Trauma caused by grasping during laparoscopic surgery is something which will never be fully eradicated however efforts should be taken to reduce the potential to cause trauma by grasping. Tissue is often grasped with excessive forces for long periods of time during surgeries such as cholecystectomies and colectomies. This along with failed grasping actions and the occurrence of slip has been shown to damage the tissue. Design features often employed within graspers such as profiling and the occlusion mechanism of the instrument cause areas of high, uneven distribution of pressures on the tissue which can result in perforation or tissue tearing. By investigating these contributing factors, development of graspers with a low risk to cause damage this combined with actuating the grasping force should reduce the incidence of grasping trauma, currently at estimated at one incidence per procedure. These trauma events can lead to conversion to open surgery, peritonitis and even death. Development of an autonomous grasping instrument to detect and prevent slip by actuating the grasping force is reported. Piezoelectric sensors are used to detect incipient slip and slip events. A closed loop control system then reacts to these perceived slip events to prevent slip occurring by actuating the applied force by small increments to increase or decrease grasping force. This leads to a system in which only the required amount of force necessary to overcome pull force is applied to the tissue. Other areas of investigation to reduce tissue trauma are presented. In chapter 3 design features such as surface profiling and fenestrations are evaluated to determine the potential to cause damage. A variety of profiles and fenestrations are studied and each is reported by representing the applied force to retention force ratio which indicates how good the profile is at retaining tissue against a pull force. The aim of this study was to develop surface profiling which had a high retention force but a reduced number of high stress areas which can lead to tissue damage. Three new parallel action grasping designs are presented and evaluated using finite element analysis. Parallel action grasping is important in reducing tissue trauma as it distributes pressure evenly across the active grasping area as opposed to more conventional pivot style graspers which have high stress concentration areas in the proximal opening. Each area of study within the thesis addresses areas of concern which have been shown to cause tissue trauma and postulates viable solutions to reduce the incidences of tissue trauma during laparoscopic surgery with the ultimate aim of developing a deployable and autonomous grasping device which will detect and prevent slip.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:633751 |
| Date | January 2014 |
| Creators | Brown, Andrew |
| Contributors | Cuschieri, Alfred ; Wang, Zhigang |
| Publisher | University of Dundee |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | https://discovery.dundee.ac.uk/en/studentTheses/8151b394-f604-4d5f-98c5-dc8516ac0c42 |
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