Skin-stretch Haptic Feedback Augmentation Improves Performance in a Simulated Laparoscopic Palpation Task.

Laparoscopic surgery brings substantial benefits to patients. However, it remains challenging for surgeons because of motion constraints and perception limitations. Notably, the perception of interactions with organs is largely compromised. This paper evaluates the effectiveness of a forearm-based skin-stretch haptic feedback system rendering surgical tool tip force. Twenty novice participants had to discern the stiffness of samples to investigate stiffness perception in a simulated laparoscopic task. The experimental protocol involved manipulating samples with three difficulty levels and testing three feedback conditions: no augmentation, visual feedback, and tactile feedback. The results demonstrate that feedback significantly enhances the success rate of laparoscopic palpation tasks. The proposed tactile feedback boosts confidence and task speed and reduces peak force and perceived workload. These benefits become even more pronounced when difficulty increases. These promising findings affirm the value of skin-stretch haptic feedback augmentation in improving performance for simulated laparoscopy tasks, paving the way for more integrated and deployable devices for the operating room.

Adaptative damping assistance in bimanual laparoscopic surgery.

PURPOSE: Laparoscopic surgery has demonstrated various advantages for the patients' care, but also presents some difficulties for the surgeons, such as kinematic restrictions. Robotic comanipulation, in which control of instruments is shared between the robot and the surgeon, can provide adaptative damping assistance which allows stabilisation of movements. The objective of the present study was to determine the contribution of this assistance on a bimanual laparoscopic task. METHODS: Adaptative damping was studied on Peg Transfer task, performed by eighteen surgery-naive subjects. This exercise was repeated seven times without (Classic repetitions) and seven times with comanipulated robots (Robot repetitions), in a randomised order. We measured task performance, using Peg Transfer score; gesture performance, using hand oscillations and travelled distance; eye-tracking movements as an indicator of emergence of expertise. Participants' perceived workload was assessed by NASA TLX questionnaire, and difference in impression between the two conditions by UEQ questionnaire. RESULTS: Adaptative damping improved gesture performance (oscillations F(1,17) = 23.473, p < 0.001, η2 = 0.580), with a statistically significant simple effect on the tool oscillation for both non-dominant (p < 0.001) and dominant hands (p = 0.005), without influencing task performance (mean Peg Transfer score t(17) = 0.920, p = 0.382, d = 0.29), but deteriorating eye-tracking movements associated with emergence of expertise (mean fixation rate per second F(1,17) = 6.318, p = 0.022, η2 = 0.271), at the cost of a high perceived workload (NASA TLX score 59.78/100). CONCLUSION: Assistance by adaptative damping applied by comanipulated robots improved gesture performance during a laparoscopic bimanual task, without impacting task's performance without allowing the emergence of comportments associated with an expertise, and at the cost of a high perceived workload. Further research should investigate this assistance on more precise and clinical tasks performed by professionals.

Cystoid Macular Edema after Rhegmatogenous Retinal Detachment Repair with Pars Plana Vitrectomy: Rate, Risk Factors, and Outcomes.

(1) Background: The aim was to describe the rate and outcomes of cystoid macular edema (CME) after pars plana vitrectomy (PPV) for primary rhegmatogenous retinal detachment (RRD) and to identify risk factors and imaging characteristics. (2) Methods: A retrospective consecutive case study was conducted over a 5-year period among adult patients who underwent PPV for primary RRD repair. The main outcome measure was the rate of CME at 12 months following PPV. (3) Results: Overall, 493 eyes were included. The CME rate was 28% (93 patients) at 12 months. In multivariate analysis, eyes with worse presenting visual acuity (VA) (odds ratio [OR], 1.55; 95% CI, 1.07-2.25; p = 0.02) and grade C proliferative vitreoretinopathy (PVR) (OR, 2.88; 95% CI, 1.04-8.16; p = 0.04) were more at risk of developing CME 1 year after PPV. Endolaser retinopexy was associated with a greater risk of CME than cryotherapy retinopexy (OR, 3.06; 95% CI, 1.33-7.84; p = 0.01). Eyes undergoing cataract surgery within 6 months of the initial RRD repair were more likely to develop CME at 12 months (OR, 1.96; 95% CI, 1.06-3.63; p = 0.03). (4) Conclusions: CME is a common complication after PPV for primary RRD repair. Eyes with worse presenting VA, severe PVR at initial presentation, endolaser retinopexy, and cataract surgery within 6 months of initial RRD repair were risk factors for postoperative CME at 12 months.

Sensors and Actuation Technologies in Exoskeletons: A Review.

Exoskeletons are robots that closely interact with humans and that are increasingly used for different purposes, such as rehabilitation, assistance in the activities of daily living (ADLs), performance augmentation or as haptic devices. In the last few decades, the research activity on these robots has grown exponentially, and sensors and actuation technologies are two fundamental research themes for their development. In this review, an in-depth study of the works related to exoskeletons and specifically to these two main aspects is carried out. A preliminary phase investigates the temporal distribution of scientific publications to capture the interest in studying and developing novel ideas, methods or solutions for exoskeleton design, actuation and sensors. The distribution of the works is also analyzed with respect to the device purpose, body part to which the device is dedicated, operation mode and design methods. Subsequently, actuation and sensing solutions for the exoskeletons described by the studies in literature are analyzed in detail, highlighting the main trends in their development and spread. The results are presented with a schematic approach, and cross analyses among taxonomies are also proposed to emphasize emerging peculiarities.

Analysis of Light Grip Influence on Standing Posture.

Upright posture control and gait are essential for achieving autonomous daily living activities. Postural control of upright posture relies, among others, on the integration of various sensory information. In this context, light touch (LT) and light grip (LG) of a stationary object provide an additional haptic sensory input that helps to reduce postural sway. When LG was studied through the grasp of a cane, the sensory role of this assistive tool was often limited to a mediation interface. Its role was restricted to transmit the interaction forces between its tip and the ground to the hand. While most studies involve participants standing in an unstable way, such as the tandem stance, in this paper we study LG from a different perspective. We attached a handle of a cane firmly to a stationary support. Thus, we can focus on the role of the hand receptors in the LG mechanism. LG condition was ensured through the tactile information gathered by FSR sensors placed on the handle surface. Moreover, participants involved in our study stood in a usual way. The study involved twelve participants in an experiment composed of two conditions: standing relaxed while lightly gripping an equipped handle attached to the ground, and standing in the same way without gripping the handle. Spatial and frequency analyses confirmed the results reported in the literature with other approaches.

Cognitive processes and a centre-of-pressure error-based moving light-touch biofeedback.

Lightly touching an earth-fixed external surface with the forefinger provides somatosensory information that reduces the center of pressure (CoP) oscillations. If this surface were to move slowly, the central nervous system (CNS) would misinterpret its movement as body self-motion, and involuntary compensatory sway responses would appear, resulting in a significant coupling between finger and CoP motions. We designed a forefinger moving light-touch biofeedback based on this finding, which controls the surface velocity to drive the CoP towards a target position. Here, we investigate this biofeedback resistance to cognitive processes. In addition to a baseline, the experimental protocol includes four main conditions. In the first, participants were utterly naive about the feedback. Then, they received additional reliable sensory information. The third condition ensured their full awareness of the external nature of the surface motion. Finally, the experimenter notified them that the external motion drives their balance and asked them to reject its influence. Our investigation shows that despite the robustness of the proposed biofeedback, light-touch remains penetrable by cognitive processes. For participants to dramatically reduce the existing coupling between the finger and CoP motions, they should be aware of the external motion, how it impacts sway, and actively reject its influence. The main implication of our findings is that light-touch exhibits the same cognitive flexibility as vision when artificially stimulated. This could be interpreted as a defense mechanism to re-weight these two sensory inputs in a moving environment.

Closed-Loop Control of the Centre of Pressure in Post-Stroke Patients With Balance Impairments.

When a lightly touched surface is moved according to a closed-loop control law, it has been shown in young adults that the centre of pressure (CoP) can be displaced in a controllable way without the conscious cooperation of participants. In this closed-loop paradigm, the surface velocity was continuously adjusted according to the CoP position. Since the closed-loop control of the CoP does not require the participant's voluntary cooperation, it could be of interest for the development of innovative biofeedback devices in balance rehabilitation. Before anticipating the implementation of this closed-loop control paradigm with patients, it is necessary to establish its effects on people suffering from balance impairments. The aim of this paper was to assess the effects of this CoP closed-loop control in post-stroke (PS) patients and aged-matched healthy controls. Efficacy of the closed-loop control for driving the patients' CoP was assessed using the saturation time and two scores computing the error between the predefined and the current CoP trajectories. 68% and 83% of the trials were considered as successful in patients and controls, respectively. The global tracking error of the closed-loop score was similar between the two groups. However, when examining the real CoP displacement from the starting position to the desired one, PS patients responded to the closed-loop control to a lesser extent than controls. These results, obtained in the same conditions for healthy and PS individuals could be improved by tuning the closed-loop parameters according to individual characteristics. This paper paves the road towards the development of involuntary/automatic biofeedback techniques in more ecological conditions.

Closed loop kinesthetic feedback for postural control rehabilitation.

Postural control rehabilitation may benefit from the use of smart devices providing biofeedback. This approach consists of increasing the patients perception of their postural state. Namely, postural state is monitored and fed back in real time to the patients through one or more sensory channels. This allows implementing rehabilitation exercises where the patients control their posture with the help of additional sensory inputs. In this paper, a closed loop control of the Center-Of-Pressure (CoP) based on kinesthetic feedback is proposed as a new form of biofeedback. The motion of a one Degree of Freedom (DoF) translational device, lightly touched by the patient's forefinger, is servoed to the patient's CoP position extracted from the measurements of a force plate on which he/she stands. As a result, the patient's CoP can be controllably displaced. A first set of experiments is used to prove the feasibility of this closed-loop control under ideal conditions favoring the perception of the kinesthetic feedback, while the subject is totally unaware of the context. A second set of experiments is then proposed to evaluate the robustness of this approach under experimental conditions that are more realistic with regards to the clinical context of a rehabilitation program involving biofeedback-based exercises.