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  • S , J KOLZ, CLAIRE ARDROP, VIVIAN HEN, KEVIN EENE C S P ...€¦ · Accordion (s) Josh 81 58 30 21 Sarah 44 32 22 20 Vivian 30 43 50 21 Claire 45 94 38 23 Kevin 75 120 34 19 The movaon
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• Decrease (me required to place kidney in bag • Protect abdominal cavity • Sterile, non‐permeable, water(ght • Should not increase chance of metastasis • Cannot cause trauma to surrounding (ssue • Support weight of removed organ • Fit through the hand port in deflated state • Fit through incision while containing the kidney • Can be used with one hand and graspers S PECIMEN BAG DESIGN C RITERIA FINAL DESIGNS S PECIMEN R ETRIEVAL B AG DECREASING OPERATIVE TIME IN HAND‐ASSISTED LAPAROSCOPIC RADICAL NEPHRECTOMY S ARAH S ANDOCK ,J OSH K OLZ ,C LAIRE WARDROP ,V IVIAN C HEN,K EVIN B EENE C LIENT : S UTCHIN P ATEL , M.D. ADVISOR : MITCHELL T YLER INTRODUCTION Crowninshield, Roy D., and Orhun K. Muratoglu. (2010) "How have new steriliza(on techniques and new forms of polyethylene influenced wear in total joint replacement?." Journal of the American Academy of Orthopaedic Surgeons. 16. (2008): S80‐85. Web.10 Oct 2010. <hdp://www.jaaos.org/cgi/content/abstract/16/suppl_1/S80>. Dhobada, Satyen, Suresh Patankar, and VaibhavGorde. (2006) "Port‐Site Metastasis aher Laparoscopic Radical Nephrectomy for Renal‐Cell Carcinoma."Journal of Endourology. 20.2 (2006): 119‐22. Print. Ganpule, Arvind P., and E. Gotov, et al. (2010) "Novel Cost‐effec(ve Specimen Retrieval Bag in Laparoscopy: Nadiad Bag." Urology. 75.5 (2010): 1213‐16. Print. Patel, Sutchin. Personal Interview. 9 Aug 2010. BIOMEDICALENGINEERING BME FUTURE BME Design 200/300 Fall 2010 CONCLUSION R EFERENCES : ACCORDION TESTING TIMING OF KIDNEY REMOVAL FINGER ‐ PORT WEIGHT CAPACITY WATERPROOF COMPETITION BACKGROUND Specimen retrieval bags are necessary during a hand‐assisted laparoscopic radical nephrectomy for the safe removal of a cancerous kidney from the abdominal cavity. The aim of this project is to design and construct a more efficient specimen retrieval bag to decrease the total opera(ve (me of the nephrectomy. Tests were conducted using an ar(ficial environment that simulates a human abdomen. Future work for next semester will be for medical students to prac(ce the nephrectomy in an animal lab on campus to test the total (me and ergonomics of the final designs while minimizing the risk of metastasis. • Removal of a cancerous kidney from the abdominal • Four incisions are made in the abdomen for the surgery: laparoscope, a pair of graspers, machine to inflate abdomen, surgeon’s hand port • Preven(on of metastasis, the spread of cancerous cells • Facilitate removal of kidney: • Limited space within abdominal cavity • Kidney is larger than surgeons hand • Kidney has considerable weight (2‐5 kg) There is no industry standard bag for this procedure. Our client currently uses the Cook LapSac. Some surgeons construct their own bags to use during the procedure. Figure 1: (leh) LapSac Surgical Tissue Touches by Cook, (center) Endocatch by Tyco, (right) Homemade Nadiad Bag (Ganpule et. al, 2010) Cook (s) Finger Port (s) Finger Port (Hand in) (s) Accordion (s) Josh 81 58 30 21 Sarah 44 32 22 20 Vivian 30 43 50 21 Claire 45 94 38 23 Kevin 75 120 34 19 The mo(va(on of this project is to decrease total opera(ve (me by changing the design of the specimen retrieval bag. Change of retrieval bag design might facilitate the removal of the kidney. Because this variable is largely dependent on surgeon preference and ability, mul(ple bags were tested to assess what might be more efficient. For tes(ng, in addi(on to prototype construc(on, a model of a cancerous kidney and an abdomen were built. Table 1: Time tes(ng for removal of cancerous kidney model from model abdomen Figure 6: Josh handling a pair of graspers and using a single hand to remove cancerous kidney model from model abdomen while using web‐camera as laparoscopic element Kidneys removed during this procedure can weight between 2‐5 kg. The prototype must be able to support this weight during removal from the abdominal cavity when held by the drawstring. Tes(ng proved the seal of the prototypes could withstand 6.94 kg before the plas(c began to tear. For the preven(on of metastasis, the seal must be water(ght. As shown, the seal used on our prototypes provides a water(ght bag. Finger port bag constructed Accordion bag constructed Prototypes excelled in tested areas Specifica(ons of common retrieval bag met Decreased opera(ve (me proven by student tes(ng ✘ Decreased opera(ve (me proven by surgeon tes(ng Immediate Future • Find moldable material that suits our needs • Have surgeon test our prototypes in our model environment • Make more prototypes so that we can be ready for future tes(ng (one (me use bags) Although we have constructed two func(onal prototypes that theore(cally should decrease opera(ve (me, this variable will be largely dependent on surgeon preference and ability. To confirm this, further tes(ng will be conducted. Figure 5: Seal provided by impulse heart sealer protec(ng against water leakage Figure 4: Seal provided by impulse heart sealer with standing about 4 kg of weight provided by metal pieces Figure 2: Prototype of accordion bag, (leh) side view, (right) top view Figure 3: Prototype of finger‐port bag, (leh) side view, (right) bodom view • Three finger ports on each side allow surgeon to easily find the finger ports • Finger ports allow surgeon to hold the mouth of the bag open to insert kidney into the bag • Drawstring and water(ght seals prevent metastasis • Takes less than 20 minutes to construct each bag • Allows for mul(ple bag sizes and thicknesses to be used based on surgeon preference • Surgeon has the op(on to insert hand into abdomen with fingers in finger ports • Accordion shape allows the bag to expand and contract • Can be compressed into a disk and placed at the bodom of the abdominal cavity • The severed kidney will be placed on the disk, and the sides of the bag are pulled upwards to enclose the kidney • Can be closed using the drawstring to prevent metastasis • Maintains its shape and opening, allowing quick inser(on of the severed kidney into the bag Materials used: 4 mil polyethylene, nylon string, impulse heat sealer Materials used: 4 mil polyethylene, nylon string, impulse heat sealer Future Semester(s) • Find a impulse hea(ng sealer that allows more flexibility in sealing • Make bags with more flowing seals as opposed to straight line seals • Have prototypes tested by interns in pig labs MoRvaRon: Decrease total opera(ve (me by decreasing (me taken to remove kidney

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Page 1: S , J KOLZ, CLAIRE ARDROP, VIVIAN HEN, KEVIN EENE C S P ...€¦ · Accordion (s) Josh 81 58 30 21 Sarah 44 32 22 20 Vivian 30 43 50 21 Claire 45 94 38 23 Kevin 75 120 34 19 The movaon

• Decrease(merequiredtoplacekidneyinbag

• Protectabdominalcavity

• Sterile,non‐permeable,water(ght

• Shouldnotincreasechanceofmetastasis

• Cannotcausetraumatosurrounding(ssue

• Supportweightofremovedorgan

• Fitthroughthehandportindeflatedstate• Fitthroughincisionwhilecontainingthekidney• Canbeusedwithonehandandgraspers

SPECIMENBAGDES IGNCRITERIA

FINALDESIGNS

SPECIMENRETRIEVALBAGDECREASINGOPERATIVETIMEINHAND‐ASSISTEDLAPAROSCOPICRADICALNEPHRECTOMY

SARAHSANDOCK,JOSHKOLZ,CLAIREWARDROP,VIVIANCHEN,KEVINBEENECLIENT:SUTCHINPATEL,M.D.ADVISOR:MITCHELLTYLER

INTRODUCTION

Crowninshield,RoyD.,andOrhunK.Muratoglu.(2010)"Howhavenewsteriliza(ontechniquesandnewformsofpolyethyleneinfluencedwearintotaljointreplacement?."JournaloftheAmericanAcademyofOrthopaedicSurgeons.16.(2008):S80‐85.Web.10Oct2010.<hdp://www.jaaos.org/cgi/content/abstract/16/suppl_1/S80>.

Dhobada,Satyen,SureshPatankar,andVaibhavGorde.(2006)"Port‐SiteMetastasisaherLaparoscopicRadicalNephrectomyforRenal‐CellCarcinoma."JournalofEndourology.20.2(2006):119‐22.Print.Ganpule,ArvindP.,andE.Gotov,etal.(2010)"NovelCost‐effec(veSpecimenRetrievalBaginLaparoscopy:NadiadBag."Urology.75.5(2010):1213‐16.Print.Patel,Sutchin.PersonalInterview.9Aug2010.

BIOMEDICALENGINEERINGBME

FUTURE

BMEDes ign 200/300 Fa l l 2010

CONCLUSION

REFERENCES :

ACCORDION

TESTINGTIMINGOF K IDNEY REMOVAL

F INGER‐PORT

WEIGHT CAPAC ITY

WATERPROOF

COMPET IT ION

BACKGROUND

Specimenretrievalbagsarenecessaryduringahand‐assistedlaparoscopicradicalnephrectomyforthesaferemovalofacancerouskidneyfromtheabdominalcavity.Theaimofthisprojectistodesignandconstructamoreefficientspecimenretrievalbagtodecreasethetotalopera(ve(meofthenephrectomy.Testswereconductedusinganar(ficialenvironmentthatsimulatesahuman abdomen. Futurework for next semesterwill be formedical students to prac(ce thenephrectomy in an animal lab on campus to test the total (me and ergonomics of the finaldesignswhileminimizingtheriskofmetastasis.

• Removalofacancerouskidneyfromtheabdominal• Fourincisionsaremadeintheabdomenforthesurgery:laparoscope,apairofgraspers,machinetoinflateabdomen,surgeon’shandport• Preven(onofmetastasis,thespreadofcancerouscells• Facilitateremovalofkidney:

•  Limitedspacewithinabdominalcavity•  Kidneyislargerthansurgeonshand•  Kidneyhasconsiderableweight(2‐5kg)

There is no industry standard bag for this procedure.Our client currently uses theCookLapSac.Somesurgeonsconstructtheirownbagstouseduringtheprocedure.

Figure1:(leh)LapSacSurgicalTissueTouchesbyCook,(center)EndocatchbyTyco,(right)HomemadeNadiadBag(Ganpuleet.al,2010)

Cook(s) FingerPort(s)

FingerPort(Handin)(s)

Accordion(s)

Josh 81 58 30 21

Sarah 44 32 22 20

Vivian 30 43 50 21

Claire 45 94 38 23

Kevin 75 120 34 19

Themo(va(onofthisprojectistodecreasetotalopera(ve(mebychanging the design of the specimen retrieval bag. Change ofretrieval bag design might facilitate the removal of the kidney.Because this variable is largely dependent on surgeon preferenceandability,mul(plebagsweretestedtoassesswhatmightbemoreefficient.Fortes(ng,inaddi(ontoprototypeconstruc(on,amodelofacancerouskidneyandanabdomenwerebuilt.

Table1:Timetes(ngforremovalofcancerouskidneymodelfrommodelabdomen

Figure6:Joshhandlingapairofgraspersand using a single hand to removecancerous kidney model from modelabdomen while using web‐camera aslaparoscopicelement

Kidneys removed during thisprocedurecanweightbetween2‐5kg.Theprototypemustbeabletosupportthis weight during removal from theabdominal cavity when held by thedrawstring. Tes(ng proved the seal oftheprototypescouldwithstand6.94kgbeforetheplas(cbegantotear.

For the preven(on of metastasis, thesealmustbewater(ght.Asshown,thesealusedonourprototypesprovidesawater(ghtbag.

 Fingerportbagconstructed

 Accordionbagconstructed

 Prototypesexcelledintestedareas

 Specifica(onsofcommonretrievalbagmet

 Decreasedopera(ve(meprovenbystudenttes(ng

✘ Decreasedopera(ve(meprovenbysurgeontes(ng

ImmediateFuture

• Findmoldablematerialthatsuitsourneeds

•  Have surgeon test our prototypes in ourmodelenvironment

• Makemore prototypes so that we can bereadyforfuturetes(ng(one(meusebags)

Althoughwehaveconstructedtwofunc(onalprototypesthattheore(callyshoulddecreaseopera(ve(me,thisvariablewillbelargelydependentonsurgeonpreferenceandability.Toconfirmthis,furthertes(ngwillbeconducted.

Figure5:Sealprovidedby impulseheartsealerprotec(ngagainstwaterleakage

Figure 4: Seal provided by impulse heart sealer with standingabout4kgofweightprovidedbymetalpieces

Figure2:Prototypeofaccordionbag,(leh)sideview,(right)topview Figure3:Prototypeoffinger‐portbag,(leh)sideview,(right)bodomview

•  Threefingerportsoneachsideallowsurgeontoeasilyfindthefingerports•  Fingerportsallowsurgeontoholdthemouthofthebagopentoinsertkidneyintothebag

•  Drawstringandwater(ghtsealspreventmetastasis•  Takeslessthan20minutestoconstructeachbag•  Allowsformul(plebagsizesandthicknessestobeusedbasedonsurgeonpreference

•  Surgeonhastheop(ontoinserthandintoabdomenwithfingersinfingerports

•  Accordionshapeallowsthebagtoexpandandcontract•  Canbecompressedintoadiskandplacedatthebodomoftheabdominalcavity

•  Theseveredkidneywillbeplacedonthedisk,andthesidesofthebagarepulledupwardstoenclosethekidney

•  Canbeclosedusingthedrawstringtopreventmetastasis

•  Maintainsitsshapeandopening,allowingquickinser(onoftheseveredkidneyintothebag

Materialsused:4milpolyethylene,nylonstring,impulseheatsealerMaterialsused:4milpolyethylene,nylonstring,impulseheatsealer

FutureSemester(s)

•  Find a impulse hea(ng sealer thatallowsmoreflexibilityinsealing

• Makebagswithmoreflowing sealsasopposedtostraightlineseals

• Haveprototypestestedbyinternsinpiglabs

MoRvaRon:Decreasetotalopera(ve(mebydecreasing(metakentoremovekidney

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