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首页> 外文期刊>Surgical Endoscopy >Effect of laparoscopic grasper force transmission ratio on grasp control.
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Effect of laparoscopic grasper force transmission ratio on grasp control.

机译：腹腔镜抓取器力传递比对抓取控制的影响。

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BACKGROUND: Surgeons may cause tissue damage by incorrect laparoscopic pinch force control. Unpredictable tissue and grasper properties may cause slips or ruptures. This study investigated how different forms of haptic feedback influence the surgeon's ability to generate a safe laparoscopic grasp while pulling tissues of variable stiffness using graspers with different force transmission ratios. The results will help define design requirements for training facilities and instruments. METHODS: For this study, 10 participants lifted an object barehanded, with tweezers, or with one of two laparoscopic graspers until they where able to complete five consecutive safe lifts under different tissue stiffness conditions. The participants were presented with indirect visual feedback of pinch force, object location, and target location. RESULTS: Lifting with instruments (tweezers or graspers) required 4.5 to 14.5 times as many practice trials as barehanded lifting, where no slips were recorded. Additionally, slips occurred more often with a decreasing force transmission ratio of the graspers and with increasing tissue stiffness. The maximal pinch force was higher in lifting with instruments than in barehanded lifting (26-60%) irrespective of the stiffness conditions. Using a grasper, the slip margin often was not high enough in the stiffest condition, resulting in slippage of up to 84%. CONCLUSIONS: Without the direct tactile feedback that occurs with normal skin-tissue contact, subjects using graspers have trouble anticipating slippage when lifting tissue with variable stiffness. Performance drops with a decreased force transmission ratio of the instrument and increased tissue stiffness. Furthermore, the pinch forces are not adapted to the variable stiffness conditions. The same pinch force is applied irrespective of tissue stiffness. It takes participants longer to learn a safe laparoscopic grasp than to learn barehanded lifts. Additionally, to perform safe laparoscopic surgery, care should be taken when graspers with a low force transmission ratio are used.
机译：背景：外科医生可能会由于不正确的腹腔镜收缩力控制而引起组织损伤。不可预测的组织和抓紧器特性可能会导致打滑或破裂。这项研究调查了不同形式的触觉反馈如何影响外科医师产生安全腹腔镜抓握的能力，同时使用具有不同力传递比的抓握器牵拉可变硬度的组织。结果将有助于确定培训设施和仪器的设计要求。方法：对于本研究，有10名参与者用镊子或两个腹腔镜抓握器徒手举起了一个物体，直到他们能够在不同的组织僵硬条件下完成五次连续的安全举升。向参与者展示了捏力，物体位置和目标位置的间接视觉反馈。结果：用仪器（镊子或抓手）进行举重所需的练习次数是徒手举起的4.5至14.5倍，徒手举起时未记录滑倒情况。另外，随着抓紧器的力传递比减小和组织刚度增大，更经常发生打滑。不管刚度条件如何，用器械提起的最大捏力都比徒手提起的最大捏力（26-60％）高。使用抓紧器，在最严酷的条件下，滑移裕度通常不够高，导致滑移率高达84％。结论：由于没有正常皮肤与皮肤接触所产生的直接触觉反馈，使用抓紧器的受试者在举起具有不同刚度的组织时难以预期滑动。随着器械传力比的降低和组织刚度的提高，性能下降。此外，挤压力不适应可变的刚度条件。不论组织刚度如何，都会施加相同的挤压力。与学习徒手升降机相比，参与者需要更长的时间来学习安全的腹腔镜检查方法。此外，为了执行安全的腹腔镜手术，当使用力传递比低的抓手时应格外小心。

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