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

BME 400 Capstone Design 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

BME Outline 400 Capstone Design

BME Problem Statement 400 Capstone Design • 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

BME Laparoscopic Surgery 400 Capstone Design Patient • Minimally invasive • Less tissue trauma • Decreased chance of infection Surgeon • Laparoscope for viewing • Watching monitor, not hands • Tools inserted into body through Figure 1: Laparoscopic cholecystectomy (left) trocar (Needle driver, bowel vs. open cholecystectomy (right) [1] grasper)

BME Laparoscopic Stapling 400 Capstone Design • Separates and seals tissues simultaneously • Decreases hemorrhagic complications Video 1: Surgical stapler in action [3] Figure 2: Laparoscopic surgery diagram [2]

BME Current Devices 400 Capstone Design Figure 3: Ethicon Echelon Flex Powered Figure 4: Medtronic iDrive Figure 5: Medtronic Endo Stapler [4] Ultra Powered Stapler [6] GIA Ultra Universal Stapler [8] Figure 6: Ethicon Endopath ETS-Flex 45 [5] Figure 7: Ethicon Echelon 45 [7]

BME Ethicon Echelon Flex 45 400 Capstone Design [9] [9] [9] Figure 8: Diagram of Mechanical Elements

BME Ergonomic Accommodation 400 Capstone Design Repetitive Anthropometry Posture Strength Motion Figure 9. Showing device usage in a Size 6 hand (left) and size 8 hand (right) [10]

BME Anthropometry 400 Capstone Design Males Females Total (% Accommodated) (% Accommodated) (% Accommodated) 48% 9% 33% Reach to Pull Trigger Reach to Push 75% 23% 54% Release with Thumb 58% 27% 45% Reach to Pull Articulation Head TARGET: 95%

BME Posture - 3DSSPP 400 Capstone Design Figure 11: 3DSSPP model of surgeon posture Figure 10: Dr. Liepert simulating use of the Echelon Flex (left) and the in-line stapler (right)

BME Design Specifications 400 Capstone Design ● ● Accommodate 95% of surgeon Validate the mechanical population feasibility ○ ● Size Assure range of motion of trigger ○ Hand posture is long enough to provide ○ Grip force to not exceed 9.2 N enough force to clamp large, inflamed tissue

BME Project History 400 Capstone Design Figure 12: Fall 2016 Final Prototype Figure 13: Spring 2017 Final Prototype Madelyn Goedland, Justin DeShaw, Gregory Wolf, Ellen Restyanszki, Therese Besser, Andrew Fugate, Albert Anderson Alexander Babinski, Jacob Andreae

BME In-line Handle 400 Capstone Design ● Curved exterior ○ Serves as handle and body ○ Hand in-line with arm ● Linearized drive system ○ Worm gear ● Reverse trigger ○ Use stronger fingers to pull Figure 14: Key Features of In-line Handle

BME Standard Grip 400 Capstone Design ● 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 Figure 15: Key features of Standard Grip Design

BME Pistol Grip 400 Capstone Design ● Straight body with angled handle ○ Hand in line with arm ● Gear system at an angle ● Still utilizes normal trigger Figure 16: Key features of Pistol Grip Design

BME Design Matrix 400 Capstone Design Design #1: In-line Handle Design #2: Standard Grip Design #3: Pistol Grip Percent Population 5/5 35 3/5 21 4/5 28 Accommodated (35) 3/5 15 4/5 20 4/5 20 Mechanical Feasibility (25) 5/5 10 3/5 6 4/5 8 Force on Wrist (10) 4/5 12 5/5 15 4/5 12 Safety (15) 4/5 8 4/5 8 3/5 6 Cost (10) 4/5 4 5/5 5 3/5 3 Ease of Fabrication (5) Total (100) 84 75 77

BME Future Work 400 Capstone Design • Adjustable stapler configurations • Meet with several surgeons to test prototypes in the simulation lab • Validate the mechanical viability of final design

BME Acknowledgements 400 Capstone Design 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

BME References 400 Capstone Design [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.

Appendix: Example of linear gear system