A sensorised surgical glove to improve training and detection of obstetric anal sphincter injury: A preclinical study on a pig model.

OBJECTIVE: To create a sensorised surgical glove that can accurately identify obstetric anal sphincter injury to facilitate timely repair, reduce complications and aid training. DESIGN: Proof-of-concept. SETTING: Laboratory. SAMPLE: Pig models. METHODS: Flexible triboelectric pressure/force sensors were mounted onto the fingertips of a routine surgical glove. The sensors produce a current when rubbed on materials of different characteristics which can be analysed. A per rectum examination was performed on the intact sphincter of pig cadavers, analogous to routine examination for obstetric anal sphincter injuries postpartum. An anal sphincter defect was created by cutting through the vaginal mucosa and into the external anal sphincter using a scalpel. The sphincter was then re-examined. Data and signals were interpreted. MAIN OUTCOME MEASURES: Sensitivity and specificity of the glove in detecting anal sphincter injury. RESULTS: In all, 200 examinations were performed. The sensors detected anal sphincter injuries in a pig model with sensitivities between 98% and 100% and a specificity of 100%. The current produced when examining an intact sphincter and sphincter with a defect was significantly different (p < 0.001). CONCLUSION: In this preliminary study, the sensorised glove accurately detected anal sphincter injury in a pig model. Future plans include its clinical translation, starting with an in-human study on postpartum women, to determine whether it can accurately detect different types of obstetric anal sphincter injury in vivo.

Low-Field Actuating Magnetic Elastomer Membranes Characterized using Fibre-Optic Interferometry.

Smart robotic devices remotely powered by magnetic field have emerged as versatile tools for wide biomedical applications. Soft magnetic elastomer (ME) composite membranes with high flexibility and responsiveness are frequently incorporated to enable local actuation for wireless sensing or cargo delivery. However, the fabrication of thin ME membranes with good control in geometry and uniformity remains challenging, as well as the optimization of their actuating performances under low fields (milli-Tesla). In this work, the development of ME membranes comprising of low-cost magnetic powder and highly soft elastomer through a simple template-assisted doctor blading approach, is reported. The fabricated ME membranes are controllable in size (up to centimetre-scale), thickness (tens of microns) and high particle loading (up to 70 wt.%). Conflicting trade-off effects of particle concentration upon magnetic responsiveness and mechanical stiffness are investigated and found to be balanced off as it exceeds 60 wt.%. A highly sensitive fibre-optic interferometric sensing system and a customized fibre-ferrule-membrane probe are first proposed to enable dynamic actuation and real-time displacement characterization. Free-standing ME membranes are magnetically excited under low field down to 2 mT, and optically monitored with nanometer accuracy. The fast and consistent responses of ME membranes showcase their promising biomedical applications in nanoscale actuation and sensing.

Fiber-optic hydrophone for detection of high-intensity ultrasound waves.

Fiber-optic hydrophones (FOHs) are widely used to detect high-intensity focused ultrasound (HIFU) fields. The most common type consists of an uncoated single-mode fiber with a perpendicularly cleaved end face. The main disadvantage of these hydrophones is their low signal-to-noise ratio (SNR). To increase the SNR, signal averaging is performed, but the associated increased acquisition times hinder ultrasound field scans. In this study, with a view to increasing SNR while withstanding HIFU pressures, the bare FOH paradigm is extended to include a partially reflective coating on the fiber end face. Here, a numerical model based on the general transfer-matrix method was implemented. Based on the simulation results, a single-layer, 172 nm TiO2-coated FOH was fabricated. The frequency range of the hydrophone was verified from 1 to 30 MHz. The SNR of the acoustic measurement with the coated sensor was 21 dB higher than that of the uncoated one. The coated sensor successfully withstood a peak positive pressure of 35 MPa for 6000 pulses.

Enhanced Photoacoustic Visualisation of Clinical Needles by Combining Interstitial and Extracorporeal Illumination of Elastomeric Nanocomposite Coatings.

Ultrasound (US) image guidance is widely used for minimally invasive procedures, but the invasive medical devices (such as metallic needles), especially their tips, can be poorly visualised in US images, leading to significant complications. Photoacoustic (PA) imaging is promising for visualising invasive devices and peripheral tissue targets. Light-emitting diodes (LEDs) acting as PA excitation sources facilitate the clinical translation of PA imaging, but the image quality is degraded due to the low pulse energy leading to insufficient contrast with needles at deep locations. In this paper, photoacoustic visualisation of clinical needles was enhanced by elastomeric nanocomposite coatings with superficial and interstitial illumination. Candle soot nanoparticle-polydimethylsiloxane (CSNP-PDMS) composites with high optical absorption and large thermal expansion coefficients were applied onto the needle exterior and the end-face of an optical fibre placed in the needle lumen. The excitation light was delivered at the surface by LED arrays and through the embedded optical fibre by a pulsed diode laser to improve the visibility of the needle tip. The performance was validated using an ex-vivo tissue model. An LED-based PA/US imaging system was used for imaging the needle out-of-plane and in-plane insertions over approach angles of 20 deg to 55 deg. The CSNP-PDMS composite conferred substantial visual enhancements on both the needle shaft and the tip, with an average of 1.7- and 1.6-fold improvements in signal-to-noise ratios (SNRs), respectively. With the extended light field involving extracorporeal and interstitial illumination and the highly absorbing coatings, enhanced visualisation of the needle shaft and needle tip was achieved with PA imaging, which could be helpful in current US-guided minimally invasive surgeries.

Intraoperative Needle Tip Tracking with an Integrated Fibre-Optic Ultrasound Sensor.

Ultrasound is an essential tool for guidance of many minimally-invasive surgical and interventional procedures, where accurate placement of the interventional device is critical to avoid adverse events. Needle insertion procedures for anaesthesia, fetal medicine and tumour biopsy are commonly ultrasound-guided, and misplacement of the needle may lead to complications such as nerve damage, organ injury or pregnancy loss. Clear visibility of the needle tip is therefore critical, but visibility is often precluded by tissue heterogeneities or specular reflections from the needle shaft. This paper presents the in vitro and ex vivo accuracy of a new, real-time, ultrasound needle tip tracking system for guidance of fetal interventions. A fibre-optic, Fabry-Pérot interferometer hydrophone is integrated into an intraoperative needle and used to localise the needle tip within a handheld ultrasound field. While previous, related work has been based on research ultrasound systems with bespoke transmission sequences, the new system-developed under the ISO 13485 Medical Devices quality standard-operates as an adjunct to a commercial ultrasound imaging system and therefore provides the image quality expected in the clinic, superimposing a cross-hair onto the ultrasound image at the needle tip position. Tracking accuracy was determined by translating the needle tip to 356 known positions in the ultrasound field of view in a tank of water, and by comparison to manual labelling of the the position of the needle in B-mode US images during an insertion into an ex vivo phantom. In water, the mean distance between tracked and true positions was 0.7 ± 0.4 mm with a mean repeatability of 0.3 ± 0.2 mm. In the tissue phantom, the mean distance between tracked and labelled positions was 1.1 ± 0.7 mm. Tracking performance was found to be independent of needle angle. The study demonstrates the performance and clinical compatibility of ultrasound needle tracking, an essential step towards a first-in-human study.

Precision-Microfabricated Fiber-Optic Probe for Intravascular Pressure and Temperature Sensing.

Small form-factor sensors are widely used in minimally invasive intravascular diagnostic procedures. Manufacturing complexities associated with miniaturizing current fiber-optic probes, particularly for multi-parameter sensing, severely constrain their adoption outside of niche fields. It is especially challenging to rapidly prototype and iterate upon sensor designs to optimize performance for medical devices. In this work, a novel technique to construct a microscale extrinsic fiber-optic sensor with a confined air cavity and sub-micron geometric resolution is presented. The confined air cavity is enclosed between a 3 µm thick pressure-sensitive distal diaphragm and a proximal temperature-sensitive plano-convex microlens segment unresponsive to changes in external pressure. Simultaneous pressure and temperature measurements are possible through optical interrogation via phase-resolved low-coherence interferometry (LCI). Upon characterization in a simulated intravascular environment, we find these sensors capable of detecting pressure changes down to 0.11 mmHg (in the range of 760 to 1060 mmHg) and temperature changes of 0.036 °C (in the range 34 to 50 °C). By virtue of these sensitivity values suited to intravascular physiological monitoring, and the scope of design flexibility enabled by the precision-fabricated photoresist microstructure, it is envisaged that this technique will enable construction of a wide range of fiber-optic sensors for guiding minimally invasive medical procedures.

Modelling and measurement of laser-generated focused ultrasound: Can interventional transducers achieve therapeutic effects?

Laser-generated focused ultrasound (LGFU) transducers used for ultrasound therapy commonly have large diameters (6-15 mm), but smaller lateral dimensions (<4 mm) are required for interventional applications. To address the question of whether miniaturized LGFU transducers could generate sufficient pressure at the focus to enable therapeutic effects, a modelling and measurement study is performed. Measurements are carried out for both linear and nonlinear propagation for various illumination schemes and compared with the model. The model comprises several innovations. First, the model allows for radially varying acoustic input distributions on the surface of the LGFU transducer, which arise from the excitation light impinging on the curved transducer surfaces. This realistic representation of the source prevents the overestimation of the achievable pressures (shown here to be as high as 1.8 times). Second, an alternative inverse Gaussian illumination paradigm is proposed to achieve higher pressures; a 35% increase is observed in the measurements. Simulations show that LGFU transducers as small as 3.5 mm could generate sufficient peak negative pressures at the focus to exceed the cavitation threshold in water and blood. Transducers of this scale could be integrated with interventional devices, thereby opening new opportunities for therapeutic applications from inside the body.

Miniature all-optical flexible forward-viewing photoacoustic endoscopy probe for surgical guidance.

A miniature flexible photoacoustic endoscopy probe that provides high-resolution 3D images of vascular structures in the forward-viewing configuration is described. A planar Fabry-Perot ultrasound sensor with a -3dB bandwidth of 53 MHz located at the tip of the probe is interrogated via a flexible fiber bundle and a miniature optical relay system to realize an all-optical probe measuring 7.4 mm in outer diameter at the tip. This approach to photoacoustic endoscopy offers advantages over previous piezoelectric based distal-end scanning probes. These include a forward-viewing configuration in widefield photoacoustic tomography mode, finer spatial sampling (87 µm spatial sampling interval), and wider detection bandwidth (53 MHz) than has been achievable with conventional ultrasound detection technology and an all-optical passive imaging head for safe endoscopic use.

Refractive Two-View Reconstruction for Underwater 3D Vision.

Recovering 3D geometry from cameras in underwater applications involves the Refractive Structure-from-Motion problem where the non-linear distortion of light induced by a change of medium density invalidates the single viewpoint assumption. The pinhole-plus-distortion camera projection model suffers from a systematic geometric bias since refractive distortion depends on object distance. This leads to inaccurate camera pose and 3D shape estimation. To account for refraction, it is possible to use the axial camera model or to explicitly consider one or multiple parallel refractive interfaces whose orientations and positions with respect to the camera can be calibrated. Although it has been demonstrated that the refractive camera model is well-suited for underwater imaging, Refractive Structure-from-Motion remains particularly difficult to use in practice when considering the seldom studied case of a camera with a flat refractive interface. Our method applies to the case of underwater imaging systems whose entrance lens is in direct contact with the external medium. By adopting the refractive camera model, we provide a succinct derivation and expression for the refractive fundamental matrix and use this as the basis for a novel two-view reconstruction method for underwater imaging. For validation we use synthetic data to show the numerical properties of our method and we provide results on real data to demonstrate its practical application within laboratory settings and for medical applications in fluid-immersed endoscopy. We demonstrate our approach outperforms classic two-view Structure-from-Motion method relying on the pinhole-plus-distortion camera model.

Dynamic Characterisation of Fibre-Optic Temperature Sensors for Physiological Monitoring.

Fast, miniature temperature sensors are required for various biomedical applications. Fibre-optics are particularly suited to minimally invasive procedures, and many types of fibre-optic temperature sensors have been demonstrated. In applications where rapidly varying temperatures are present, a fast and well-known response time is important; however, in many cases, the dynamic behaviour of the sensor is not well-known. In this article, we investigate the dynamic response of a polymer-based interferometric temperature sensor, using both an experimental technique employing optical heating with a pulsed laser, and a computational heat transfer model based on the finite element method. Our results show that the sensor has a time constant on the order of milliseconds and a -6 dB bandwidth of up to 178 Hz, indicating its suitability for applications such as flow measurement by thermal techniques, photothermal spectroscopy, and monitoring of thermal treatments.

Use of a flexible optical fibre bundle to interrogate a Fabry-Perot sensor for photoacoustic imaging.

Photoacoustic imaging systems based on a Fabry Perot (FP) ultrasound sensor that is read-out by scanning a free-space laser beam over its surface can provide high resolution photoacoustic images. However, this type of free-space scanning usually requires a bulky 2-axis galvanometer based scanner that is not conducive to the realization of a lightweight compact imaging head. It is also unsuitable for endoscopic applications that may require complex and flexible access. To address these limitations, the use of a flexible, coherent fibre bundle to interrogate the FP sensor has been investigated. A laboratory set-up comprising an x-y scanner, a commercially available, 1.35 mm diameter, 18,000 core flexible fibre bundle with a custom-designed telecentric optical relay at its distal end was used. Measurements of the optical and acoustic performance of the FP sensor were made and compared to that obtained using a conventional free-space FP based scanner. Spatial variations in acoustic sensitivity were greater and the SNR lower with the fibre bundle implementation but high quality photoacoustic images could still be obtained. 3D images of phantoms and ex vivo tissues with a spatial resolution and fidelity consistent with a free-space scanner were acquired. By demonstrating the feasibility of interrogating the FP sensor with a flexible fibre bundle, this study advances the realization of compact hand-held clinical scanners and flexible endoscopic devices based on the FP sensing concept.

Handheld Real-Time LED-Based Photoacoustic and Ultrasound Imaging System for Accurate Visualization of Clinical Metal Needles and Superficial Vasculature to Guide Minimally Invasive Procedures.

Ultrasound imaging is widely used to guide minimally invasive procedures, but the visualization of the invasive medical device and the procedure’s target is often challenging. Photoacoustic imaging has shown great promise for guiding minimally invasive procedures, but clinical translation of this technology has often been limited by bulky and expensive excitation sources. In this work, we demonstrate the feasibility of guiding minimally invasive procedures using a dual-mode photoacoustic and ultrasound imaging system with excitation from compact arrays of light-emitting diodes (LEDs) at 850 nm. Three validation experiments were performed. First, clinical metal needles inserted into biological tissue were imaged. Second, the imaging depth of the system was characterized using a blood-vessel-mimicking phantom. Third, the superficial vasculature in human volunteers was imaged. It was found that photoacoustic imaging enabled needle visualization with signal-to-noise ratios that were 1.2 to 2.2 times higher than those obtained with ultrasound imaging, over insertion angles of 26 to 51 degrees. With the blood vessel mimicking phantom, the maximum imaging depth was 38 mm. The superficial vasculature of a human middle finger and a human wrist were clearly visualized in real-time. We conclude that the LED-based system is promising for guiding minimally invasive procedures with peripheral tissue targets.

Identification of liver metastases with probe-based confocal laser endomicroscopy at two excitation wavelengths.

BACKGROUND: Metastasis of colorectal cancer to the liver is the most common indication for hepatic resection in a western population. Incomplete excision of malignancy due to residual microscopic disease normally results in worse patient outcome. Therefore, a method aiding in the real time discrimination of normal and malignant tissue on a microscopic level would be of benefit. MATERIAL AND METHODS: The ability of fluorescent probe-based confocal laser endomicroscopy (pCLE) to identify normal and malignant liver tissue was evaluated in an orthotopic murine model of colorectal cancer liver metastasis (CRLM). To maximise information yield, two clinical fluorophores, fluorescein and indocyanine green (ICG) were injected and imaged in a dual wavelength approach (488 and 660 nm, respectively). Visual tissue characteristics on pCLE examination were compared with histological features. Fluorescence intensity in both tissues was statistically analysed to elucidate if this can be used to differentiate between normal and malignant tissue. RESULTS: Fluorescein (488 nm) enabled good visualisation of normal and CRLM tissue, whereas ICG (660 nm) visualisation was limited to normal liver tissue only. Fluorescence intensity in areas of CRLM was typically 53-100% lower than normal hepatic parenchyma. Using general linear mixed modelling and receiver operating characteristic analysis, high fluorescence intensity was found to be statistically more likely in normal hepatic tissue. CONCLUSION: Real time discrimination between normal liver parenchyma and metastatic tissue with pCLE examination of fluorescein and ICG is feasible. Employing two (rather than a single) fluorophores allows a combination of qualitative and quantitative characteristics to be used to distinguish between hepatic parenchyma and CRLM. Lasers Surg. Med. 49:280-292, 2017. © 2016 Wiley Periodicals, Inc.

Utilizing confocal laser endomicroscopy for evaluating the adequacy of laparoscopic liver ablation.

BACKGROUND: Laparoscopic liver ablation therapy can be used for the treatment of primary and secondary liver malignancy. The increased incidence of cancer recurrence associated with this approach, has been attributed to the inability of monitoring the extent of ablated liver tissue. METHODS: The feasibility of assessing liver ablation with probe-based confocal laser endomicroscopy (CLE) was studied in a porcine model of laparoscopic microwave liver ablation. Following the intravenous injection of the fluorophores fluorescein and indocyanine green, CLE images were recorded at 488 nm and 660 nm wavelength and compared to liver histology. Statistical analysis was performed to assess if fluorescence intensity change can predict the presence of ablated liver tissue. RESULTS: CLE imaging of fluorescein at 488 nm provided good visualization of the hepatic microvasculature; whereas, CLE imaging of indocyanine green at 660 nm enabled detailed visualization of hepatic sinusoid architecture and interlobular septations. Fluorescence intensity as measured in relative fluorescence units was found to be 75-100% lower in ablated compared to healthy liver regions. General linear mixed modeling and ROC analysis found the decrease in fluorescence to be statistically significant. CONCLUSION: Laparoscopic, dual wavelength CLE imaging using two different fluorophores enables clinically useful visualization of multiple liver tissue compartments, in greater detail than is possible at a single wavelength. CLE imaging may provide valuable intraoperative information on the extent of laparoscopic liver ablation.

Construction of 3-Dimensional Printed Ultrasound Phantoms With Wall-less Vessels.

Ultrasound phantoms are invaluable as training tools for vascular access procedures. We developed ultrasound phantoms with wall-less vessels using 3-dimensional printed chambers. Agar was used as a soft tissue-mimicking material, and the wall-less vessels were created with rods that were retracted after the agar was set. The chambers had integrated luer connectors to allow for fluid injections with clinical syringes. Several variations on this design are presented, which include branched and stenotic vessels. The results show that 3-dimensional printing can be well suited to the construction of wall-less ultrasound phantoms, with designs that can be readily customized and shared electronically.

Comprehensive volumetric optical microscopy in vivo.

Comprehensive volumetric microscopy of epithelial, mucosal and endothelial tissues in living human patients would have a profound impact in medicine by enabling diagnostic imaging at the cellular level over large surface areas. Considering the vast area of these tissues with respect to the desired sampling interval, achieving this goal requires rapid sampling. Although noninvasive diagnostic technologies are preferred, many applications could be served by minimally invasive instruments capable of accessing remote locations within the body. We have developed a fiber-optic imaging technique termed optical frequency-domain imaging (OFDI) that satisfies these requirements by rapidly acquiring high-resolution, cross-sectional images through flexible, narrow-diameter catheters. Using a prototype system, we show comprehensive microscopy of esophageal mucosa and of coronary arteries in vivo. Our pilot study results suggest that this technology may be a useful clinical tool for comprehensive diagnostic imaging for epithelial disease and for evaluating coronary pathology and iatrogenic effects.

Bend-insensitive fiber optic ultrasonic tracking probe for cardiovascular interventions.

BACKGROUND: Transesophageal echocardiography (TEE) is widely used to guide medical device placement in minimally invasive cardiovascular procedures. However, visualization of the device tip with TEE can be challenging. Ultrasonic tracking, enabled by an integrated fiber optic ultrasound sensor (FOUS) that receives transmissions from the TEE probe, is very well suited to improving device localization in this context. The problem addressed in this study is that tight deflections of devices such as a steerable guide catheter can result in bending of the FOUS beyond its specifications and a corresponding loss of ultrasound sensitivity. PURPOSE: A bend-insensitive FOUS was developed, and its utility with ultrasonic tracking of a steerable tip during TEE-based image guidance was demonstrated. METHODS: Fiberoptic ultrasound sensors were fabricated using both standard and bend insensitive single mode fibers and subjected to static bending at the distal end. The interference transfer function and ultrasound sensitivities were compared for both types of FOUS. The bend-insensitive FOUS was integrated within a steerable guide catheter, which served as an exemplar device; the signal-to-noise ratio (SNR) of tracking signals from the catheter tip with a straight and a fully deflected distal end were measured in a cardiac ultrasound phantom for over 100 frames. RESULTS: With tight bending at the distal end (bend radius < 10 mm), the standard FOUS experienced a complete loss of US sensitivity due to high attenuation in the fiber, whereas the bend-insensitive FOUS had largely unchanged performance, with a SNR of 47.7 for straight fiber and a SNR of 36.8 at a bend radius of 3.0 mm. When integrated into the steerable guide catheter, the mean SNRs of the ultrasonic tracking signals recorded with the catheter in a cardiac phantom were similar for straight and fully deflected distal ends: 195 and 163. CONCLUSION: The FOUS fabricated from bend-insensitive fiber overcomes the bend restrictions associated with the FOUS fabricated from standard single mode fiber, thereby enabling its use in ultrasonic tracking in a wide range of cardiovascular devices.

All-optical ultrasound catheter for rapid B-mode oesophageal imaging.

All-optical ultrasound (OpUS) is an imaging paradigm that uses light to both generate and receive ultrasound, and has progressed from benchtop to in vivo studies in recent years, demonstrating promise for minimally invasive surgical applications. In this work, we present a rapid pullback imaging catheter for side-viewing B-mode ultrasound imaging within the upper gastrointestinal tract. The device comprised an ultrasound transmitter configured to generate ultrasound laterally from the catheter and a plano-concave microresonator for ultrasound reception. This imaging probe was capable of generating ultrasound pressures in excess of 1 MPa with corresponding -6 dB bandwidths > 20 MHz. This enabled imaging resolutions as low as 45 µm and 120 µm in the axial and lateral extent respectively, with a corresponding signal-to-noise ratio (SNR) of 42 dB. To demonstrate the potential of the device for clinical imaging, an ex vivo swine oesophagus was imaged using the working channel of a mock endoscope for device delivery. The full thickness of the oesophagus was resolved and several tissue layers were present in the resulting ultrasound images. This work demonstrates the promise for OpUS to provide rapid diagnostics and guidance alongside conventional endoscopy.

Enhancement of instrumented ultrasonic tracking images using deep learning.

PURPOSE: Instrumented ultrasonic tracking provides needle localisation during ultrasound-guided minimally invasive percutaneous procedures. Here, a post-processing framework based on a convolutional neural network (CNN) is proposed to improve the spatial resolution of ultrasonic tracking images. METHODS: The custom ultrasonic tracking system comprised a needle with an integrated fibre-optic ultrasound (US) transmitter and a clinical US probe for receiving those transmissions and for acquiring B-mode US images. For post-processing of tracking images reconstructed from the received fibre-optic US transmissions, a recently-developed framework based on ResNet architecture, trained with a purely synthetic dataset, was employed. A preliminary evaluation of this framework was performed with data acquired from needle insertions in the heart of a fetal sheep in vivo. The axial and lateral spatial resolution of the tracking images were used as performance metrics of the trained network. RESULTS: Application of the CNN yielded improvements in the spatial resolution of the tracking images. In three needle insertions, in which the tip depth ranged from 23.9 to 38.4 mm, the lateral resolution improved from 2.11 to 1.58 mm, and the axial resolution improved from 1.29 to 0.46 mm. CONCLUSION: The results provide strong indications of the potential of CNNs to improve the spatial resolution of ultrasonic tracking images and thereby to increase the accuracy of needle tip localisation. These improvements could have broad applicability and impact across multiple clinical fields, which could lead to improvements in procedural efficiency and reductions in risk of complications.

A Triboelectric Nanocomposite for Sterile Sensing, Energy Harvesting, and Haptic Diagnostics in Interventional Procedures from Surgical Gloves.

Advanced interfacial engineering has the potential to enable the successful realization of three features that are particularly important for a variety of healthcare applications: wettability control, antimicrobial activity to reduce infection risks, and sensing of physiological parameters. Here, a sprayable multifunctional triboelectric coating is exploited as a nontoxic, ultrathin tactile sensor that can be integrated directly on the fingertips of surgical gloves. The coating is based on a polymer blend mixed with zinc oxide (ZnO) nanoparticles, which enables antifouling and antibacterial properties. Additionally, the nanocomposite is superhydrophobic (self-cleaning) and is not cytotoxic. The coating is also triboelectric and can be applied directly onto surgical gloves with printed electrodes. The sensorized gloves so obtained enable mechanical energy harvesting, force sensing, and detection of materials stiffness changes directly from fingertip, which may complement proprioceptive feedback for clinicians. Just as importantly, the sensors also work with a second glove on top offering better reassurance regarding sterility in interventional procedures. As a case study of clinical use for stiffness detection, the sensors demonstrate successful detection of pig anal sphincter injury ex vivo. This may lead to improving the accuracy of diagnosing obstetric anal sphincter injury, resulting in prompt repair, fewer complications, and improved quality of life.