Palpation in Robotic Surgery: Compensating for Tactile Loss Through Visual Feedback

In open and video-assisted thoracic surgery (VATS) pulmonary surgery, direct palpation allows surgeons to locate small or deep pulmonary nodules with the sense of touch. However, in robotic-assisted thoracic surgery (RATS), the absence of tactile feedback represents a significant limitation. This video illustrates how visual strategies can be used to compensate for this loss. 

By utilizing high-definition 3D vision and precise anatomical orientation, surgeons rely on visual cues and gentle instrument compression to assess tissue characteristics. By delicately applying the back of the Maryland forceps over the estimated area of the lesion, it is possible to reproduce, a form of "visual palpation" that can be reproduced, enabling the identification of subpleural or nonvisible nodules without tactile feedback. 

The authors present a case of robotic pulmonary resection in which no physical palpation was possible; however, the lesion was accurately identified and resected based on visual cues. This approach underscores the evolving skill set in robotic thoracic surgery and highlights the importance of training the eye to "feel" through sight. 

References

1. Colan J, et al. Tactile Feedback in Robot‐Assisted Minimally Invasive Surgery: A Systematic Review. The International Journal of Medical Robotics and Computer Assisted Surgery, 2024; 20:e70019. https://doi.org/10.1002/rcs.70019
2. Abiri A, et al. Artificial Palpation in Robotic Surgery using Haptic Feedback. Surg Endosc. 2019 April ; 33(4): 1252–1259. doi:10.1007/s00464-018-6405-8.
3. Chang ATC, et al. Lung nodule localization techniques in minimally invasive and video-assisted thoracoscopic surgery: a literature review. Video-assist Thorac Surg 2023;8:29 | https://dx.doi.org/10.21037

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