Engineers, surgeons design breakthrough laparoscopy tool
Newswise — A new articulated grasping tool will revolutionize laparoscopic surgery, those responsible for the design at the University of Nebraska say.
The tool, trademarked under the name Intuitool, is designed by professor Susan Hallbeck and a team of undergraduate and graduate engineering students at the University of Nebraska-Lincoln in collaboration with physicians at the University of Nebraska Medical Center.
Often called laparoscopic or keyhole surgery, minimally invasive surgery is done through small incisions. Using specialized techniques and tools, miniature cameras with microscopes, tiny fiber-optic flashlights and high definition monitors, surgeons are able to perform a growing number of operations using the technique.
Laparoscopic surgery, the fastest growing surgical technique, was developed about 1990, said Dmitry Oleynikov, M.D., assistant professor of surgery at UNMC. While this surgery has definite patient benefits -- including faster recovery and less risk of infection -- there are downsides for surgeons. Many are posed by the tools surgeons have to use.
"Current tools are essentially regular surgical tools on a long stick," Hallbeck said. The handles look like toy scissors and are "one size fits all," she said, and surgeons with unusually large or small hands are hampered. The tools also are usually to be used right-handed, forcing lefties to adapt.
"The current tools mean you are basically forced to perform complicated tasks with chopsticks," Oleynikov said. "They are rigid, unwieldy instruments."
Because the tools can grasp, but not rotate inside the body, the surgeon has to manipulate the tools outside the body, often using both hands. This forces the surgeon to hold the tools awkwardly, often causing stress and fatigue in the surgeon's hands, arms and shoulders.
Hallbeck said many surgeons report numbness, tingling, pain and other problems when doing these surgeries. Over time, this repetitive stress could shorten or end a career or cause permanent damage. And because of pain or fatigue, surgeons might have to stop during a surgery to rest before resuming the task, lengthening the surgery.
The breakthrough in the Intuitool is in the articulation function -- the grasper end rotates up to 120 degrees side to side using a roller ball the surgeon actuates using his or her thumb.
"Essentially, the Intuitool gives you a wrist on the tool," Hallbeck said.
"This is an unprecedented, even revolutionary breakthrough," Oleynikov said. "No one else has anything remotely similar. It absolutely excited the imagination of surgeons."
The Intuitool, patented and trademarked by UNL, has been licensed to Gyrus Medical, based in Minneapolis, to develop, manufacture and market the tool. It's yet to win approval by the Federal Drug Administration for use in humans, but Hallbeck said she is confident that will come once the design is finalized.
The device won an honorable mention in the Third Annual User-Centered Product Design Award from the Human Factors and Ergonomics Society in 2004.
An initial survey of 18 surgeons asked them to describe their concerns with current tools and their goals for a new tool. A later survey of 38 physicians asked their impressions of the latest model. In the latter study, the prototype tool was preferred. Some 92 percent of those surveyed indicated they thought the articulated tool would be somewhat or very useful and 89 percent said they would try the prototype once commercially available.
Hallbeck said that while an articulated tool was a high priority for surgeons, the "holy grail" for laparoscopy tools would allow the ability to distinguish tissue textures.
Oleynikov agreed. "The ultimate tool for surgeons is our hands. Laparoscopic surgery took our hands out of the mix. A surgeon really feels the most comfortable with his or her own hands doing the work on tissues. We are as close as we can get with current technology and a tool with tactile sensation would be extremely important," he said.
Tactile feedback would help surgeons determine what they are grasping, confirming what they are seeing on two-dimensional video monitors.
"That's the pitfall of being an ergonomist. I see everything that's wrong with tools in my world, and I want to make them better," Hallbeck said.
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