Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Mar;62(3):890-9.
doi: 10.1109/TBME.2014.2369956. Epub 2014 Nov 12.

Characterization of force and torque interactions during a simulated transgastric appendectomy procedure

Saurabh Dargar, Cecilia Brino, Kai Matthes, Ganesh Sankaranarayanan, Suvranu De

Characterization of force and torque interactions during a simulated transgastric appendectomy procedure

Saurabh Dargar et al. IEEE Trans Biomed Eng. 2015 Mar.

Abstract

We have developed an instrumented endoscope grip handle equipped with a six-axis load cell and measured forces and torques during a simulated transgastric natural orifice translumenal endoscopic surgery appendectomy procedure performed in an EASIE-R ex vivo simulator. The data were collected from ten participating surgeons of varying degrees of expertise which was analyzed to compute a set of six force and torque parameters for each coordinate axis for each of the nine tasks of the appendectomy procedure. The mean push/pull force was found to be 3.64 N (σ = 3.54 N) in the push direction and the mean torque was 3.3 N · mm (σ = 38.6 N · mm) in the counterclockwise direction about the push/pull axis. Most interestingly, the force and torque data about the nondominant x and z axes showed a statistically significant difference (p < 0.05) between the expert and novice groups for five of the nine tasks. These data may be useful in developing surgical platforms especially new haptic devices and simulation systems for emerging natural orifice procedures.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
(a) The EASIE-R™ simulator with ex-planted pig organs and access ports (b) The EASIE-R™ simulator with the molded belly
Fig. 1
Fig. 1
(a) The EASIE-R™ simulator with ex-planted pig organs and access ports (b) The EASIE-R™ simulator with the molded belly
Fig. 2
Fig. 2
A demonstrator holding the flexible endoscope. One hand holds the endoscope handle while the other holds the shaft of the endoscope.
Fig. 3
Fig. 3
(a) CAD model of device attached to endoscope (b) Front view of force/torque recording device.
Fig. 3
Fig. 3
(a) CAD model of device attached to endoscope (b) Front view of force/torque recording device.
Fig. 4
Fig. 4
A schematic identifying the coordinate system of the 6-axis load cell with respect to the location of the user’s hand while manipulating the endoscope
Fig. 5
Fig. 5
Histograms of the forces applied by all users (experts and novices) during all of the nine tasks which comprise of the NOTES appendectomy procedure.
Fig. 6
Fig. 6
Histograms of the torques applied by all users (experts and novices) during all of the nine tasks which comprise of the transgastric appendectomy procedure.
Fig. 7
Fig. 7
A time series plot comparing the force signatures of an expert and novice for task #4 which includes the placement of the deflated radial expansion balloon and eventual inflation to increase the size of incision in the gastric wall.
Fig. 8
Fig. 8
A time series plot comparing the torque signatures of an expert and novice for task #4 which includes the placement of the deflated radial expansion balloon and eventual inflation to increase the size of incision in the gastric wall.
Fig. 9
Fig. 9
Plots (a) through (r) compare the peak and RMS force/torque parameters between experts and novices for each of the nine tasks of the NOTES appendectomy procedure. (a,b) Task #1: insertion of endoscope through the esophagus (c,d) Task #2: entry into stomach and insufflation (e,f) Task #3: create gastric wall incision using electrosurgical tip (g,h) Task #4: placement and inflation of controlled radial expansion balloon (i,j) Task #5: push inflated controlled radial expansion balloon through the gastric incision (k,l) Task #6: exposure and assessment of the appendix (m,n) Task #7: dissection and division of appendix (o,p) Task #8: Removal of appendix from location of dissection to outside gastric port (q,r) Task #9: Gastric closure of incision using closure clips.
See this image and copyright information in PMC

References

    1. Rattner D, Kalloo A. ASGE/SAGES Working Group on Natural Orifice Translumenal Endoscopic Surgery: October 2005. Surg. Endosc. 2006 Jan;20(2):329–333. - PubMed
    1. Pai RD, Fong DG, Bundga ME, Odze RD, Rattner DW, Thompson CC. Transcolonic endoscopic cholecystectomy: a NOTES survival study in a porcine model (with video) Gastrointest. Endosc. 2006 Sep;64(3):428–434. - PubMed
    1. Rolanda C, Lima E, Pêgo JM, Henriques-Coelho T, Silva D, Moreira I, Macedo G, Carvalho JL, Correia-Pinto J. Third-generation cholecystectomy by natural orifices: transgastric and transvesical combined approach (with video) Gastrointest. Endosc. 2007 Jan;65(1):111–117. - PubMed
    1. Wagh MS, Thompson CC. Surgery Insight: natural orifice transluminal endoscopic surgery[mdash]an analysis of work to date. Nat Clin Pr. Gastroenterol Hepatol. 2007 Jul;4(7):386–392. - PubMed
    1. Zorron R, Palanivelu C, Galvão Neto MP, Ramos A, Salinas G, Burghardt J, DeCarli L, Henrique Sousa L, Forgione A, Pugliese R, Branco AJ, Balashanmugan TS, Boza C, Corcione F, D’Ávila Avila F, Arturo Gómez N, Galvão Ribeiro PA, Martins S, Filgueiras M, Gellert K, Wood Branco A, Kondo W, Inacio Sanseverino J, de Sousa JAG, Saavedra L, Ramírez E, Campos J, Sivakumar K, Rajan Pidigu Seshiyer, Jategaonkar Priyadarshan Anand, Ranagrajan M, Parthasarathi R, Senthilnathan P, Prasad M, Cuccurullo D, Müller V. International Multicenter Trial on Clinical Natural Orifice Surgery—NOTES IMTN Study: Preliminary Results of 362 Patients. Surg. Innov. 2010 Jun;17(2):142–158. - PubMed

Publication types