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Tool-tissue forces in surgery: A systematic review

Golahmadi, AK; Khan, DZ; Mylonas, GP; Marcus, H; (2021) Tool-tissue forces in surgery: A systematic review. Annals of Medicine and Surgery , 65 , Article 102268. 10.1016/j.amsu.2021.102268. Green open access

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Abstract

Background: Excessive tool-tissue interaction forces often result in tissue damage and intraoperative complications, while insufficient forces prevent the completion of the task. This review sought to explore the tool-tissue interaction forces exerted by instruments during surgery across different specialities, tissues, manoeuvres and experience levels./ Materials & methods: A PRISMA-guided systematic review was carried out using Embase, Medline and Web of Science databases. / Results: Of 462 articles screened, 45 studies discussing surgical tool-tissue forces were included. The studies were categorized into 9 different specialities with the mean of average forces lowest for ophthalmology (0.04N) and highest for orthopaedic surgery (210N). Nervous tissue required the least amount of force to manipulate (mean of average: 0.4N), whilst connective tissue (including bone) required the most (mean of average: 45.8). For manoeuvres, drilling recorded the highest forces (mean of average: 14N), whilst sharp dissection recorded the lowest (mean of average: 0.03N). When comparing differences in the mean of average forces between groups, novices exerted 22.7% more force than experts, and presence of a feedback mechanism (e.g. audio) reduced exerted forces by 47.9%. / Conclusions: The measurement of tool-tissue forces is a novel but rapidly expanding field. The range of forces applied varies according to surgical speciality, tissue, manoeuvre, operator experience and feedback provided. Knowledge of the safe range of surgical forces will improve surgical safety whilst maintaining effectiveness. Measuring forces during surgery may provide an objective metric for training and assessment. Development of smart instruments, robotics and integrated feedback systems will facilitate this.

Type: Article
Title: Tool-tissue forces in surgery: A systematic review
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.amsu.2021.102268
Publisher version: https://dx.doi.org/10.1016/j.amsu.2021.102268
Language: English
Additional information: © 2021 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.This is an open access article under the CC BY license
Keywords: Tool-tissue interaction; Operative forces; Surgical forces; Force feedback; Force sensors; Haptic feedback; Smart instruments; Robotics; Robotic surgery
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
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Department of Neuromuscular Diseases
URI: https://discovery.ucl.ac.uk/id/eprint/10125578
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