Introducing the Nuances of Tool–Tissue Interaction Forces in Hemangioblastoma Surgery
Bibliographic record
Abstract
Objectives: Surgical resection of intracranial hemangioblastoma poses technical challenges which may be difficult to impart to trainees. The use of excessive force in such lesion may result in bleeding and failure of task completion. Knowledge of the ideal forces required for hemangioblastoma dissection has not been quantified nor analyzed with respect to surgical performance and education. Here, we introduce an early level data on the forces in Newton (N), observed for different surgical tasks in hemangioblastoma surgery comparing the force profiles of trainees to expert surgeons. Methods: “SmartForceps System,” a force-sensing bipolar forceps was developed to quantify tool-tissue forces during surgery. Seven surgeons (2 groups: novice and expert) participated in the study, with expert surgeons ( n = 1, 10+ years of experience), and novice surgeons ( n = 6, PGY 1–6 including clinical fellowship). Five patients who underwent surgical resection of hemangioblastoma using the SmartForceps System between October 2019 and June 2021 were included. Demographics, histopathology, and radiology data were recorded. We recorded the force profile of five predetermined surgical tasks: (1) dissection, (2) coagulation, (3) retracting, (4) pulling, and (5) manipulating. Task-specific force recording started from the time when the surgeon stated the specific task, and stopped when the forceps tip was no longer in contact with the tissue. The force profile was measured for each trial and included force duration, average, maximum, minimum, range, standard deviation, and correlation coefficient. Results: All patients were male with a mean age of 48 years (range 41–69 years). All tumors were located in the cerebellum, and had a cystic component. Force data from 718 trials were collected, of which 452 trials were recorded for expert surgeons. The mean (SD) for tumor coagulation was 0.17 ± 0.10 N. The forces exerted by novice surgeons were significantly lower than those of the expert surgeon (0.13 vs 0.22; p < 0.0001). Force variability decreased from novice (0.63) to expert surgeon (0.56). The duration of task completion was similar in both groups. Of all the tasks, dissection required the least amount of force, and was significantly lower than most other tasks. Surgeons use higher force toward the end of tumor resection (0.17 vs 0.20; p = 0.003) Conclusion: Trainees exert lower forces during hemangioblastoma surgery. This finding may suggest hesitancy by trainees to avoid injury to delicate structures and bleeding. The use of slightly higher force was particularly common at the end of the surgery, which might be related to surgeon fatigue. The quantification of tool–tissue interaction forces during hemangioblastoma surgery with feedback to the surgeon could well enhance surgical training and the avoidance of bleeding associated with high force error. Fig. 1 Publication History Article published online: 15 February 2022 © 2022. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".