Minimally invasive surgeries are still predominantly performed using handheld instruments. As such, surgeons need appropriate tools to translate elaborate hand motions towards the surgical site through the very small incisions that limit their capabilities.
In the race to provide the surgical instruments that surgeons need, the healthcare industry is dominated by a couple of big players that control the market. For decades, these companies have been supplying traditional instruments to surgeons, who have gotten used to them and based their surgical techniques on the available tools. Moreover, most of the instruments that you will find in a traditional operating room (OR) are antiquated tools that limit the performance of surgeons.
When going through the history of surgical instrumentation, it is noticeable that the tools have not changed much since Greco-Roman times, aside from the obvious improvement in materials. Is it then safe to assume that these instruments are the best they could be, just because they have been used for ages?
It is time to challenge the status quo in order to evolve our healthcare system.
Same vs. New
Traditional minimally invasive instrumentation is very simple technology-wise, aiming only to fix an obvious problem (to reach the inside of the human body), but not to improve the surgeon’s capabilities. The focus has been on creating tools that surgeons can use to manipulate tissues inside our bodies. As any other good hammer, screwdriver or drill, these surgical instruments are robust tools, but they are also uncomfortable to manipulate (especially through small incisions).
Example of a typical pre-bent surgical instrument for arthroscopy
Current minimally invasive devices, especially for orthopedy and arthroscopy, are strong and stiff instruments. The need to cut cartilage and other tough tissues has led to the mass commercialization of steel-made pre-bent instruments that serve a purpose, but are still far from ideal. As they are fixed at one particular angle, surgeons need large sets of multiple instruments (each at a different bending angle) to reach the surgical site through 3- or 5-mm incisions. However, there is more: in their effort to perform the surgeries more efficiently and with fewer instruments, surgeons manipulate the instruments in uncomfortable positions, and they end up hurting their wrists and the insertion portal (healthy tissue) of the patient.
“A clear example is in arthroscopic surgery, where surgeons have been using the same instruments for the last 10-15 years. The typical instruments are pre-bent at a fixed angle, so the surgeon needs several instruments to reach difficult locations inside the knee,” says Dr. Jenny Dankelman, Professor of Minimally Invasive Surgery and Intervention Techniques at Delft University of Technology. “Surgeons need to change their instruments quite often and they need to be very careful not to damage any surrounding tissues.”
This frustrating situation can also be found in laparoscopy. “In my work as a laparoscopic surgeon, I sometimes encounter situations in which anatomical areas are hard to reach with the currently available instruments,” says Dr. Roel Postema, MD, laparoscopic surgeon at Amsterdam UMC.
However, in the case of laparoscopy, the problem is even bigger, as Dr. Postema keeps explaining, “An instrument with a steerable tip would be the solution to this problem, but over the past years, these instruments have had very bulky and complex structures. Steering the tip of these instruments is awkward and unreliable, especially in situations where we have to operate through small incisions with small trocars.”
Over the past years, some steerable devices have been launched for the laparoscopic market. Here again, in their efforts to solve the obvious reachability problem, other equally important issues have been neglected. The mobility mechanisms employed are based on cables and pulleys, which are controlled through complex handles that require specialized cleaning and sterilization systems (when not disposable). Not all surgeons can handle these instruments, and not all hospitals can afford the cost of buying and sterilizing such complex tools.
Ideally, a surgeon should be able to reach any required space in our body without hurting themselves or compromising other tissues. Hence, if the current instruments do not allow for the freedom of performance that surgeons require, then why do they keep using the same tools?
A New Generation of Instruments
Surgeons are as free in their endoscopic movements as their instruments allow. An easy-to-use steerable instrument would certainly improve their reach inside the body and the patient care they deliver.
There are already some innovative steerable instruments approaching their market launch that surgeons highly expect . “Refined, efficiently designed and robust steerable laparoscopic instruments would be the solution to this [reachability and complexity] problem, allowing me to deliver better patient care. Surge-on Medical has designed a new and very promising generation of these instruments. Next to the brilliant and very sophisticated design of the instruments, there is a strong focus on usability and cleanability in order to satisfy the needs of all stakeholders,” says Dr. Roel Postema.
It will be a group effort to accept and promote the slow transition from traditional tools to this new generation of surgical instruments. As always, many stakeholders will be reluctant to change, but in this case, pressure from patients, surgeons and regulations regarding medical devices has been adding up and demanding a change.
Steerable and sustainable instruments would not only provide better assistance during surgery but would also effect a change in traditional procedures. We are talking about changing the system as a whole, from the instruments, the procedures to be followed, the cleaning techniques required and even the recovery time for patients. With all this, we might be able to make a real impact on the healthcare system, improving it not only for patients but also for surgeons.
Half measures are not acceptable in healthcare anymore. It is not enough to have the bare minimum tools that solve a problem but create others. We demand more organic solutions that will empower surgeons everywhere.
(Updated on June 9th, 2020. Links to the funding page removed as funding successfully completed).