Journal of Surgical Simulation 2017; 4: B: 9 - 9
Published: 11 May 2017
Special Issue: Grasping improvements in laparoscopic surgery
Tissue trauma as a result of surgical manipulation occurs routinely during laparoscopic surgery with potentially severe consequences. The use of surgical graspers (forceps) on delicate tissues like the bowel can lead to an intestinal inflammatory response that contributes to post-operative ileus, increases the risk of complications and delays discharge. A major causative factor is believed to be limitations in the instrumentation, most notably a lack of haptic feedback which results in excessive pressures being applied to tissues by the grasper jaws. Our research has sought to develop a mechanistic understanding of how instrument-induced tissue trauma occurs in laparoscopic surgery, ultimately to inform improvements in patient safety. We firstly sought to understand how laparoscopic graspers are used in a surgical context, using digitally-instrumented graspers in simulated surgical procedures with a cohort of surgeons at different training levels. Our results show the pressure characteristics applied to soft tissues have a wide variability across and within training levels, indicating that regulation of force is both difficult to achieve, and not a primary goal, while grasping. Secondly, we investigated the mechanics of grasper-induced trauma using parametric lab studies, an ex vivo tissue model and histological analyses. We found that trauma occurred as a function of both pressure magnitude, rate and exposure time. Furthermore, we observed that the onset of trauma can be predicted through readily available measures of the tissue’s mechanical response during grasping. The outcomes of this research have significance for both surgical training (improving understanding of the risks of mechanical-tissue trauma and mitigation strategies) and improved instrumentation (e.g. grasper systems with feedback and control). These approaches can help to reduce unnecessary tissue trauma and associated complications to enhance the benefits of laparoscopic surgery and improve patient safety.
tissue trauma; forceps; surgical graspers; patient safety
This presentation was given at the one day symposium, Current Approaches to Understanding Surgical Error, University of Leeds, Leeds, UK, on 9 December 2016.
Conflicts of interest: none declared.
J Chandler, D Jones, B Moxley-Wyles, J Barrie, GW Taylor, PR Culmer: School of Mechanical Engineering, University of Leeds, UK