From forceps manipulation theory to cognitive support in robotic surgery: Conceptualizing “Level 0+” as a cognitive-support state in fully surgeon-controlled surgery

Yuji Nishizawa; Toshikazu Kawai; Atsushi Nishikawa

doi:10.1016/j.lers.2026.07.003

July 1, 2026Laparoscopic Endoscopic and Robotic SurgeryOpen Access

From forceps manipulation theory to cognitive support in robotic surgery: Conceptualizing “Level 0+” as a cognitive-support state in fully surgeon-controlled surgery

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Key Points

To establish a theoretical framework defining Level 0+ cognitive support in robotic surgical platforms based on forceps manipulation theory.
Conceptual model development synthesizing principles of surgical forceps manipulation and robotic autonomy taxonomies.
Defines Level 0+ as a robotic assistance paradigm providing sensory and informational guidance while keeping physical tool manipulation entirely under surgeon control.
Integrates forceps mechanics with cognitive-assistance interfaces to enhance intraoperative precision and surgeon decision-making.

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Implication

Conceptual analysis proposes a Level 0+ cognitive support state in robotic surgery, suggesting improved situational awareness without relinquishing direct manual control.

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Nishizawa et al. (2026) studied this question.

synapsesocial.com/papers/6a8cded3f64a4c3baf990b4a https://doi.org/10.1016/j.lers.2026.07.003

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From forceps manipulation theory to cognitive support in robotic surgery: Conceptualizing “Level 0+” as a cognitive-support state in fully surgeon-controlled surgery

Key Points

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Implication

Abstract

Discussion

Cite This Study

From forceps manipulation theory to cognitive support in robotic surgery: Conceptualizing “Level 0+” as a cognitive-support state in fully surgeon-controlled surgery

Key Points

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Implication

Abstract

Discussion

Cite This Study

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