Modern surgery has undergone a dramatic transformation, evolving from extensive incisions to minimally invasive procedures guided by robotic systems and artificial intelligence. However, this progress has come at a cost: surgeons are losing the vital ability to physically feel inside the body during operations. This loss of “palpation” – the ability to assess tissue characteristics through touch – can hinder the detection of subtle abnormalities, potentially impacting surgical precision and patient outcomes.
Now, a collaborative effort across Europe is aiming to restore this crucial aspect of surgery. Researchers are developing a soft robotic “fingertip” designed to sense tissue firmness during minimally invasive and robotic procedures, offering surgeons a new way to “feel” what they are operating on. The EU-funded PALPABLE project, running until the end of 2026, anticipates initial prototype testing with surgeons around March 2026.
The team’s approach combines optical sensing, soft robotics, and AI to create a probe that mimics the nuanced tactile experience of a human fingertip. This device will gently probe organs, generating a visual map of tissue stiffness displayed on a screen, providing surgeons with real-time feedback during operations. This technology aims to bridge the gap created by the increasing reliance on robotic surgery, where tactile feedback is often limited or absent.
“We started 30 years ago with open surgery and using our fingers,” explains Professor Alberto Arezzo from the University of Turin, Italy, specializing in minimally invasive and robotic surgery for colorectal cancer. “Then we moved into the era of keyhole surgery, which reduced tactile feedback because we began to use long instruments.”
The Challenge of Lost Touch
The shift towards keyhole surgery in the 1990s, while offering benefits like reduced trauma, shorter hospital stays, and faster recovery times, came with a trade-off: the loss of direct physical contact with the tissue. This is particularly significant because tumors often exhibit different physical characteristics than healthy tissue – they may be stiffer, less pliable, or have irregular shapes – differences that experienced surgeons can detect through touch.
Precisely defining tumor margins during cancer surgery is a critical challenge. Surgeons strive to remove all cancerous tissue while preserving as much healthy tissue as possible. “We don’t seek to do that [remove too much or too little]. We want it done in one shot,” says Dr. Gadi Marom at Hadassah Medical Centre in Jerusalem, specializing in minimally invasive and robotic surgery for stomach and esophageal diseases. The PALPABLE project aims to provide surgeons with a tool to more accurately determine these margins.
Using Light to ‘Feel’ Tissue
The core of the PALPABLE project lies in its innovative use of light to replicate the sense of touch. The probe being developed incorporates fiber-optic cables embedded within a soft, flexible tip. When pressed against tissue, the tip deforms, altering the way light travels through the fibers. “A silicone dome presses against soft tissue, allowing us to map both the direction and the magnitude of the applied force,” explains Dr. Georgios Violakis at Hellenic Mediterranean University in Heraklion, Crete.
These subtle shifts in light intensity and wavelength are then translated into data representing tissue stiffness. The team has already constructed and calibrated early versions of the soft membrane and light-based sensors, with contributions from various partner institutions. Queen Mary University of London (UK) is refining the membranes, the Fraunhofer Institute (Germany) is developing functional films, and Bendabl (Greece), Tech Hive Labs (Greece), and the University of Essex (UK) are advancing the software needed to visualize the stiffness maps.
The Future of Robotic Surgery and Tactile Feedback
As robotic surgery becomes increasingly prevalent, the require to restore tactile feedback is growing. “When I operate with a robot I have the advantage of 3D vision,” says Dr. Marom. “And I don’t have to stand for the entire surgery.” This is particularly beneficial during lengthy procedures, such as esophageal removal, which can take up to eight hours. Robotic surgery similarly opens possibilities for more precise procedures, potentially allowing surgeons to remove little tumors without removing entire organs in select cases.
However, the absence of tactile feedback remains a significant limitation. “In robotic surgery, tactile feedback is largely absent,” notes Professor Arezzo. “That’s why this work is so significant.” Both surgeons believe that the continued expansion of robotics in the operating room hinges on providing surgeons with enhanced sensory information. “Sooner or later, I believe the vast majority of surgeries will be robotic,” predicts Professor Arezzo.
The collaboration between surgeons and engineers is proving essential. Dr. Marom emphasizes the value of exposure to new technologies and the potential for developing innovative surgical instruments. “The bottom line is that we will be able to give better care to our patients,” he concludes.
Research for this project is funded by the EU’s Horizon Programme. The views expressed by the interviewees do not necessarily reflect those of the European Commission.
This article was originally published in Horizon, the EU Research and Innovation magazine.
Disclaimer: This article provides information about medical research, and technology. This proves not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
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