Affordable devices for laparoscopic surgery

Background
Laparoscopic surgeries are largely done in one of the two manners – standard or robot-assisted. In some scenarios, it can even have an element
of both. These minimalistic techniques enable the treatment of a patient in a faster and less invasive environment with shorter recovery times. In
some scenarios, it can even have an element of both.
Problem
The standard laparoscopic surgery is prone to many limitations that can hinder the precision and accuracy of the procedure. This has an impact
on the general ergonomics of an operation theatre and can even affect the outcome for the patient. These limitations include the camera
becoming blurry multiple times as a result of the smoke, debris and condensation inside the abdomen. To overcome this, the surgeon removes
and cleans the laparoscope with solution and then reinserts it which can be time-consuming in a surgery. The vision of the surgeon is only
limited to 2D vision in a standard laparoscopic surgery, therefore, limiting the surgeon’s depth of perception. The specific ideal posture of the
surgeon during standard laparoscopic surgery is characterized by the arms being rotated inward and retroverted while the hands should handle
the device; leading to stiffness of the surgeons’ shoulders and consequently an increased number of surgeons calling in sick. Robotic-assisted
laparoscopic surgery (RAS) was developed to address these limitations, however, this high technology system is expensive. Consequently, the
accessibility to such a surgical device is limited in low income counties as well as in some developed countries. In 2012, only 64 out of 195
countries worldwide were able to successfully implement RAS in a medical procedure. Therefore, an affordable, easily accessible and adaptable
device that will improve the standard laparoscopic surgery is desirable.
State of the art
Currently, laparoscopic techniques such as Natural Orifice Transluminal Endoscopic Surgery (NOTES) and Single port laparoscopic
surgery (SPLS) have been aimed at making laparoscopy minimally invasive or “scare less”. NOTES is used for accessing the abdominal cavity
whereby a flexible endoscope is passed through a natural orifice (gastrointestinal (GI) tract, vagina, urethra and anus) thus avoiding any external
incisions or scars. However, NOTES can lead to complications such as adhesion formation, visceral and vascular injuries. The SPLS technique
uses a single port, usually at the umbilical site, for the entry of all the necessary instruments and endoscope. SPLS improves cosmesis, however,
there is insufficient triangulation of devices and limited retraction due to the conferment of the instrumentation to a single axis. Laparoscopic
equipment's have also developed over the years with the development of tools such as the FlexDex surgical tool that provides surgeons with
additional degrees of motion compared with traditional laparoscopic instruments and the ‘DaVinci’, which is a robotically assisted laparoscopic
surgery that offers a higher number of degrees of freedom, 3D vision to the surgeon and improved dexterity. The DaVinci has the limitation that
it is expensive to purchase and maintain and hence, affordable, equally efficient and adaptable equipment’s are desired.
Aims
We aim to understand challenges faced by surgeons and as an overall objective, carry out the required research in the field of standard and
robotic assisted laparoscopic surgery and to investigate and create new engineering solutions to those problems. We aim to find high-impact
issues, in order to positively affect the medical community and improve the life of the surgeons and patients. The research outcome would be a
short paper, describing the current landscape or our proposal and on a second level, an idea, that can be implemented within the constraints of
time, budget and expertise. In this project, we also aim to design an affordable, easily accessible and adaptable device or solution that will
improve the standard laparoscopic surgery.
Work plan
The plan of this project is divided into four phases as follows:
 Phase 1- Understanding laparoscopy
Research on the general literature of laparoscopic surgeries; including understanding a range of topics such as the history of
laparoscopy, how it is performed, types of laparoscopic surgeries, laparoscopic market segment, natural orifice transluminal endoscopic
surgery, as well as discovering inventions that companies and surgeons specialised in laparoscopy are working on.
 Phase 2- Exploring challenges in laparoscopy
This stage is split into three sections:
i. Designing a questionnaire for the surgeons based on the information obtained in Phase 1.
ii. Exploring the challenges faced in the different fields of laparoscopy (gynaecology, gastrectomy, colorectal and urology) by
arranging meetings with surgeons and attending operating theatres.
iii. Accessing and narrowing down the challenges observed and create main issues observed.

 Phase 3- Brainstorming
Out of the ideation process, brainstorm to create more specific approaches and devise solutions to those problems
 Phase 4 - Market research and impact factor
 Create a hierarchical categorisation of those solutions and define their impact factor using population, people involved, patients, lives
saved, market size and various other metrics. Using the hierarchical categorisation to decide on what idea to develop further. Get
feedback from stakeholders (doctors, patients, or parties involved).
 Phase 5 – Product design
i. Empathise: Create user stories. Understand the stakeholders, their problems and their stories.
ii. Define: Create the right point of view for users' needs and insights.
iii. Ideate or Brainstorm: Engineering solutions to those problems.
iv. Prototype: Build prototypes that test the above hypothesis. A ground to develop more ideas or have space to modify areas that
they don’t work as expected.
v. Test Before pilot clinical testing, get stakeholder’s feedback and re-iterate. This feedback will aid to further development of the
solution. Define metrics.
vi. Product ready design
Deliverables
The project will result in 1) a written review, describing the current landscape in the specific laparoscopic surgery area focused or specific to our
own solution 2) a product design, where it makes sense, to produce a new, cost-effective, efficient solution (in the form of a medical device) for
use in operative laparoscopic procedures.
Evaluation
Project timeline

Oct-1 Nov-14 Dec-3 Jan-14 Feb-11 March-29

Phase 1
Phase 2
Phase 3
Phase 4
Phase 5
Report