The impact of electrosurgical heat on optical force feedback sensors

J.A.C. Heijmans1, M.P.H. Vleugels2,3, E. Tabak1, T.v.d. Dool1, M.P. Oderwald1

1

TNO Science and Industry/Advanced Precision and Production Equipment, Delft, Netherlands
2
EFI BV, Maastricht, Netherlands
3
Rivierenland Hospital, Netherlands

Abstract Electrosurgery enables cutting and coagulation

(desiccation) of tissue for Minimally Invasive Surgery.
Measurements performed by TNO with an infrared camera
showed that the forceps of an endoscopic instrument can be
over 300C in temperature. During electro-surgery the
surgeon relies on the power control and endoscopic images to
perform the procedure successfully.
Manipulation of tissue with the present forceps does not
give accurate tissue information due to the presence of friction
in the transmission mechanism and in turn force, control of the
operating surgeon is poor. The latest developed instruments
incorporates sensors and actuators that enable better control
of force application on the tissue and give a better feeling of
the tissue to the surgeon. TNO works for EFI BV on the
development of a surgical instrument that senses and controls
the gripping force even during electrosurgery.
Electric sensors and actuators experience Electro Magnetic
Interference during the use of electro-surgery, making it
impossible to control the force. The high temperature that
arises at the forceps influences and possibly destroys the
sensors when positioned nearby the heat source. Based on the
experience with optical fiber sensors TNO has developed an
instrument that is immune to EMI and withstands
temperatures up to 200C. This optical sensor is based on a
Fiber Bragg Grating (FBG). The FBG read out system, named
the interrogator, transfers the optical fiber signal from the
mechanical local strain. By this way the force exerted on the
tissue and its resistance can be measured. However this sensor
system is also sensitive to temperature changes. To control
accurately he gripping force, the measurement must be
independent of temperature. Therefore the thermal load at the
forceps were measured and analyzed. The results are used for
the instrument design and location of sensors.
Keywords Electrosurgery,
coagulation,
Minimally
Invasive Surgery, Fiber Bragg Grating, optical force sensor

instruments has started. The majority of these instruments

are based on existing instruments, used in conventional
surgical procedures. These evaluated into devices which are
difficult in handling and which lost force control. Moreover
information of the force created by the tissue resistance on
the tip of the instrument is absent. These disadvantages
added to the poor visualization of the area of operation,
decrease the usability performance of the instruments and
hampers the introduction of minimal invasive surgery into
areas with higher demands on accuracy. By introducing
novel technologies from the field of robotics into the
instruments, the mechanical disadvantages of the current
instruments can be tackled. Innovation in medical
technology is rather difficult due to the harsh environment
in which the instrument must operate. However, thorough
understanding of the medical problem and the issues related
to human interfacing is just as important [1]. The
cooperation of medical company EFI BV with TNO Science
and Industry covers both the medical and technical field.
The concept for this next generation of surgical
instrumentation comes from EFI BV, (Endoscopic Forcereflecting Instrument). The control issues related to haptic
feedback, the mechatronical and fiber optic (FO) issues are
all dealt with by TNO.
II. SYSTEM OVERVIEW
A. Instrument overview
Figure 1 shows the design of an endoscopic instrument
for surgery with haptic feedback. It consists of forceps for
gripping tissue, a shaft with a rod inside for moving the

I. INTRODUCTION
Minimally Invasive Surgery is performed with instrumentation that enables surgery through small incisions. This type
of surgery enables faster recovery of the patient and reduces
the change on postoperative complications. The surgeon,
however, makes sacrifices on its perception and ergonomics.
With the introduction of minimally invasive surgical
procedures, the development of a new range of surgical

Fig. 1

Conceptual design of the endoscopic instrument

J. Vander Sloten, P. Verdonck, M. Nyssen, J. Haueisen (Eds.): ECIFMBE 2008, IFMBE Proceedings 22, pp. 914917, 2008
www.springerlink.com Springer-Verlag Berlin Heidelberg 2009

The impact of electrosurgical heat on optical force feedback sensors

915

forceps, and a handle that moves the rod relative to the

shaft. This instrument is connected through a cable with an
external controller (not shown).
A regular handle is shaped like a simple pair of scissors.
This handle has been replaced by a type that houses two
actuators, one for actuating the forceps and one for
actuating the trigger. In the present regular instruments for
Minimally Invasive Surgery (MIS) the surgeon has little
feeling of the tissue which he is gripping due to friction in
the handle, the rod inside the shaft, and hinges in the
forceps. The newly developed forceps has fiber optic FBG
sensors that accurately measure the gripping force. This
force is relayed to the controller which in turn sends signals
to the actuators in the handle such that the desired force is
exerted on the tissue and an exact scaled force is exerted on
the trigger at the same time which enables the surgeon to
feel the tissue characteristics. Also the force can
automatically be limited to safe values that prevent tissue
damage. The measuring range of the clamping force is up to
20N with a resolution of 10mN.
A further advantage of a wired MIS instrument is that it
allows for independent scaling of force and displacement.
This enables highly accurate operation of delicate tissue as
is the case in an extreme degree for neuro- and eye surgery.
One of the challenges for the endoscopic instrument is the
need to perform electrosurgery. This requires the instrument
to accurately measure the force while the forceps is charged
with electric signals with frequencies in between 350kHz
and 3.3MHz. Besides the EMC the instrument must be reusable and therefore allow demounting, cleaning and
sterilizing by autoclavation.

Multiple sensors can be used inside one fiber, known as

multiplexing. The length of the grating is typically 1 to
10mm in length. The diameter of the sensor is generally in
between 10^m up to 100^m that corresponds with the fiber
core and cladding respectively.
The signal can be monitored with an optical instrument
which is named an interrogator. This instrument analyses
the signal with interferometry or spectroscopy. To create a
realistic haptic feedback system, an interrogator is used with
a bandwidth of 19kHz. This relatively high bandwidth is
commercially available nowadays [3].

B. Fiber optic sensor, FBG

Fiber optic (FO) sensors are a relatively new type of
sensors and their application fields rapidly grow. Medical
technology is one of these applications. Here fiber optics is
very attractive due to their insensitivity to electromagnetic
fields, their small dimensions and their intrinsic electrical
safety [2].
The FBG sensor used for this application is used for force
measurement at the distal end of a surgical instrument. The
functionality is quite identical to an electrical strain gauge
with the difference that no electrical signal comes from the
sensor. A grating situated in the fiber reflects a small band
of wavelength from the light that is sent in the fiber. A
change in the grating results in a change of the reflected
wavelength. This is in general a length difference of the
sensor (strain) or a temperature difference. The sensitivity
of an FBG sensor expressed in wavelength shift for these
parameters is typically 10pm per Kelvin, 1.2pm per strain
(1 strain = 110-6 [-]).

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III. EXPERIMENT
As the FO FBG sensor is sensitive to temperature
changes an experiment has been performed to determine the
thermal effects of electrosurgery. In order to obtain the
required force measurement accuracy the temperature must
be known within 2C. Even without electrosurgery the
temperatures vary from 20C to 37C, clearly indicating the
need for temperature compensation. Therefore a second
FBG is used that only measures the temperature at the
forceps. However, the temperature gradient in the forceps
should be sufficiently homogenous. Since the aim is that the
instrument can be used at all times, even during
electrosurgery, experiments have been carried out in order
to measure thermal effects during electrosurgery. In figure 2
a schematic representation is given of the experimental
setup.
The Valleylab Force 30 (1) is used for both electrical
cutting and desiccation. A handheld device (2) is used to
initiate the electrosurgery. The device is electrically

(1)

(2)
(3)

(4)

(7)

(5)

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(6)

Fig. 2 Schematic representation of the test setup

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J.A.C. Heijmans, M.P.H. Vleugels, E. Tabak, T.v.d. Dool, M.P. Oderwald

connected (3) to the endoscopic instrument (4).

Thermocouples (not depicted) are glued to the forceps of
the instrument that are monitored with a multimeter (5). A
piece of chicken meat (6), which is connected to the return
electrode (7), is used to simulate human tissue. When
electrosurgery is performed heat is generated at the contact
area of the forceps with the tissue.
Figure 3 depicts the actual setup. The temperature
distribution is measured using an infrared camera (7), which
is placed just above the tissue. At first, the thermocouples
(8) are calibrated offline. Secondly, the results from the
camera are calibrated using the thermocouples.

IV. RESULTS
Measurements show that cutting results in slightly higher
temperature than desiccation. Figure 4 depicts a typical
temperature distribution during cutting. Maximum
temperatures of 160C are measured at the tip of the
forceps.

(7)
(8)
Fig. 4

Temperature distribution in the forceps and tissue

during cutting with representative settings

The result of the second experiment (increased power) is

depicted in figure 5. The maximum temperature at the tip is
approximately 300C.
Fig. 3

The actual test setup in which the temperature distribution is

measured using an infrared camera (7). A detail of the forceps and
thermocouples (8) are depicted at the corner, far right

In order for the experiments to be representative, the

measurement procedure is formulated in consultation with a
surgeon (M.Vleugels2,3). Both (monopolair) cutting and
desiccation is performed. Cutting is done by applying a cut
of approximately 3 to 4 centimeters. Next, a waiting period
is introduced of 3 seconds and than another cut is made. In
the measurements four cuts are made. The power used for
the desiccation and cutting is depicted in figure 2.
A second experiment is carried out in which a high load
situation has been examined. In this case the power is
increased by a factor of 2 and is applied for 20 instead of 3
seconds continuously. It must be noted that the heat load is
depending on the power, the contact area between tissue and
forceps and the amount of moisture in the tissue.
A third experiment is carried out with a FBG sensor
fixed to the forceps. When applying cutting and desiccation
to this sample, the FBG signal is read out simultaneously.
The purpose is to show the thermal effects experimentally
and to verify that the sensor and interrogator are indeed
insensitive to electromagnetic fields.

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Fig. 5 Temperature distribution in the forceps and

tissue during cutting with increased heat load

The result of the third experiment is shown in figure 6,

showing the response of the FBG sensor to the heat that
arises from electrosurgery. After nine seconds the forceps
cuts in the tissue for three seconds. This is repeated for four
times. The FBG signal is clearly affected and therefore a

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simultaneous temperature measurement must be taken to

decouple the clamping force from the rise in temperature.
Note that the signal from the FBG sensor is not affected by
the EMC but is only sensitive to temperature changes.

the FBG sensor. Therefore the temperature must be

measured separately and subtracted from the force
measurement. Correct fixation of the FBG sensor is
essential to make the characterization reproducible. The
cooperation between medical company EFI BV and
research institute TNO has been vital for the successful
development of this high tech surgical instrument.

1550.1

Optical strain [nm]

Wavelength
[nm]

1550
1549.9

VI. FUTURE DEVELOPMENTS

1549.8
1549.7
1549.6
1549.5
1549.4
1549.3

10

20

30
time [s]

40

50

60

Fig. 6 Optical signal due to heating when performing electrosurgery

Finally, a study to different sensor fixations has been
performed. Results from this study showed the impact of the
geometry and materials to the reproducibility of the sensor
signal in time and after autoclavation. This has led to the
design of a stable fixation with a reproducibility error of
less than 0.9% after 10 cycles of cleaning and autoclavation.

The FBG sensors, including the adhesive that is used to

fix them, need to be able to withstand the high mechanical,
chemical, and thermal loads due to coagulation, cleaning
and sterilization. Tests will therefore be conducted with
washing (100 cycles) and sterilization (1000 cycles) to see
if any degradation occurs.
A first prototype of this MIS instrument is being realized.
This instrument will be used for experimental surgery on
cadavers to verify the advantages of such an instrument in
practice. With the experience and knowledge acquired, a
MIS product based on this technology will be realized.

REFERENCES
1.

2.

V. CONCLUSIONS
3.

The realized demonstrator has shown the achievability of

force sensing during electrosurgery with a fiber optic
sensor. Measuring the clamping force in the forceps with an
optical strain sensor requires that the temperature must be
taken into account. Tests have shown that during
electrosurgery temperatures can rise up to 160C and up to
300C for high load situations. This heat load at the forceps
causes a significant deviation in the strain read out signal of

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Wieringa F, Poley M, Dumay A. et al. (2007). Avoiding pitfalls in

the road from idea to certified product (and the harsh clinical
environment thereafter) when innovating medical devices. In 7th
Belgian Day on Biomedical Engineering, Brussels, Belgium, 2007
Heijmans J, Cheng L, Wieringa F, Optical fiber sensors for medical
applications, IFMBE Proc., 4th European Congress on Med. &
Biomed. Eng., Antwerp, Belgium, 2008
Cheng L, Groote Schaarsberg J, Osnabrugge van, J, et al. (2001)
Novel Fiber Bragg Grating sensor system for high -speed structure
monitoring, 3rd Int. Workshop on Struct. Health Mon., Stanford,
2001.
Author:
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IFMBE Proceedings Vol. 22

J.A.C.Heijmans
TNO Science and Industry
Stieltjesweg 1
Delft
Netherlands
teun.vandendool@tno.nl

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