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A Sensorized Physical Simulator for Training in Robot-Assisted Lung Lobectomy

The introduction of robot-assisted thoracoscopic surgery (RATS) has brought numerous advantages in performing complex procedures like lung lobectomy. Still, one of the common drawbacks of RATS is the complete loss of haptic feedback. Together with the complexity of surgery as a sensory-motor task, the need to learn the new control dynamics of the surgical instruments makes practical skill training a fundamental step. We present a new methodology of training based on realistic sensorized physical simulator, able to provide objective skill assessment of the surgeon. The developed simulator wants to reproduce the most critical step of robotic lung lobectomy: blood vessel stapling. During this step, the application of excessive tension on the mean blood vessels, accentuated by the lack of haptic feedback in robotic systems, can bring to vessels’ wall rupture and to a consequent massive bleeding (2.4% of cases). A blood vessel simulator was thus sensorized to monitor applied strain and a concurrent feedback can be given to the trainee as a warning when a certain threshold is surpassed. A user study was conducted to assess the concurrent feedback utility and showed that people training with feedback learn to apply smaller tensions on the simulated blood vessel. It is possible that training with this new sensorized simulator could help in decreasing the onset of intra-operative major bleeding, making the procedure safer.