Minimally invasive surgery (MIS) is carried out using long, narrow instruments and significantly reduces trauma to the body, postoperative pain, and recovery time. Unfortunately, the restricted access conditions, limited instrument motion, and degraded sense of touch inherent in MIS result in new perceptual-motor relationships, which are unfamiliar to the surgeon and require training to overcome. Current training methods do not adequately address the needs of surgeons interested in acquiring these skills. Although a significant amount of research has been focused on the development of sensorized systems for surgery, there is still a need for a system that can be used in any training scenario (laparoscopic trainer, animal laboratories, or real surgery) for the purpose of skills assessment and training. A sensorized laparoscopic instrument has been designed that is capable of noninvasively measuring its interaction with tissue in the form of forces or torques acting in all five degrees-of-freedom (DOFs) available during MIS. Strain gauges attached to concentric shafts within the instrument allow the forces acting in different directions to be isolated. An electromagnetic tracking system is used for position tracking. Two prototypes of the sensorized instrument were constructed. Position calibration shows a maximum root mean square (RMS) error of 1.3 mm. The results of the force calibration show a maximum RMS error of 0.35 N for the actuation force, 0.07 N in the x and y directions, and 1.5 N mm for the torque calibration with good repeatability and low hysteresis. Axial measurements were significantly affected by drift, noise, and coupling leading to high errors in the readings. Novel sensorized instruments for skills assessment and training have been developed and a patent has been filed for the design and operation. The instruments measure forces and torques acting at the tip of the instrument corresponding to all five DOFs available during MIS and provide position feedback in six DOFs. The instruments are similar in shape, size, and weight to traditional laparoscopic instruments allowing them to be used in any training environment. Furthermore, replaceable tips and handles allow the instruments to be used for a variety of different tasks.
An evidence-based review of enhanced recovery interventions in knee replacement surgery