A Sensorised Surgical Glove to Analyze Forces During Neurosurgery

Abstract

Background: Measuring intraoperative forces in real time can provide feedback mechanisms to improve patient safety and surgical training. Previous force monitoring has been achieved through the development of specialized and adapted instruments or use designs that are incompatible with neurosurgical workflow.

Objective: To design a universal sensorised surgical glove to detect intraoperative forces, applicable to any surgical procedure, and any surgical instrument in either hand.

Methods: We created a sensorised surgical glove that was calibrated across 0 to 10 N. A laboratory experiment demonstrated that the sensorised glove was able to determine instrument-tissue forces. Six expert and 6 novice neurosurgeons completed a validated grape dissection task 20 times consecutively wearing the sensorised glove. The primary outcome was median and maximum force (N).

Results: The sensorised glove was able to determine instrument-tissue forces reliably. The average force applied by experts (2.14 N) was significantly lower than the average force exerted by novices (7.15 N) ( P = .002). The maximum force applied by experts (6.32 N) was also significantly lower than the maximum force exerted by novices (9.80 N) ( P = .004). The sensorised surgical glove's introduction to operative workflow was feasible and did not impede on task performance.

Conclusion: We demonstrate a novel and scalable technique to detect forces during neurosurgery. Force analysis can provide real-time data to optimize intraoperative tissue forces, reduce the risk of tissue injury, and provide objective metrics for training and assessment.

FIGURE 1.

Summary of piezoresistive “sensorised surgical glove” fabrication. A, Schematic representation of the fabrication steps of the piezoresistive foam. B, Field emission scanning electron microscope of the piezoresistive foam: (a) the interconnected 3-dimensional pore structure of melamine with impregnated CNF and (b) magnified image showing fiber-like CNF adhered on the melamine framework. C, Mechanism of action of piezoresistive foam. Black arrows indicate CNF coming into contact with one another. D, Schematic of sensorised surgical glove. CNF, carbon nanofiber; F, force; R, resistance.

FIGURE 2.

A, Laboratory experimental setup. B, Determining forces at the glove-instrument and the instrument-tissue interfaces from laboratory experiment. 3D, 3-dimensional.

FIGURE 3.

Photographs demonstrating experimental setup of A, expert performing grape dissection task with sensorised glove on the right hand. B, Magnified image of sensorised smart glove. C, and D, Demonstrate the validated dissection task “star's the limit” with dissection of the grape skin in the shape of a star, while leaving the grape flesh intact.

FIGURE 4.

Summary of expert A, and novice B, exerted forces during grape dissection task. C, Median force applied by experts and novices (P = .002). D, Median maximum force applied by experts and novices (P = .004).