Surgical Stapler Redesign Therese Besser, Kelsey Linsmeier, Ellen - - PowerPoint PPT Presentation

Surgical Stapler Redesign

Therese Besser, Kelsey Linsmeier, Ellen Restyanszki, Yaniv Sadka, Jamie Spellman

Mitchell E. Tyler - Advisor, Department of Biomedical Engineering Amy E. Liepert, M.D. - Client, Department of Surgery, UW Health

October 6, 2017

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Outline

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Problem Statement

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• Current laparoscopic surgical device only

accommodates 33% of surgeon population

• Bulky and straining
• Create a design that reduces strain on arm, wrist and

finger muscles

• Handle redesign and trigger adjustment
• Ensure that the mechanical components of the device

function with the new design

Laparoscopic Surgery

Patient

• Minimally invasive
• Less tissue trauma
• Decreased chance of infection

Surgeon

• Laparoscope for viewing
• Watching monitor, not hands
• Tools inserted into body through

trocar (Needle driver, bowel grasper)

Figure 1: Laparoscopic cholecystectomy (left)

• vs. open cholecystectomy (right) [1]

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Laparoscopic Stapling

• Separates and seals tissues simultaneously
• Decreases hemorrhagic complications

Figure 2: Laparoscopic surgery diagram [2]

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Video 1: Surgical stapler in action [3]

Current Devices

Figure 6: Ethicon Endopath ETS-Flex 45 [5]

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Figure 4: Medtronic iDrive Ultra Powered Stapler [6] Figure 7: Ethicon Echelon 45 [7] Figure 3: Ethicon Echelon Flex Powered Stapler [4] Figure 5: Medtronic Endo GIA Ultra Universal Stapler [8]

Ethicon Echelon Flex 45

Figure 8: Diagram of Mechanical Elements

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[9] [9] [9]

Ergonomic Accommodation

Anthropometry Posture Strength

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Repetitive Motion

Figure 9. Showing device usage in a Size 6 hand (left) and size 8 hand (right) [10]

Males

(% Accommodated)

Females

(% Accommodated)

Total

(% Accommodated)

Reach to Pull Trigger

48% 9% 33%

Reach to Push Release with Thumb

75% 23% 54%

Reach to Pull Articulation Head

58% 27% 45%

Anthropometry

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TARGET: 95%

Posture - 3DSSPP

Figure 10: Dr. Liepert simulating use of the Echelon Flex (left) and the in-line stapler (right) Figure 11: 3DSSPP model of surgeon posture

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Design Specifications

• Accommodate 95% of surgeon

population ○ Size ○ Hand posture ○ Grip force to not exceed 9.2 N

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• Validate the mechanical

feasibility

• Assure range of motion of trigger

is long enough to provide enough force to clamp large, inflamed tissue

Project History

Figure 12: Fall 2016 Final Prototype

Madelyn Goedland, Justin DeShaw, Gregory Wolf, Alexander Babinski, Jacob Andreae

Figure 13: Spring 2017 Final Prototype

Ellen Restyanszki, Therese Besser, Andrew Fugate, Albert Anderson

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In-line Handle

• Curved exterior

○ Serves as handle and body ○ Hand in-line with arm

• Linearized drive system

○ Worm gear

• Reverse trigger

○ Use stronger fingers to pull

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Figure 14: Key Features of In-line Handle

Standard Grip

• 90 degree angle between handle

and body ○ Modeled off of echelon flex

• No need to change gear system
• Still allows us to edit trigger

○ Reverse trigger ○ Use stronger fingers to pull

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Figure 15: Key features of Standard Grip Design

Pistol Grip

• Straight body with angled

handle ○ Hand in line with arm

• Gear system at an angle
• Still utilizes normal trigger

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Figure 16: Key features of Pistol Grip Design

Design #1: In-line Handle Design #2: Standard Grip Design #3: Pistol Grip

Percent Population Accommodated (35)

5/5 35 3/5 21 4/5 28

Mechanical Feasibility (25)

3/5 15 4/5 20 4/5 20

Force on Wrist (10)

5/5 10 3/5 6 4/5 8

Safety (15)

4/5 12 5/5 15 4/5 12

Cost (10)

4/5 8 4/5 8 3/5 6

Ease of Fabrication (5)

4/5 4 5/5 5 3/5 3 Total (100) 84 75 77

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Design Matrix

Future Work

• Adjustable stapler configurations
• Meet with several surgeons to test prototypes

in the simulation lab

• Validate the mechanical viability of final design

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Acknowledgements

Client, Dr. Amy Liepert Advisor, Professor Mitch Tyler Previous Design Team Members:

Madelyn Goedland, Justin DeShaw, Gregory Wolf, Alexander Babinski, Jacob Andreae, Andrew Fugate, Albert Anderson 400

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References

[1]Aastha Health care, Laparoscopic Cholecystectomy. 2017. [2]ETHICON, ECHELON FLEX Powered Vascular Stapler. 2017. [3]ETHICON, Ethicon Echelon Flex Device Demo Video. 2017. [4]]Jiangsu Baichang Pharmaceutical Co. LTD, ECHELON FLEX Powered ENDOPATH Stapler. 2017. [5]Health Products Express, Inc., ETHATS45H : ENDOPATH ETS 45mm Linear Cutters by Ethicon. 2017. [6]Medtronic, iDrive™ Ultra Powered Stapling System. 2017. [7] Medical Expo, Straight / Laparoscopic / Sharp Surgery Stapler. 2017. [8] Medtronic, Medtronic Endi GIA Ultra Universal Stapler. 2017. [9] ETHICON, ECHELON FLEX™ Powered Stapler Technology. 2017. [10]ETHICON, Surgical Stapling Grip. 2017. [11] "Amy E. Liepert, MD," in UW Health Find a Doctor, UW Health, 2016. [Online]. Available: http://www.uwhealth.org/findadoctor/profile/amy-e-liepert-md/9451. Accessed: Feb. 15, 2017. [12] J. TOEWS, "A Grip-Strength Study Among Steelworkers," Archives of physical medicine and rehabilitation., vol. 45, pp. 413–7, Aug. 1964. [Online]. Available: https://www.ncbi.nlm.nih.gov/pubmed/14180439. Accessed: Feb. 15, 2017. [13] L. Vassar, "How medical specialties vary by gender," in American Medical Association, AMA Wire, 2016. [Online]. Available: https://wire.ama-assn.org/education/how-medical-specialties-vary-gender. Accessed: Feb. 15, 2017. [14] Esposito, Ciro et al. "Work-Related Upper Limb Musculoskeletal Disorders In Paediatric Laparoscopic Surgery. A Multicenter Survey". Journal of Pediatric Surgery 48.8 (2013): 1750-1756. Web. 4 May 2017.

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Appendix: Example of linear gear system