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Research Papers

Comparison of Two Control Methods for Minimally Invasive Surgical Instruments

[+] Author and Article Information
Chunman Fan

Faculty Mechanical, Maritime, and Materials Engineering,Department Biomechanical Engineering,  Delft University of Technology, Mekelweg 2, 2628CD Delft, The Netherlandsc.fan@tudelft.nl

Hélène Clogenson

Faculty Mechanical, Maritime, and Materials Engineering,Department Biomechanical Engineering,  Delft University of Technology, Mekelweg 2, 2628CD Delft, The Netherlandsh.c.clogenson@tudelft.nl

Paul Breedveld

Faculty Mechanical, Maritime, and Materials Engineering,Department Biomechanical Engineering,  Delft University of Technology, Mekelweg 2, 2628CD Delft, The Netherlandsp.breedveld@tudelft.nl

John J. van den Dobbelsteen

Faculty Mechanical, Maritime, and Materials Engineering,Department Biomechanical Engineering,  Delft University of Technology, Mekelweg 2, 2628CD Delft, The Netherlandsj.j.vandendobbelsteen@tudelft.nl

Jenny Dankelman

Faculty Mechanical, Maritime, and Materials Engineering,Department Biomechanical Engineering,  Delft University of Technology, Mekelweg 2, 2628CD Delft, The Netherlandsj.dankelman@tudelft.nl

J. Med. Devices 6(2), 021005 (Apr 26, 2012) (6 pages) doi:10.1115/1.4006544 History: Received October 18, 2011; Revised March 03, 2012; Published April 26, 2012; Online April 26, 2012

Laparoscopic surgery is performed with long and slender instruments through one or several incisions in the abdominal wall. Steerable instruments with flexible distal tips have been developed for improving the ease of access to anatomic structures. However, the development of an intuitive and efficient control method for such steerable instruments remains a challenge. To determine which interface are most intuitive and effective to control steerable instruments, the current study evaluates the performance of novices in orienting the tip of a steerable laparoscopic forceps using thumb control or wrist control. Using two steerable instruments, one controlled by the thumb and the other by the wrist, 24 novices were divided into two groups that had to carry out an experimental task in an EndoTrainer with one of the two instruments. The participants had to orient the tip of the instrument relative to five targets that were presented in a random order. After a break, the participants switched to a second measurement session with the other instrument, followed by a third measurement session with the first instrument. Each participant performed the task 240 times over the three measurement sessions. The performance was assessed by measuring the performance time, using a questionnaire and grading the work load. The performance time showed a significant learning curve for each control method. The shortest performance time was recorded during the third session with both control methods (42.7 s for thumb control and 44.6 s for wrist control). A significant difference in the performance time was observed in the second session (p <0.02) but not in the first and third session. The questionnaire showed that most participants had a preference for thumb control. After a brief training period, thumb control and wrist control did not reveal significant differences in task performance. However, thumb control was strongly preferred by the participants due to the perceptive feeling in performance.

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Copyright © 2012 by American Society of Mechanical Engineers
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Figures

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Figure 1

Wrist control instrument Laparo-Angle (Cambridge Endo, U.S.). Up: The handle and tip are at downward position. Down: The handle and tip are at upward position.

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Figure 2

Thumb control instrument Microflex (DEAM, NL). Up: The ratchet and tip are at downward position. Down: The ratchet and tip are at upward position.

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Figure 3

The two laparoscopic instruments (with modification) used in this study. In both instruments, the steerable tip has been covered by an aluminum tube locking the jaws in closed position and giving both tips the same length.

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Figure 4

Sketch (top) and photo (bottom) of experiment setup

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Figure 5

Sketch (top) and photo (bottom) of the transparent target tubes

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Figure 6

Flow chart of experiment procedure and order of the two control methods in the two groups

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Figure 7

Average task performance time in each session. The filled boxes indicate the results from group A, whereas the unfilled boxes indicate the results from group B. The results are presented as box and whisker plots, where every box has a line at quartile, median, and upper quartile values. ** p < 0.02.

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Figure 8

Average task performance time in each trial from three sessions. Filled marks indicate group A, whereas unfilled marks indicate group B.

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Figure 9

Effect of different control methods on physical demand and effort in each session. The filled boxes indicate group A, whereas the unfilled boxes indicate group B. The results are presented as box and whisker plots, where every box has a line at quartile, median, and upper quartile values. **p < 0.02, ***p < 0.001.

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Figure 10

Questionnaire results for final preference

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Figure 11

Illustration of control motions in this experiment. Top: Common control motions in laparoscopic procedure (four DoF), pull/push and rotation along the instrument shaft, up/down, left/right at the incision. Middle: Thumb control motions (two DoF), left/right and up/down; Bottom: Wrist control motions (two DoF), left/right and up/down.

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