腹腔鏡手術用鉗子先端に加わる作用力の計測と剝 離操作における技能分析

摘要

In laparoscopic surgery it is difficult to ascertain the force direction from endoscopic images of twoorgans being dissected by a surgical instrument. Therefore quantitative skill analysis using force sensor with ahigh degree of freedom would be useful, especially in dissection procedures. We developed a system to measurethe force on the tip of laparoscopic instruments with a spatula-shaped-tip. A forceps was cut at 61 mm from the tip,and a 3 DOF sensor that can detect vertical and shear forces was installed between the cutting edges. Twoexperienced laparoscopic surgeons and three novices carried out a dissection procedure using their dominanthand in an in vitro testing using a kidney of the dead pig. For the vertical and shear forces, the timing andintervals of the peak force, the percentage of the forces and the force applying time are examined. Experts appliedthe vertical peak force earlier than novices when carrying out a dissection procedure, and then gradually relaxedthe force. These results suggest that experts try to keep the instrument tip visualized in the operative field.