The article presents a comprehensive study on the development and validation of a novel force-sensing surgical instrument specific for endometrial repair. This innovative approach aims to enhance the safety and effectiveness of surgical procedures targeting uterine conditions, such as intrauterine adhesions and thin endometrium, which affect the reproductive function of women globally.

Background and Motivation

The World Health Organization reports that infertility affects approximately 30 million women worldwide. A significant contributor to infertility is the damage to the uterine endometrium, resulting from conditions like intrauterine adhesions (IUAs) and scarred uterus. Traditional surgical methods, including transcervical resection of adhesions (TCRA), exhibit high recurrence rates, calling for improved surgical techniques. The advent of surgical robots has shown promise in addressing these challenges by facilitating precise and minimally invasive procedures, particularly in the context of stem cell therapy for endometrial repair. However, current robotic systems lack the ability to sense interaction forces between surgical instruments and the tissue, which is crucial for preventing secondary damage during delicate operations.

Methods and Instrument Design

The research introduces a dynamic and novel force-sensing surgical instrument specific for endometrial repair that comprises an inner scraping component and an outer flexible sheath for force sensing. The external flexible sheath utilises actuation forces to predict real-time tangential and normal forces exerted by the scraping action on the endometrial surface. The instrument’s design addresses the challenges posed by the limited anatomical space within the uterus while ensuring continuous rotation capabilities.

Experiments were conducted to assess the force sensing accuracy by simulating various operational conditions with different force thresholds, leading to the measurement of mean errors and standard deviations in the force readings. The results affirmed the instrument’s capability to provide real-time and precise measurements of dynamic scraping forces.

Results and Discussion

The experimental findings indicated that the proposed method effectively estimates the scraping force applied by the instrument during endometrial operations. The study highlighted the importance of accurately sensing both tangential and normal forces, as these are vital for maintaining operational safety and achieving desired therapeutic outcomes. The force sensing method allows for a nuanced understanding of the interaction between the instrument and the tissue, enabling surgeons to avoid excessive force that could lead to further tissue damage.

The results demonstrated variability in sensing errors, particularly under different operational scenarios, such as adhesion removal and scraping scarred membranes. The accuracy of force measurements tended to decrease with increased normal forces, attributed to the larger contact area and higher friction coefficients encountered during such operations. The research suggests that calibration of the force sensing coefficients should be performed near the thresholds of applied forces to maintain optimal accuracy.

Conclusion and Future Directions

The study concludes that the integration of force sensing into robotic instruments represents a significant advancement in the field of minimally invasive surgery. The developed instrument not only enhances the precision of endometrial scraping procedures but also contributes to the broader application of robotics in surgical environments characterized by confined spaces and complex interactions.

Future research will focus on refining the relationship between the applied forces and various endometrial conditions, as well as exploring the potential for improved sensing capabilities. This will ultimately lead to enhanced therapeutic performance and increased safety for patients undergoing endometrial repair surgeries.

SOURCE… https://onlinelibrary.wiley.com/doi/full/10.1002/rcs.70045

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