Design and In Vitro Validation of an Orthopaedic Drill Guide for Femoral Stem Revision in Total Hip Arthroplasty.

Objective: Cemented total hip arthroplasty (THA) demonstrates superior survival rates compared to uncemented procedures. Nevertheless, most younger patients opt for uncemented THA, as removing well-fixed bone cement in the femur during revisions is complex, particularly the distal cement plug. This removal procedure often increases the risk of femoral fracture or perforation, haemorrhage and weakening bone due to poor drill control and positioning.

"O.R. GOES GREEN": a first step toward reducing our carbon footprint in the operating room and hospital.

Hospitals in Europe produce approximately 6 million tons of medical waste annually, about one-third of this originating in operating rooms. Most of it is solid waste, which can be recycled if bodily fluids do not contaminate it. Only 2-3% of hospital waste must be disposed of as infectious waste, and this is much lower than the 50-70% of garbage in the biohazard waste stream.

Design and evaluation of a smart passive dynamic arm support for robotic-assisted laparoscopic surgery.

Surgeons performing robotic-assisted laparoscopic surgery experience physical stress and overuse of shoulder muscles due to sub-optimal arm support during surgery. The objective is to present a novel design and prototype of a dynamic arm support for robotic laparoscopic surgery to evaluate its ergonomics and performance on the AdLap-VR simulation training device. The prototype was designed using the mechanical engineering design process: Technical requirements, concept creation, concept selection, 3D-design and built of the prototype.

The MISLI-Drive, a modular sterilizable robotic driver for steerable laparoscopic instruments.

Based on the success of the former "Shaft-Actuated, Tip-Articulated" SATA-Drive, a prototype robotic instrument driver for modular, steerable, laparoscopic instruments, a new driver is designed and tested to improve previously lacking features concerning cleanability, instrument adaptation, practical application and control. The design of the driver engages these issues with a modular design aimed at re-use of both the instrument and the driver, for which a set of design requirements are established. A new modular design has been developed to improve cleanability through separation of the electro-motors and the instrument mechanism which clutches the instrument.

Design and Evaluation of a Balanced Compliant Laparoscopic Grasper.

In laparoscopic surgery, quality of haptic feedback is reduced compared to conventional surgery, leading to unintentional tissue damage during grasping. From the perspective of haptics, poor mechanical design of laparoscopic instrument joints induces friction and a nonlinear actuation-tip force relation. In this study, a novel laparoscopic grasper using compliant joints and a magnetic balancer is presented, and the reduction in hysteresis and friction is evaluated.

Escape of surgical smoke particles, comparing conventional and valveless trocar systems.

Background: During minimal access surgery, surgical smoke is produced which can potentially be inhaled by the surgical team, leading to several health risks. This smoke can escape from the abdominal cavity into the operating room due to trocar leakage. The trocars and insufflator that are used during surgery influence gas leakage.

Crossover-effects in technical skills between laparoscopy and robot-assisted surgery.

Introduction: Robot-assisted surgery is often performed by experienced laparoscopic surgeons. However, this technique requires a different set of technical skills and surgeons are expected to alternate between these approaches. The aim of this study is to investigate the crossover effects when switching between laparoscopic and robot-assisted surgery.

Force-based assessment of tissue handling skills in simulation training for robot-assisted surgery.

Introduction: Although robotic-assisted surgery is increasingly performed, objective assessment of technical skills is lacking. The aim of this study is to provide validity evidence for objective assessment of technical skills for robotic-assisted surgery.

Methods: An international multicenter study was conducted with participants from the academic hospitals Heidelberg University Hospital (Germany, Heidelberg) and the Amsterdam University Medical Centers (The Netherlands, Amsterdam).

Dynamic characteristics of skin reaction force in different body postures.

Mechanical stress influences scarring of a surgical wound. Several lines have been proposed for the best excision direction. It is unknown if these lines still apply when the body posture changes.

Question-based development of high-risk medical devices: A proposal for a structured design and review process.

Introduction: The recent introduction of the European Medical Device Regulation poses stricter legislation for manufacturers developing medical devices in the EU. Many devices have been placed into a higher risk category, thus requiring more data before market approval, and a much larger focus has been placed on safety. For implantable and Class III devices, the highest risk class, clinical evidence is a necessity.

Reprocessing Zamak laryngoscope blades into new instrument parts; an 'all-in-one' experimental study.

Introduction: Disposable instruments in healthcare have led to a significant increase of medical waste. The aim of this study is to validate the recycling of disposable Zamak laryngoscope blades into new medical components by using a new 'all-in-one' affordable reprocessing setup as alternative for die-casting.

Methods: A n "all-in-one" casting set-up was designed and built.

Design of an Affordable, Modular Implant Device for Soft Tissue Tension Assessment and Range of Motion Tracking During Total Hip Arthroplasty.

In hip arthroplasties, surgeons rely on their experience to assess the stability and balance of hip tissues when fitting the implant to their patients. During the operation, surgeons use a modular, temporary set of implants to feel the tension in the surrounding soft tissues and adjust the implant configuration. This process is naturally subjective and therefore depends on the operator.

Using Acoustic Vibrations as a Method for Implant Insertion Assessment in Total Hip Arthroplasty.

The success of total hip arthroplasty depends on the experience of the surgeon, and one of the ways the surgeon currently determines the final implant insertion depth is to listen to the change in audible pitch of the hammering sound. We investigated the use of vibration emissions as a novel method for insertion quality assessment. A non-invasive contact microphone-based measurement system for insertion depth estimation, fixation and fracture detection was developed using a simplified in vitro bone/implant (n = 5).

Validation of the portable virtual reality training system for robotic surgery (PoLaRS): a randomized controlled trial.

Background: As global use of surgical robotic systems is steadily increasing, surgical simulation can be an excellent way for robotic surgeons to acquire and retain their skills in a safe environment. To address the need for training in less wealthy parts of the world, an affordable surgical robot simulator (PoLaRS) was designed.

Methods: The aim of this pilot study is to compare learning curve data of the PoLaRS prototype with those of Intuitive Surgical's da Vinci Skills Simulator (dVSS) and to establish face- and construct validity.

Characterisation of trocar associated gas leaks during laparoscopic surgery.

Background: During laparoscopy, the abdominal cavity is insufflated with carbon dioxide (CO) that could become contaminated with viruses and surgical smoke. Medical staff is potentially exposed when this gas leaks into the operating room through the instruments and past trocar valves. No detailed studies currently exist that have quantified these leakage pathways.

Assessment of technical skills based on learning curve analyses in laparoscopic surgery training.

Background: Objective force- and motion-based assessment is currently lacking in laparoscopic skills curricula. This study aimed to evaluate the added value of parameter-based assessment and feedback during training.

Methods: Laparoscopy-naïve surgical residents that took part in a 3-week skills training curriculum were included.

A new bone-cutting approach for minimally invasive surgery.

Aims: Resection of bone is performed in over 75% of all orthopaedic procedures and the electrically powered oscillating saw is commonly used to cut bone. Drawbacks are relatively large incisions and tissue damage due to overshooting often occur. Therefore, the goal of this study is to develop an improved bone-cutting system that has minimally invasive characteristics.

Knotless seton for perianal fistulas: feasibility and effect on perianal disease activity.

Patients with perianal fistulas are frequently treated by a knotted seton which is well-known for causing complaints. We aimed to assess the feasibility of the knotless SuperSeton and advantages with respect to perianal disease activity. In a prospective cohort study, we included all consecutive adult patients with a knotted seton in situ or a perianal fistula requiring new seton drainage.

Haptic exploration improves performance of a laparoscopic training task.

Background: Laparoscopy has reduced tactile and visual feedback compared to open surgery. There is increasing evidence that visual and haptic information converge to form a more robust mental representation of an object. We investigated whether tactile exploration of an object prior to executing a laparoscopic action on it improves performance.

Reprocessing filtering facepiece respirators in primary care using medical autoclave: prospective, bench-to-bedside, single-centre study.

Objective: There are widespread shortages of personal protective equipment as a result of the COVID-19 pandemic. Reprocessing filtering facepiece particle (FFP)-type respirators may provide an alternative solution in keeping healthcare professionals safe.

Design: Prospective, bench-to-bedside.

Measuring Forces in Suture Techniques for Wound Closure.

Background: The use of sutures remains the first choice for wound closure. However, incorrect use of a suture technique can lead to impaired healing. Many techniques are described for high-tension wounds, but not much is known about their mechanical properties.

A new modular mechanism that allows full detachability and cleaning of steerable laparoscopic instruments.

Background: Ever since the introduction of laparoscopic surgery, researchers have been trying to add steerability to instruments to allow the surgeon to operate with better reachability and less tissue interaction force. Traditional solutions to introduce this often use a combination of springs, cables, pulleys, and guiding structures, resulting in instruments that cannot be properly cleaned and thus are very costly to manufacture and maintain. The aim of the study is to develop a novel affordable, sustainable, cableless, and fully steerable laparoscopic grasper, and to test its ease of assembly, disassembly, and use.