• Taku Sugiyama, Liu Shi Gan, Kourosh Zareinia, Sanju Lama, and Garnette R Sutherland.
• Department of Clinical Neurosciences and the Hotchkiss Brain Institute, University of Calgary, Calgary AB, Canada; Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
• World Neurosurg. 2017 Jun 1; 102: 221-228.

ObjectiveSurgical resection of a brain arteriovenous malformation (AVM) poses a technical challenge because of the fragility and number of small feeding and draining vessels around the nidus. Acquiring knowledge of the optimal force applied to such tissue is important in surgical performance and education.MethodsA force-sensing bipolar forceps was developed through installation of strain gauge sensors, and force profiles were obtained from 2 AVM surgeries. The force data associated with vessel injury, unsuccessful trial, was compared with that from successful trials. Receiver operating curve analysis was used for determining optimal force threshold and evaluating the discriminative accuracy of measurement.ResultsForce data from 519 trials was collected, of which 16 (3.1%) were unsuccessful. The mean and maximum forces in successful trials were 0.23 ± 0.06 N and 0.35 ± 0.11 N compared with unsuccessful trials of 0.33 ± 0.05 N and 0.53 ± 0.11 N, respectively (P < 0.001). There was a strong association of mean and maximum force peaks with unsuccessful trials as reflected by the area under the curve of 0.91 and 0.87, respectively. Threshold analysis showed that the rate of unsuccessful trials and error forces tended to increase with surgical time.ConclusionsExcessive force at the tool tip may result in injury to fragile vessels during AVM surgery. A quantifiable metric through force sensing instruments can detect and predict the occurrence of such injury. Such an instrument may be ideal for resident training and evaluation.Copyright © 2017 Elsevier Inc. All rights reserved.

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