2010 年 48 巻 1 号 p. 25-32
In laparoscopic surgery it is difficult to ascertain the force direction from endoscopic images of two organs being dissected by a surgical instrument. Therefore quantitative skill analysis using force sensor with a high degree of freedom would be useful, especially in dissection procedures. We developed a system to measure the force on the tip of laparoscopic instruments with a spatula-shaped-tip. A forceps was cut at 61mm from the tip, and a 3 DOF sensor that can detect vertical and shear forces was installed between the cutting edges. Two experienced laparoscopic surgeons and three novices carried out a dissection procedure using their dominant hand in an in vitro testing using a kidney of the dead pig. For the vertical and shear forces, the timing and intervals of the peak force, the percentage of the forces and the force applying time are examined. Experts applied the vertical peak force earlier than novices when carrying out a dissection procedure, and then gradually relaxed the force. These results suggest that experts try to keep the instrument tip visualized in the operative field.