Modern surgical techniques have evolved significantly over the past few decades, shifting from lengthy incisions to minimally invasive procedures guided by robots and artificial intelligence. However, this advancement has led to a notable loss: surgeons can no longer feel the tissues they are manipulating, which can hinder their ability to detect abnormalities. To address this challenge, a team of surgeons and engineers across Europe is developing a soft robotic “fingertip” designed to restore tactile feedback during surgery. This initiative is part of an EU-funded research collaboration known as PALPABLE, set to run until the end of 2026.
The first prototype of this innovative device is expected to be tested by surgeons in March 2026. The project combines advanced technologies, including optical sensing, soft robotics, and artificial intelligence, to create a probe that mimics the sensation of a human fingertip. This device would gently probe organs and generate a visual map of tissue stiffness, displayed on a screen to aid surgeons in their operations.
Understanding the Loss of Tactile Feedback
For many in the surgical field, the diminishing ability to directly feel tissues has become a significant concern. Professor Alberto Arezzo from the University of Turin, who specializes in minimally invasive and robotic surgery, noted, “We started 30 years ago with open surgery and using our fingers. Then we moved into the era of keyhole surgery, which reduced tactile feedback because we began to use long instruments.”
Since the 1990s, keyhole surgery has gained popularity due to its benefits, including reduced trauma for patients, shorter hospital stays, and faster recovery times. However, these advantages have come at the cost of surgeons’ ability to physically assess the tissues they are operating on. This is particularly critical in cancer surgeries, where distinguishing between healthy tissue and tumors can mean the difference between successful treatment and recurrence.
Dr. Gadi Marom, a specialist in minimally invasive and robotic surgery at Hadassah Medical Centre in Jerusalem, highlighted the importance of tactile feedback, stating, “We don’t want to do that. We want it done in one shot,” referring to the need for precise tissue removal during cancer procedures.
Innovative Solutions Using Light Technology
To recreate the sensation of touch, the team is exploring the use of light. The developing probe features embedded fibre-optic cables within a soft, flexible tip. When this tip comes into contact with tissue, it deforms, causing changes in the light that travels through the fibres. Dr. Georgios Violakis from Hellenic Mediterranean University explained, “A silicone dome presses against soft tissue, allowing us to map both the direction and the magnitude of the applied force.” This mapping provides crucial information about tissue stiffness, which can help guide surgical decisions.
Early versions of the device have already been constructed and calibrated in laboratory settings. Collaborating institutions, including Queen Mary University of London, the Fraunhofer Institute in Germany, and various Greek entities, are each contributing to different facets of the project, from membrane design to software development for visualizing stiffness and tactile maps. Validation of the prototype will first occur through lab tests before any patient applications.
The potential impact of this research is significant. “The bottom line is that we will be able to give better care to our patients,” stated Dr. Marom. The fibre-optic technology, traditionally employed in large-scale structures like aircraft and skyscrapers, is being adapted here for the delicate task of sensing human tissue.
As robotic surgery becomes more prevalent, the absence of tactile feedback poses an increasing challenge. Professor Arezzo remarked on the advantages of robotic systems, saying, “When I operate with a robot, I have the advantage of 3D vision.” He emphasized the necessity of restoring tactile feedback to ensure that these robotic systems can be utilized effectively in surgical environments.
Both Professor Arezzo and Dr. Marom agree that advancements in sensory technology are essential for the future of surgical procedures. “Sooner or later, I believe the vast majority of surgeries will be robotic,” Arezzo stated, illustrating the urgent need for tools that can provide surgeons with the sensory information they require.
The collaboration between engineers and surgeons has proven invaluable in this project. Dr. Marom noted, “I am exposed to soft robotics and many new technologies. I see how new instruments can be developed.” The ongoing research, supported by the EU’s Horizon Programme, aims to bridge the gap between robotic surgery and the essential tactile feedback that surgeons have traditionally relied upon to ensure optimal patient outcomes.
The implications of this research extend beyond the operating room, potentially transforming how surgical procedures are performed in the future. As technology continues to advance, the restoration of a surgeon’s sense of touch may redefine the standards of care in medicine, leading to better patient outcomes and enhanced surgical precision.
