1,720,965 research outputs found
Augmented reality simulation for laparoscopic training realistic haptic feedback and meaningful assessment
No full textIndustrial Design Engineerin
The feasibility of vacuum technique in minimal invasive surgery: Improving the patient safety through instrument design
No full textGrasping in minimal invasive surgery (MIS) is conducted with so called laparoscopic graspers. These graspers are generally derivatives of instruments used in open surgery. The performance of these graspers depends on the technical and medical functionality, the skills and experience of the user, the surgeon, and the comfort of use related to the instrument. The foremost characteristic required for any grasp instrument in grasping soft organs and tissue is the so called ‘safe grip’. The technical and medical functionality of any grasp instrument depends on this property. The patient safety was defined as the completion of a procedure throughout which no adverse events take place which compromise the physical (and also mental) wellbeing of a patient. Vacuum technique as grasping technique for MIS was chosen as research subject for this thesis. There were three main reasons for this choice. First, vacuum technique is a widely applied grasp technique in industry. Besides the potential induced by its variety of applications in industry, vacuum technique, as grasp technique for MIS, has been studied concerning its potential. These studies underline the potential of vacuum technique however, the findings were not translated to actual applications in MIS nor was any knowledge provided concerning the conditions or requirements in relation to vacuum grasping which ensure a safe grip. The third aspect of vacuum technique is its physical principles. Vacuum grasping is a very controlled and homogenous way of grasping. The ‘object’ type which was grasped by means of vacuum was the bowel. The bowel is an organ which is frequently grasped during MIS procedures. It is a very delicate and easily damaged. Bowel damage can have serious consequences for the patient. With regard to grasping the bowel no research has yet been conducted concerning vacuum grasping. Design Inclusive Research (DIR) was applied as the methodological tool concerning this project. DIR is characterized by the incorporation of design activities which support and provide as input for the research activities. This particular method was chosen due to the intention and necessity of developing vacuum grasp instruments on behalf of the research activities. As stated above, this thesis focusses on the feasibility of vacuum technique as grasp technique for MIS. This is based on the premise that we strive to a constant performance regardless of the skills and experience of the user. The research question was defined as, is vacuum technique feasible as grasping technique for minimal invasive surgery? This feasibility can be interpreted as the feasibility of a vacuum grasp instrument. The performance is determined by the technical aspects, the skills and experience of the surgeon and the comfort of use. This leads to three focus areas. The first two focus points are related to the technical and medical functionality (grip and damage). The third focus point is derived the comfort of use. From this study it can be conclude that, vacuum technique as grasp technique has potential to be used in minimal invasive surgery, no damage to the bowel was encountered either at the macroscopic or at the microscopic level. A try-out towards grasping other types of tissue showed that vacuum also has potential to safely grasp the liver, gallbladder and spleen. From a technical view point vacuum technique offers a number of benefits concerning the physical principle of vacuum grasping. It is a very constant and controllable way of grasping which provides sufficient grip on the bowel. Vacuum technique does not compress the tissue and seems none sensitive to variations in the tissue such as differences in wall thickness and tissue folds which adds to the safe way of grasping. The nozzles of the instruments have no moving parts and the vacuum is limited. Therefore it makes no difference whether the instruments are used by an expert or a novice. The performance on this aspect is constant regardless of the skills and experience of the user. The overall conclusion is that basically vacuum technique is a safe and useful technique to grasp the bowel.Industrial DesignIndustrial Design Engineerin
Creating caring hands through technology: An industrial designer's approach to medical teleconsultation
No full textDoctor-patient teleconsultations have the potential to address the challenges of accessibility, quality and costs of healthcare. However, the diffusion of these systems into mainstream healthcare remains low. Taking a designer’s approach to developing teleconsultation systems is expected to have a positive effect on its acceptance. The aim of the research was therefore to support designers in the development process by creating a framework and a set of guidelines. These help the designer in the analysis phase by giving structure in the complexity of the teleconsultation context and guiding the development of a program of requirements. They also serve as inspirational tools to designers, sensitizing them for the nonverbal and emotional components of a doctor-patient consultation which influence both patient experience and medical decision making. Part of the studies was based on the Virtual Policlinic project, which was set up to connect patients on the island of Ameland to a specialist in the hospital on the mainland. This project was nominated for the 2009 Spider Award for most innovative project in healthcare.Design for SustainabilityIndustrial Design Engineerin
Safety in the Operating Theatre | a Multi Factor Approach for Patients and Teams
No full textDue to the advances in high-tech technology in the operating theatre, the increased number of persons involved, and the increased complexity of surgical procedures, medical errors are inflicted. To answer the main question: How to improve patient safety in the operating theatre during surgery? this thesis is split into three parts. Part A focuses on the processes concerning ‘planning, acting/ performing and recording’ surgical procedures. Currently, no surgical protocol uniformity exists and most operative notes are still dictated postoperatively. Operative notes are sometimes not written according to the guidelines for operative note writing, are subjective, and do not fully correspond to the actual events observed in the video recordings of that particular procedure. Part B focuses on the implementation of a Time Out Procedure plus Debriefing (TOPplus). Results show that operating team members hold different perceptions of communication, teamwork and situation awareness. Designing TOPplus by means of the user-centred participatory design approach, in combination with the context-specific design principles, proves advantageous for implementing the procedures and acts as a catalyst for related patient safety initiatives. Part C focuses on improving the working conditions of the operating team. During surgery problems are encountered within the sensorial, cognitive, physical, and environmental domain. Surgeons performing minimally invasive surgery experience physical discomfort in mainly neck, shoulder, and back. Although the importance of ergonomics is recognised, only few surgeons are aware of general ergonomic guidelines to improve their working conditions. Finally, product evaluation of two types of surgical lights shows that specific disciplines require different lights.Industrial DesignIndustrial Design Engineerin
Ergonomic Factors during Laparoscopic Surgery Training
No full textWith the introduction of minimally invasive surgery (MIS), the patient experiences the benefits of less pain, a more rapid recovery and a shorter stay in hospital. However, MIS provides many challenges to surgeons and they need extensive training to acquire this new technique. This training consists of developing cognitive, clinical, and technical skills. However, acquiring full training ‘‘on the job’’ is not always possible because of patient safety and restrictions of residents’ working hours. This situation led to the development of surgical skills centres or laboratories. These skills laboratories can offer a protected, mistake-free training environment and validated surgical training curriculum that allows surgical trainees to practice in a safe and controlled preclinical environment before operating on actual patients. In addition, following the example of the aviation and military industries, surgical simulation is now being widely used to train surgical trainees from basic tasks to cognitively demanding tasks. The overall aim of this thesis is to define the optimal ergonomic settings and conditions needed to provide an optimal environment for effective training in MIS. This environment should allow training resembling actual laparoscopic surgery in a real OR. In order to achieve this, the study included an elaborate literature review, experimental investigation and design cases. This thesis is divided into three parts referred to as Parts A, B and C. Part A (Chapters 2 and 3) focuses on the review of ergonomic factors during laparoscopic surgery and training; Part B (Chapters 4, 5 and 6) describe a portable Ergo-Lap simulator and the validation of this simulator with laparoscopic specialist and surgical trainees. And finally, Part C (Chapter 7) focuses on distractions and interferences during the intro-operative procedure. Part A deals with ergonomic factors during laparoscopic surgery and training. Chapter 2 investigates ergonomic factors that can influence the task performance, and evaluates the effect of these ergonomic factors on task performance and trainees’ posture during laparoscopic surgery training. Posture analysis showed that subjects can keep a much more neutral posture under optimal conditions than under non-optimal conditions. The subjects experienced less joint excursion and less discomfort in their necks, shoulders, and arms under optimal conditions. Significant differences of task performance showed that the group trained under the optimal ergonomic setting performed significantly better than that the group trained under a non-optimal setting. It can be concluded that surgeons’ learning skills are affected by the ergonomics of simulation setting. Chapter 3 investigates ergonomic factors that can influence surgical training efficiency in several aspects by adopting the ergonomic guidelines for the OR and MIS procedures, performing observations in the OR and in the skills lab as well as interviewing expert surgeons on their opinion of the optimal ergonomic setting in general of skills lab. This chapter also discusses a case study of designing a surgical training table. The aim of this case study is to design an optimal table to meet multiple training requirements, particularly for laparoscopy surgical training. Part B focuses on design and validation of a portable ergonomic laparoscopic simulator (Ergo-Lap simulator). Chapter 4 describes the scientifically-based development of an inexpensive and portable multi-task Ergonomic Laparoscopic Skills (Ergo-Lap) simulator. The design of this Ergo-Lap simulator and related training task panel was based on scientific research regarding the representative skills and the ergonomic guidelines for laparoscopic surgery. A user-centred design approach was followed. Chapter 5 is intended to verify the face and content validity of the new portable Ergonomic Laparoscopic Skills simulator (Ergo-Lap simulator) and to assess the construct validity of the Ergo-Lap simulator in four basic skills tasks. This Ergo-Lap simulator with multiple tasks was rated as a useful training tool that can distinguish between various levels of laparoscopic expertise. Chapter 6 evaluates the face validity of the Ergo-Lap simulator for training basic single-incision laparoscopic surgical skills (SILS). The Ergo-Lap simulator was taken to the 20th International Congress of the EAES 2012 in Brussels. During the congress, the simulator was assessed by 13 general surgeons with different levels of SILS experience using a standardized questionnaire to determine the usability of the Ergo-Lap simulator training for basic SILS skills. For SILS skills training, this inexpensive and portable Ergo-Lap simulator offers a feasible training opportunity to help trainees to practice their SILS skills. Part C focuses on distractions during the intra-operative procedure. Chapter 7 contains a systematic literature search conducted to review the literature on distractions and interruptions during intra-operative phase of different surgical procedures in both the real OR and skills lab setting. In total, 27 articles were included in this review. Twelve observational studies were carried out during the OR to observe interruptions and distractions during the procedure. In addition, 11 experimental studies used a surgical simulator with simulated distractions and interruptions to investigate the effect of distracting events on the task performance. In four qualitative studies the surgical team was interviewed to investigate the influence of intra-operative distractions on their performance. Surgeons face multiple distractions and interactions during surgery, most of which can cause stress to the surgeon and may disrupt the surgical flow, potentially resulting in adverse events. Thorough analysis of interruptions and the way surgeons cope with them could potentially contribute to the positive outcome of procedures. Analysis of experimental studies focusing on the effects of disruptions and interrupting events both in the OR and skills lab setting provide evidence for the need to develop an effective, comprehensive training programme in an environment similar to the OR. Finally, Chapter 8 recapitulates all the research findings and discusses these in a wider range. Factors which are relevant for surgical training efficiency are discussed. The recommendations for the setting up of the skills lab and future research are described.Industrial DesignIndustrial Design Engineerin
Mind the Gap: Designing Sustainable Healthcare for Humanitarian Aid
No full textHumanitarian emergencies like the natural disasters in Nepal, Haiti or Pakistan or the thousands of refugees and internally displaced people fleeing from long-term conflict in Syria or South Sudan are likely to increase. To provide healthcare assistance, international humanitarian organizations transfer a variety of medical equipment and staff to an affected area with the purpose of reinforcing or even replacing disrupted healthcare activities. The replacement system they transfer is usually of a high quality standard, and therefore not suitable to be transported, used, maintained and disposed in austere and low-resource settings. In comparison to providing food or shelter assistance, providing safe healthcare in such situations is particularly challenging due to the level of medical and technical expertise required. In this thesis, the unsustainability of the transfer process of medical equipment in humanitarian emergencies is addressed by describing and analysing how the transfer takes place. Furthermore, two field studies in Indonesia and Haiti are presented. The humanitarian sector is increasingly challenged by the need to become more efficient and competitive. The recent adoption of the ‘humanitarian innovation’ concept, defined by words like “sustainable”, “beneficiaries”, and “long-term” brings an encouraging view ahead towards a more sustainable transfer of medical equipment. A combination of field, interview and literature studies, led to the development of a systems design approach to the transfer of medical equipment in humanitarian emergencies that challenges the field of medical design engineering to broaden its scope and disciplinary boundaries.Design EngineeringIndustrial Design Engineerin
Exploring Philips Medical Systems: A tool for creative designers
No full textBiomechanical EngineeringMechanical, Maritime and Materials Engineerin
Creating a comfortable working environment for cath lab physicians: Design of a body support
No full textThis project is about developing a solution for cath lab physicians. A cath lab physician is a medical doctor, with a background in cardiology, neurology, electro physiology or radiology, who performs cath lab procedures. A cath lab procedure is a minimal invasive procedure in which a catheter is brought into the body of a patient via a small incision. Cath lab physicians suffer from injuries due to the heavy physical workload of their job. The lead apron they wear to protect themselves against the radiation used during the procedures, in combination with long periods of standing, are the main cause of these injuries. An analysis is performed to get more insight in the nature of the injuries and of the environment of the physicians. To start prototyping in an early stage, a short ideation phase took place directly after the analysis. As a result, this phase brought requirements, wishes and concluded with two design directions. A stool with some new features was the best solution. This stool was designed to support the user. The seat will prevent the injuries on the legs while the integrated sternum support reduces the forces in the back muscle. A test was performed to validate the effect of the sternum support. The test shows a reduction between 10% and 15% of the tension in the back muscle. Further research will have to show if the use of the designed solution will actually prevent hernias in the future.Industrial Design EngineeringIndustrial Desig
Improving patient safety in image-based procedures: Bridging the gap between preferred and actual proficiency
No full textFor patients less invasive image-based procedures (IBP) such as laparoscopy have many benefits in comparison to traditional open surgery, such as less pain, faster recovery, and fewer scars. However, to perform IBP effectively, efficiently, and above all safely, the surgical team is highly dependent on technology. The interaction with the surgical instruments and equipment requires extensive training. The proficiency level of the physician and the interaction with the instruments and equipment are key factors in ensuring quality of surgical performance in IBP and patient safety. During surgery, the surgeon should be able to concentrate on the therapeutic tasks. To achieve this, the gap between the preferred and actual level of proficiency of the physician should first of all be minimised by means of preclinical training using simulation tools. In this thesis, the validity of virtual reality simulators for training and assessment of basic psychomotor skills for laparoscopic surgery and flexible lower gastrointestinal endoscopy (colonoscopy) is established. The relation between different IBP skills was also investigated. The performance on two basic laparoscopy tasks (bimanual tissue manipulation and angled laparoscope navigation) proves to be not related; clinically-based expertise in laparoscopic tissue manipulation does not infer skilfulness in angled laparoscope navigation. Training in basic laparoscopy tasks does not affect performance of basic colonoscopy tasks (and vice versa). Training and assessment of basic IBP skills should thus focus on each IBP skill type independently. The influence of specific characteristics of the simulator interface on the efficacy of preclinical training on simulators was also studied. The angled laparoscope navigation task is performed better in an abstract virtual environment than in a virtual environment with simulated anatomic landmarks of the abdomen. And, for training of laparoscopic suturing tasks haptic feedback is a prerequisite. Furthermore, the quality of performance and patient safety should be better safeguarded by improving the interaction with the instruments and equipment in the operating room. Using an integrated operating room system together with the prototype of Pro/cheQ (a digital integrated procedural checklist tool) reduces the number of equipment and instrument related risk sensitive events further than using only an integrated operating room system.Industrial DesignIndustrial Design Engineerin
A Sense of Touch in Laparoscopy: Using Augmented Haptic Feedback to Improve Grasp Control
No full textLaparoscopy is Minimally Invasive Surgery (MIS) that is conducted in the belly alcove and which enables instruments, which enter the body through small incisions, to manipulate tissue. The possible complications arising during laparoscopic surgery are partly caused by improper grasp control on the part of the surgeons using the graspers. This is mainly caused by a reduction in the perception of haptic information (combination of tactile and kinaesthetic information) from the grasped tissue as a result of indirect grasping. The experiments presented in this thesis focus on the improvement of laparoscopic grasp control and the related learning aspects, to see if the former might be improved by means of augmented feedback received on haptic information. The aim of this thesis is to answer the following main research question: “Can augmented feedback on haptic information enhance the surgeon’s control of laparoscopic grasp force?” To understand natural haptics and perception, the parts of the human motion control system involved in grasping are discussed in Chapter 2. The discussion includes barehanded human grasp control and a description is given of the sensory systems involved. A literature review describes the current situation surrounding haptics in MIS, the factors that influence the amount of grasp force applied to the tissue and precisely what sensory information is at present available during the use of laparoscopic graspers. Questionnaire results show the importance of this topic from a surgeon’s point of view. Surgeons need haptic feedback as that is reduced when traditional MIS instruments are used and it is completely absent in Robotic assisted Minimally Invasive Surgery (RMIS). At the start of this PhD project it was not clear which factors control the application of laparoscopic grasp force to tissue. Experiments, presented in Chapter 3, were done in which tasks that were carried out barehanded were compared to tasks that were carried out laparoscopically via instruments with various force transmission ratios. These experiments provided insight into how accurately a human can sense forces and tactile information through a laparoscopic instrument during tissue-grasping tasks. The results of experiments show that in order to successfully control the force applied to the tissue, tactile feedback is essential. The question is whether humans can learn to control their grasp without such tactile feedback but with the help of augmented feedback that compensates for the missing haptic information. The principals of human grasp control discussed in the opening chapters show that both haptics and vision are important in the controlling of hand forces. These principals are the same as those required for the safe control of instruments in MIS. However, the instruments cause a disturbance in visual and kinaesthetic feedback and they cannot provide tactile information at all. The numbers of consequential and inconsequential errors that are being made due to insufficient grasp force control indicate that there is a need to enhance the currently available combination of visual and haptic feedback. The matter of whether augmented feedback can help performance in laparoscopic grasping is tested and discussed in chapter 4. Several augmented feedback modalities are considered (visual, tactile, illusionary and combinations thereof). Experiments, show that having augmented tactile feedback on grasp forces is a good way to help in laparoscopic grasp control. Surgeons at all levels of experience benefit to control their grasp forces with the aid of augmented haptic feedback. With the help of augmented feedback they learn more quickly to control their laparoscopic grasp force and apply reduced overall grasp forces. In addition to receiving augmented haptic feedback all the time during tool usage the question raised if it is possible to train the surgeons to cope with the distorted intrinsic feedback provided by the current graspers by means of only training with augmented feedback. This is supported by the fact that it is known that augmented feedback during the learning process can aid performance in several tasks other than grasping. The advantage of learning to cope with distorted intrinsic feedback is that there is no need for the development of new and expensive instruments in the operating room as the normal instruments can still be used. The results of experiments presented in Chapter 4 show that the majority of surgeons do not become dependent on the augmented signal. This implies that when the augmented feedback is removed they continue to perform with the same improved force control and thus learned to deal with the intrinsic feedback available. Furthermore, experiments showed that performance was still enhanced when the participant’s attention was distracted by introducing an additional aiming-task (with the second hand), while the task whereby controlling grasp forces was needed continued with the other hand. To optimise the augmented haptic feedback signal used in the experiments presented in Chapter 4, a design for a new grasper handle was developed. This new laparoscopic grasper handle with integrated augmented tactile feedback actuators is presented in Chapter 5. To see if people are able to learn grasp control with two hands simultaneously, two of these new handles were used in experiments. The results show that learning with two hands simultaneously is indeed possible and that people do not get confused as a result. From the research done during this PhD project it can be concluded that augmented tactile feedback on grasp forces can aid laparoscopic grasp control even if it is only provided during a training period. Furthermore, the research conducted resulted in the development of a working prototype of a laparoscopic grasper containing augmented tactile feedback on grasp forces together with guidelines for training devices containing augmented haptic feedback.AEDIndustrial Design Engineerin
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