Tactile diagnostics in robotic surgery
Background: Robotic surgery undergoes its wide acceptance achieved due to minimizing trauma to patients. However, currently robotic surgery lacks a tactile feedback, and it is an essential limiting factor for its further expansion. The problem can be solved by utilization of Medical Tactile Endosurgical complex (MTEC). This complex measures and displays tactile properties of tissues during endoscopic surgeries in real time. It was developed in Lomonosov Moscow State University and officially admitted for clinical use in 2012. Materials and method: MTEC palpation device performs tactile examinations via pressure sensors located in the operating head of the device under a soft membrane. Sensors wirelessly transmit measurement results to a computer in real time. Computer performs processing and output of tactile data to a standard monitor and to specialized tactile display from which data can be read simply via a finger. Processing includes automated analysis of registered tactile data aimed at the identification of heterogeneities which simplifies the identification of lesion boundaries. The utilization of MTEC in endoscopic surgery was tested from January 2015 to December 2015 in hospital No. 31 (Moscow). Nine elective surgeries were performed with da Vinci robotic system (Intuitive Surgical, USA): 2 gastrectomies, 2 stomach resections, 2 resections of pancreas, 2 prostatectomies and 1 right hemicolectomy. Patients’ ages were from 30 to 76. During the surgeries an assistant performed tactile examination under the guidance of surgeon. Operating surgeon identified boundaries of pathological process using a tactile display, and assistant inspected the visualization of tactile data. Results: MTEC was first tested on visually identifiable lesions in stomach and intestine (5 cases). In all cases it correctly localized boundaries of pathological processes. Then the method was applied to pancreas and prostate pathologies and also led to correct decisions in all cases, including a case in which the whole pancreas was involved in process and hence no boundaries were detectable. Conclusion: Utilization of MTEC provides a tactile feedback in robotic surgery thus increasing its capabilities by correct identification of boundaries of a pathological process in the absence of sufficient visual data.