• Abdulrahman Albakr, Amir Baghdadi, Rahul Singh, Sanju Lama, and Garnette R Sutherland.
• Project neuroArm, Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Division of Neurosurgery, Department of Surgery, King Saud University, Riyadh, Saudi Arabia.
• World Neurosurg. 2022 Apr 1; 160: e242-e249.

ObjectiveSurgical resection of intracranial hemangioblastoma poses technical challenges that may be difficult to impart to trainees. Here, we introduce knowledge of tool-tissue forces in Newton (N), observed during hemangioblastoma surgery.MethodsSeven surgeons (2 groups: trainees and mentor), with mentor (n = 1) and trainees (n = 6, PGY 1-6 including clinical fellowship), participated in 6 intracranial hemangioblastoma surgeries. Using sensorized bipolar forceps, we evaluated tool-tissue force profiles of 5 predetermined surgical tasks: 1) dissection, 2) coagulation, 3) retracting, 4) pulling, and 5) manipulating. Force profile for each trial included force duration, average, maximum, minimum, range, standard deviation (SD), and correlation coefficient. Force errors including unsuccessful trial bleeding or incomplete were compared between surgeons and with successful trials.ResultsForce data from 718 trials were collected. The mean (standard deviation) of force used in all surgical tasks and across all surgical levels was 0.20 ± 0.17 N. The forces exerted by trainee surgeons were significantly lower than those of the mentor (0.15 vs. 0.24; P < 0.0001). A total of 18 (4.5%) trials were unsuccessful, 4 of them being unsuccessful trial-bleeding and the rest, unsuccessful trial-incomplete. The force in unsuccessful trial-bleeding was higher than successful trials (0.3 [0.09] vs. 0.17 [0.11]; P = 0.0401). Toward the end of surgery, higher force was observed (0.17 vs. 0.20; P < 0.0001).ConclusionsThe quantification of tool-tissue forces during hemangioblastoma surgery with feedback to the surgeon, could well enhance surgical training and allow avoidance of bleeding associated with high force error.Copyright © 2022 Elsevier Inc. All rights reserved.

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