Surgeons' requirements for a surgical support system to improve laparoscopic access

Abstract

Creating surgical access is a critical step in laparoscopic surgery. Surgeons have to insert a sharp instrument such as the Veress needle or a trocar into the patient's abdomen until the peritoneal cavity is reached. They solely rely on their experience and distorted tactile feedback in that process, leading to a complication rate as high as 14% of all cases. Recent studies have shown the feasibility of surgical support systems that provide intraoperative feedback regarding the insertion process to improve laparoscopic access outcomes. However, to date, the surgeons' requirements for such support systems remain unclear. This research article presents the results of an explorative study that aimed to acquire data about the information that helps surgeons improve laparoscopic access outcomes. The results indicate that feedback regarding the reaching of the peritoneal cavity is of significant importance and should be presented visually or acoustically. Finally, a solution should be straightforward and intuitive to use, should support or even improve the clinical workflow, but also cheap enough to facilitate its usage rate. While this study was tailored to laparoscopic access, its results also apply to other minimally invasive procedures.

Keywords: Audio sensing; Capnoperitoneum; Intraoperative support systems; Laparoscopic access; Laparoscopy; Minimally invasive surgery; Online questionnaire; Peritoneal cavity; Pneumoperitoneum; Survey.

Fig. 1

Demographical data of the survey participants by Age (A), Position (B) and Clinical Specialty (C)

Fig. 2

When inserting the Veress needle, surgeons rely heavily on practical experience and tactile perception. The “click” sound and the visual indicator, which are triggered by the needle’s spring mechanism, are not widely used

Fig. 3

Similar observations like for the Veress needle could be made for alternative tools such as trocars. Most surgeons also rely on practical experience and tactile perception. The optical core (visual feedback), integrated as a safety mechanism into some trocars, is not used by everybody

Fig. 4

More than 60% of the participants would like to be supported by feedback regarding the reaching of the peritoneal cavity (option 5) and an alarm concerning a potential injury of intraabdominal structures (option 6) during laparoscopic access

Fig. 5

Most proposed feedback approaches were rejected by the participants. They mainly accepted feedback in their focus such as visual feedback via LEDs (option 2) or a speaker (option 6) integrated into the sensing module. Some surgeons can imagine the feedback to be displayed on an external screen (option 1) or as a vibration of the sensing module (option 8)

Fig. 6

Most participants prefer visual feedback via LEDs integrated into the sensing module or on an external screen. Force measurements and real-time plots of the acquired audio signal were not accepted

Fig. 7

Verbal feedback during needle insertion was clearly rejected by the participants (66% in the lower box). Fourteen participants each found the acoustic feedback similar to a park distance control (option 1) and the continuous, magnified audio signal (option 2) suitable. However, option 1 was only rejected by eight participants in the lower box, while 13 participants rejected option 2