BACKGROUND: Natural orifice transluminal endoscopic surgery (NOTES) may represent the next frontier for therapeutic minimally invasive surgery; however, its feasibility is currently limited by the lack of suitable instruments. Identifying the forces required to manipulate tissue during NOTES is a necessary first step in the development of better instrumentation. METHODS: Sensorized instruments were used to measure the forces acting at the tip of the instruments during transgastric and transperineal NOTES procedures performed in two female pigs. The maximum and average forces when handling tissue were determined and compared. RESULTS: The results show that, for the transgastric approach, the average forces required are significantly less than in the transperineal approach (43% less), and that the maximum forces required are almost 8 and 16 N in the transgastric and transperineal approaches, respectively. The forces were higher than 5 N in 1.6% of the measurements in the transgastric approach and 2.9% in the transperineal approach. CONCLUSIONS: This study presents an experimental measurement of tissue manipulation forces in a NOTES procedure. This information may be valuable for research groups interested in developing NOTES instruments and devices. It is recommended that NOTES instruments be designed to easily handle forces as high as 16 N.
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机译：背景：自然孔腔内镜手术（NOTES）可能代表微创治疗的下一个前沿领域。但是，由于缺乏合适的仪器，其可行性目前受到限制。识别NOTES期间操纵组织所需的力是开发更好的仪器的必要的第一步。方法：在两只雌性猪的经胃和经会阴NOTES程序中，使用传感器化的仪器测量作用在仪器尖端的力。确定并比较处理组织时的最大和平均力。结果：结果表明，对于经胃入路，平均所需力明显小于经会阴法（减少了43％），并且经胃和经会阴法所需的最大力分别约为8 N和16 N 。经胃入路的测量结果中，有1.6％的测量结果中的力高于5 N，经会阴部的测量中中值显示为2.9％。结论：本研究提出了在NOTES程序中组织操纵力的实验测量。该信息对于有兴趣开发NOTES仪器和设备的研究小组可能是有价值的。建议将NOTES仪器设计为易于承受高达16 N的力。
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