UMR 7222, INSERM, U1150, Agathe-ISIR, F-75005, Paris, France e-mail: howard@isir.upmc.fr "Assisting control of forces in laparoscopy using tactile and visual sensory substitution“ T. Howard, J. Szewczyk; MESROB 2015, 8 - 10 juillet 2015, Nantes
Laparoscopic surgery "Assisting control of forces in laparoscopy using tactile and visual sensory substitution“ T. Howard, J. Szewczyk; MESROB 2015, 8 - 10 juillet 2015, Nantes
Laparoscopic surgery • Reduced trauma • Reduced incidence of complications • Reduced hospitalization time • Reduced convalescence time • Better cosmesis • Reduced cost • Improved diagnosis "Assisting control of forces in laparoscopy using tactile and visual sensory substitution“ T. Howard, J. Szewczyk; MESROB 2015, 8 - 10 juillet 2015, Nantes
Laparoscopic surgery : a complex task Limitations in perception and action [01][02] [01] O.S. Bholat et al. "Tactile feedback is present during minimally invasive surgery," J Am Coll Surg ., vol. 189, pp. 349-355, 1999. [02] H. Xin, J. S. Zelek, H. Carnahan , “Laparoscopic surgery, perceptual limitations and force: A review” "Assisting control of forces in laparoscopy using tactile and visual sensory substitution“ T. Howard, J. Szewczyk; MESROB 2015, 8 - 10 juillet 2015, Nantes
Laparoscopic surgery : a complex task Limitations in perception and action [01][02] Dexterity Visual Haptic [01] O.S. Bholat et al. "Tactile feedback is present during minimally invasive surgery," J Am Coll Surg ., vol. 189, pp. 349-355, 1999. [02] H. Xin, J. S. Zelek, H. Carnahan , “Laparoscopic surgery, perceptual limitations and force: A review” "Assisting control of forces in laparoscopy using tactile and visual sensory substitution“ T. Howard, J. Szewczyk; MESROB 2015, 8 - 10 juillet 2015, Nantes
Laparoscopic surgery : a complex task Limitations in perception and action [01][02] Dexterity Visual Haptic Loss of 2 DoF at trocar, Distorsions Partial loss Limited Partial loss of inversion of Hand-eye of tactile and of tactile movements, coordination FoV depth cues kinaesthetic perception varying lever perception effect [01] O.S. Bholat et al. "Tactile feedback is present during minimally invasive surgery," J Am Coll Surg ., vol. 189, pp. 349-355, 1999. [02] H. Xin, J. S. Zelek, H. Carnahan , “Laparoscopic surgery, perceptual limitations and force: A review” "Assisting control of forces in laparoscopy using tactile and visual sensory substitution“ T. Howard, J. Szewczyk; MESROB 2015, 8 - 10 juillet 2015, Nantes
General problem Observation : • In laparoscopy, surgeons almost exclusively rely on vision and use the sense of touch only very little • Some safety-critical information (interaction forces, position of instruments within patient) are not available to the surgeon or are available in low quality Idea : • Feed back relevant information to the surgeon in order to assist his/her gesture, • Provide said information through the haptic sensory modality as it has a limited « natural » use in laparoscopy "Assisting control of forces in laparoscopy using tactile and visual sensory substitution“ T. Howard, J. Szewczyk; MESROB 2015, 8 - 10 juillet 2015, Nantes
Controlling distal interaction forces When tightening an intra-corporeal knot in laparoscopy, • Does feeding back information on the amplitude of the resulting distal interaction forces allow the surgeon to better control of those forces? • What are the advantages and drawbacks of various modes of presentation of this force information? "Assisting control of forces in laparoscopy using tactile and visual sensory substitution“ T. Howard, J. Szewczyk; MESROB 2015, 8 - 10 juillet 2015, Nantes
Controlling distal interaction forces When tightening an intra-corporeal knot in laparoscopy, Thread tension Excess force force [N] Thread may break / Tissue may tear Safe zone Insufficient force Knot may come undone 0 • Does feeding back information on the amplitude of the resulting distal interaction forces allow the surgeon to better control of those forces? • What are the advantages and drawbacks of various modes of presentation of this force information? "Assisting control of forces in laparoscopy using tactile and visual sensory substitution“ T. Howard, J. Szewczyk; MESROB 2015, 8 - 10 juillet 2015, Nantes
Controlling distal interaction forces When tightening an intra-corporeal knot in laparoscopy, Thread tension Excess force force [N] Thread may break / Tissue may tear Safe zone Insufficient force Knot may come undone 0 • Does feeding back information on the amplitude of the resulting distal interaction forces allow the surgeon to better control those forces? • What are the advantages and drawbacks of various modes of presentation of this force information? "Assisting control of forces in laparoscopy using tactile and visual sensory substitution“ T. Howard, J. Szewczyk; MESROB 2015, 8 - 10 juillet 2015, Nantes
Controlling distal interaction forces When tightening an intra-corporeal knot in laparoscopy, Thread tension Excess force force [N] Thread may break / Tissue may tear Safe zone Insufficient force Knot may come undone 0 • Does feeding back information on the amplitude of the resulting distal interaction forces allow the surgeon to better control those forces? • What are the advantages and drawbacks of various modes of presentation of this force information? "Assisting control of forces in laparoscopy using tactile and visual sensory substitution“ T. Howard, J. Szewczyk; MESROB 2015, 8 - 10 juillet 2015, Nantes
Controlling distal interaction forces - protocol Setup : Task to be performed : • Define a target force between 1 and 3N (for practical reasons) Feedback corresponding to the studied condition is provided • 1 Force reach task: Having changed the instrument orientation, aim for the target as precisely as possible • 1 Force hold task (duration = 20s) • 3 Force repeat tasks: "Assisting control of forces in laparoscopy using tactile and visual sensory substitution“ T. Howard, J. Szewczyk; MESROB 2015, 8 - 10 juillet 2015, Nantes
Controlling distal interaction forces - protocol Setup : Task to be performed : • Define a target force between 1 and 3N (for practical reasons) Feedback corresponding to the studied condition is provided • 1 Force reach task: Having changed the instrument orientation, aim for the target as precisely as possible • 1 Force hold task (duration = 20s) • 3 Force repeat tasks: "Assisting control of forces in laparoscopy using tactile and visual sensory substitution“ T. Howard, J. Szewczyk; MESROB 2015, 8 - 10 juillet 2015, Nantes
Controlling distal interaction forces - protocol Setup : Task to be performed : • Define a target force between 1 and 3N (for practical reasons) Feedback corresponding to the studied condition is provided • 1 Force reach task: Having changed the instrument orientation, aim for the target as precisely as possible • 1 Force hold task (duration = 20s) • 3 Force repeat tasks: "Assisting control of forces in laparoscopy using tactile and visual sensory substitution“ T. Howard, J. Szewczyk; MESROB 2015, 8 - 10 juillet 2015, Nantes
Controlling distal interaction forces - protocol POPULATION EXPERIMENT 16 subjects Performance comparison between : Conventional laparoscopy (L), (all novices in laparoscopy) with visual force feedback (V), RANDOMIZATION continuous vibrotactile force feedback (T), Full Randomization of three variants of pulsed vibrotactiles force conditions : feedback (Uf, Up, Uq), L – V – T – Uf – Up – Uq – {One variant of visual+tactile and visuel+tactile combinations (TV, UV) combination} "Assisting control of forces in laparoscopy using tactile and visual sensory substitution“ T. Howard, J. Szewczyk; MESROB 2015, 8 - 10 juillet 2015, Nantes
Experimental conditions • [L] Reference – Laparoscopy : Closed laparo-trainer, simple endoscopic image, no feedback of force magnitude • [V] Visual feedback Feedback of force magnitude through on-screen bar-graph • [T] Continuous proportional vibrotactile feedback Provided by an ERM motor strapped to the subject’s hand • [U Pulsed vibrotactile feedback – F]: fixed pulse length, interval between pulses varying proportionally to the exerted force – P]: pulse length and interval jointly vary proportionally to the exerted force – Q]: fixed pulse interval, pulse length varying proportionally to the exerted force • TV, UfV, UpV, UqV : Combinaisons de retours visuels+vibrotactiles "Assisting control of forces in laparoscopy using tactile and visual sensory substitution“ T. Howard, J. Szewczyk; MESROB 2015, 8 - 10 juillet 2015, Nantes
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