The Intuitool: A Comfortable Laparoscopic Grasper

Transcription

1 The Intuitool: A Comfortable Laparoscopic Grasper

2 Current Tools Increase Surgeon Discomfort Problems recorded by surgeons Neck pain Neck stiffness Shoulder/arm pain Shoulder/arm stiffness Hand/wrist pain Hand/wrist stiffness Back pain Back stiffness Numbness of fingers or thumb Headaches Mental fatigue,irritability, or exhaustion Excessive tachycardia, sweating, or tremors Instruments awkward to manipulate Not able to perform fine or precise motion Minimally invasive surgery, or MIS, is surgery done with a small incision to limit the pain of the patient. Current tools, along with the operating room environment and posture of the surgeon cause fatigue, discomfort, and instances of long-term damage to the surgeons hands, wrists, arms, and shoulders. (1-13) An operating surgeon using an unintuitive conventional tool is limited in external and internal range of motion. Limited range leads to extended operative time along with surgeon discomfort and fatigue. Extended operation time also leads to additional patient discomfort and health risk. Limiting these factors are major goals of MIS surgery, and surgeons in general. Not able to perform fine or precise motion Instruments awkward to manipulate Excessuve tachycardia, sweating or tremors Mental fatigue, irritability, or exhaustion Headaches Numbness of fingers or thumb Back stiffness Back pain Hand/wrist stiffness Hand/wrist pains Shoulder/arm stiffness Shoulder/arm pain Neck pain Neck stiffness 10% 20% 30% 40% 50% 60% 70% 2 Figure 1: Percentage of surgeons experiencing slight or substantial problems

3 Pressure Points Eight to twelve percent of practicing laparoscopic surgeons frequently experience post-operative pain or numbness. Post-operative pain or numbness is generally attributable to pressure points on the laparoscopic tool handle. (4) A study of four different handle designs (shank, pistol, axial, and ring handle) resulted in displaying painful pressure spots that caused extreme ulnar deviation. (5) The wrist is especially significant because it is most frequently affected by cumulative trauma disorders (CTDs). (14) The Intuitool features: 120 degree Articulat- ing Grasper Control Sphere Ergonomic Handle Squeeze Grip Rear-hinged grasper Grasper lock Shaft Rotator 3 Figure 2: Hand holding a conventional tool Figure 3: Pressure points (red circles) and joint and muscle areas (blue circles)

4 Posture Recognized Design Process Human Factors and Ergonom- ics Society honorable mention for the User-Centered Design Award 2004 Considered for the R&D 100 award in 2005 Existing tools are awkward to manipulate and unable to perform fine or precise motion. (13) The Intuitool was designed with the surgeon in mind. The Intuitool s ability to change hand postures reduces muscle fatigue on the fingers, hand, wrist, and shoulder. The gripping method on the tool is the most important factor for limiting CTDs. As a result, there is opportunity to reduce the risk of CTDs by improving the grip of current laparoscopes. Teaching surgeons how to correctly grip an advanced laparoscopic tool will reduce flexion or extension of the surgeon s wrist. Proper gripping methods will keep ulnar deviation minimal, improve the surgeon s dexterity, and decrease operation time. When compared to traditional tools, loop posture, the Intuitool has less wrist flexion which promotes wrist health. (15) 4

5 Meet the Inventors Dr. Dmitry Oleynikov M.D., FACS is an associate Professor of Surgery, the Co- Director of Education and Training Center for Minimally Invasive and Computer Assisted Surgery Initiative, the Medical Director for the Nebraska Medical Center s Minimally Invasive Surgery Program (MIS) and the Joseph and Richard Still Faculty Fellow in Medicine. He has extensive experience in minimally invasive and videoendoscopic surgery and is currently engaged in research in Laparoscopic and Esophageal Surgery, Esophageal motility, and robotic surgery. Dmitry Oleynikov, M.D. 5 Dr. M. Susan Hallbeck, P.E., C.P.E. is a Professor of Industrial and Management Systems Engineering. She also holds a courtesy appointment in Surgery at UNMC. She is the director of the Innovative Design and Ergonomic Analysis Lab and the coordinator of the award-winning FINDER group - collaboration among physicists, chemists, electrical, materials and industrial engineers for detection of neutrons for homeland security. She has been a guest researcher at the National Institute for Working Life in Sweden and a NASA summer research faculty at NASA-Ames Research Center. Dr. Hallbeck is a founding member of the Center for Advanced Surgical Technologies and the Center for Ergonomics and Safety Research. She is also a member of the Nebraska Center for Materials and Nanoscience. Her current multi-disciplinary research in the IDEA Lab includes: Development of laparoscopic surgical tools; Methodology standardization for operating room medical device usability; Development of a neutron detector for homeland security; Investigation of single and double mouse clicks on computer user workload and Evaluation of a 7/8 piano keyboard. M. Susan Hallbeck, P.E.

6 UNeMed Contact UNeMed UNeMed Nebraska Medical Center Omaha NE Telephone: Fax: Joe Runge Licensing Specialist E: UNeMed is a for profit technology transfer firm that provides services to the University of Nebraska Medical Center, the Eastern Nebraska Veterans Administration Hospital and a variety of other technology organizations in the midwest. UNeMed is committed to developing and fostering relationships with industry to transfer intellectual property from the laboratory to the marketplace. Consistent with it s focus, UNeMed continues to seek industrial licensing opportunities to enhance the development of its technologies and foster scientific breakthroughs. UNeMed Facts - A for profit company entirely owned by the Board of Regents of the University of Nebraska doing business as the University of Nebraska Medical Center - Currently offers an extensive portfolio of over 100 technologies available for licensing - Negotiates approximately 300 contracts per year enabling research and collaboration at UNMC

7 References 1) Berguer, R., G. T. Rab, et al. (1997). A comparison of surgeons posture during laparoscopic and open surgical procedures. Surgical Endoscopy 11(2): ) Berguer, R. (1998a). Surgical technology and the ergonomics of laparoscopic instruments. Surgical Endoscopy 12: ) Berguer, R., S. Gerber, et al. (1998b). An ergonomic comparison of in-line vs. pistol-grip handle configuration in a laparoscopic grasper. Surgical Endoscopy 12: ) Berguer, R., D. L. Forkey, et al. (1999). Ergonomic problems associated with laparoscopic surgery. Surgical Endoscopy 13(5): ) Matern, U. and P. Waller (1999b). Instruments for minimally invasive surgery. Surgical Endoscopy 13: ) Berguer, R., D. L. Forkey, et al. (2001a). The effect of laparoscopic instrument working angle on surgeons upper extremity workload. Surgical Endoscopy 15: ) Berguer, R., W. D. Smith, et al. (2001b). Performing laparoscopic surgery is significantly more stressful for the surgeon than open surgery. Surgical Endoscopy 15(10): ) Emam, T. A., T. G. Frank, et al. (2001). Influence of handle design on the surgeon s upper limb movements, muscle recruitment, and fatigue during endoscopic suturing. Surgical Endoscopy 15: ) Matern, U., C. Giebmeyer, et al. (2002). Ergonomic aspects of four different types of laparoscopic instrument handles with respect to elbow angle: An electromyogram-based study. Surgical Endoscopy 16: ) Nguyen, M. D., N.T., M. D. H. S. Ho, et al. (2001). An ergonomic evaluation of surgeons axial skeletal and upper extremity movements during laparoscopic and open surgery. The American Journal of Surgery 182(6): ) van Veelen, M. A., D. W. Meijer, et al. (2001a). Improved usability of a new handle design for laparoscopic dissection forceps. Surgical Endoscopy 16(1): ) van Veelen, M. A., D. W. Meijer, et al. (2001b). New Ergonomic Design Criteria for Handles of Laparoscopic Dissection Forceps. Journal of Laparoendoscopic & Advanced Surgical Techniques 11(1): ) Doné, Kathryn, DiMartino, Allison, et al. (2004). Evaluation of Laparoscopic Tools for Usability and Comfort. Proceedings of the Human Factors and Ergonomics Society 48th Annual Meeting ) Tanaka S., McGlothlin J., (1989). A conceptual model to assess musculoskeletal stress of manual work for establishment of quantitative guidelines to prevent hand and wrist cumulative trauma disorders (CTDs). Advances in Industrial Ergonomics and Safety ) van Veelen, M.A., Jakimowicz, J.J., Kazemier, G. (2004). Improved physical Developmental Status Non-functional prototype Patent pending Initial project in examining improved ergonomics in laparoscopic surgery ergonomics of laparoscopic surgery. Minimally Invasive Ther. Allied Technol. 13, ) Trejo, A.E., Jung, M.C., et al. (2007). Effect of handle design and target location on insertion and aim with a laparoscopic surgical tool. Applied Ergonomics 38,