Visual Force Feedback for Hand-Held Microsurgical Instruments
Microsurgery is technically challenging, demanding both rigorous precision under the operating microscope and great care when handling tissue. Applying excessive force can result in irreversible tissue injury, but sufficient force must be exerted to carry
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Abstract. Microsurgery is technically challenging, demanding both rigorous precision under the operating microscope and great care when handling tissue. Applying excessive force can result in irreversible tissue injury, but sufficient force must be exerted to carry out manoeuvres in an efficient manner. Technological advances in hand-held instruments have allowed the integration of force sensing capabilities into surgical tools, resulting in the possibility of force feedback during an operation. This paper presents a novel method of graduated online visual forcefeedback for hand-held microsurgical instruments. Unlike existing visual force-feedback techniques, the force information is integrated into the surgical scene by highlighting the area around the point of contact while preserving salient anatomical features. We demonstrate that the proposed technique can be integrated seamlessly with image guidance techniques. Critical anatomy beyond the exposed tissue surface is revealed using an augmented reality overlay when the user is exerting large forces within their proximity. The force information is further used to improve the quality of the augmented reality by displacing the overlay based on the forces exerted. Detailed user studies were performed to assess the efficacy of the proposed method.
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Introduction
Delicate neurovascular tissue requires the performance of microsurgical procedures with high dexterity and accuracy. Technological advances of the past decade have facilitated the integration of force-sensing with new surgical devices. Robotic platforms such as the NeuroArm and the Steady-Hand Robot have incorporated force limiting, scaling, and feedback capabilities. Hand-held microinstruments have also benefited from increased force-sensing capabilities. These instruments represent simple, low cost, yet intrinsically robust alternatives to conventional master-slave and co-operative control platforms. Various modes of force-feedback have been used in both hand-held and robotic devices including tactile, auditory, and visual cues [1,2]. Previous work has suggested that all of these forms of feedback have a comparable influence on surgical performance [3]. However, these modes differ considerably in the nature in which c Springer International Publishing Switzerland 2015 N. Navab et al. (Eds.): MICCAI 2015, Part I, LNCS 9349, pp. 480–487, 2015. DOI: 10.1007/978-3-319-24553-9_59
Visual Force Feedback for Hand-Held Microsurgical Instruments
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they may be integrated into the operative workflow. Tactile feedback may represent the most intuitive method to indicate when a force threshold is breached, but is best suited to conveying binary rather than graduated information. Auditory feedback does allow for more granular feedback, but may not be recognised above the ambient noise of a busy operating room. Visual feedback can provide detailed information in an unambiguous fashion, but it risks inattention blindness - cues located away from the operating site may distract the surgeon, and cues overlying the operating s
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