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A "Smart" Force-Limiting Instrument for Microsurgery: Laboratory and In Vivo Validation

Marcus, HJ; Payne, CJ; Kailaya-Vasa, A; Griffiths, S; Clark, J; Yang, G-Z; Darzi, A; (2016) A "Smart" Force-Limiting Instrument for Microsurgery: Laboratory and In Vivo Validation. PLoS One , 11 (9) , Article e0162232. 10.1371/journal.pone.0162232. Green open access

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Abstract

Residents are required to learn a multitude of skills during their microsurgical training. One such skill is the judicious application of force when handling delicate tissue. An instrument has been developed that indicates to the surgeon when a force threshold has been exceeded by providing vibrotactile feedback. The objective of this study was to validate the use of this "smart" force-limiting instrument for microsurgery. A laboratory and an in vivo experiment were performed to evaluate the force-limiting instrument. In the laboratory experiment, twelve novice surgeons were randomly allocated to use either the force-limiting instrument or a standard instrument. Surgeons were then asked to perform microsurgical dissection in a model. In the in vivo experiment, an intermediate surgeon performed microsurgical dissection in a stepwise fashion, alternating every 30 seconds between use of the force-limiting instrument and a standard instrument. The primary outcomes were the forces exerted and the OSATS scores. In the laboratory experiment, the maximal forces exerted by novices using the force-limiting instrument were significantly less than using a standard instrument, and were comparable to intermediate and expert surgeons (0.637N versus 4.576N; p = 0.007). In the in vivo experiment, the maximal forces exerted with the force-limiting instrument were also significantly less than with a standard instrument (0.441N versus 0.742N; p <0.001). Notably, use of the force-limiting instrument did not significantly impede the surgical workflow as measured by the OSATS score (p >0.1). In conclusion, the development and use of this force-limiting instrument in a clinical setting may improve patient safety.

Type: Article
Title: A "Smart" Force-Limiting Instrument for Microsurgery: Laboratory and In Vivo Validation
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1371/journal.pone.0162232
Publisher version: http://dx.doi.org/10.1371/journal.pone.0162232
Language: English
Additional information: © 2016 Marcus et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Keywords: Adult, Dissection, Feedback, Female, Humans, Male, Microsurgery, Stress, Mechanical, Surgical Instruments, Young Adult
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology
URI: https://discovery.ucl.ac.uk/id/eprint/10031850
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