Adriana Ene

Good design: The operating room bed

The OR bed is used to position the patient during surgery, and it must be sturdy and have different attachments that the surgeon can use during surgery. At first, I thought that the bed design could be a better one because at least three people needed to help the patient be moved from the hospital bed to the OR bed. Multiple people are involved in stabilizing him in different ways, and it requires a lot of extra attachments. For example, for one of the surgeries I’ve seen, three people were struggling to position the arm before spinal surgery to get the nerves of the brachial plexus stimulated; another issue why I thought maybe the bed was a poor design was to get attachments of the retractor on the bed involved several people. For the vascular part of one of the surgeries, getting the protractors attached to the bed was a very tedious process and lengthy. However, after talking to the x-ray tech and the physicians, I discovered that the bed is actually a great design. The X-ray tech told me that the neurosurgery OR bed is radiolucent, so they can use an O-arm machine to scan the patient during surgery, which is impossible with other beds. He also mentioned that the bed is easy to move during surgery, which is essential to get the best view for the physician and other staff.  The physician mentioned that the bed’s flexibility makes it easier to position and move the patient during surgery, which is a big plus for spine surgery especially in emergent cases where they have to move the patient quickly.

Bad design: The blood transfusion tube

During one of the surgeries I’ve seen, one of the anesthesiologists struggled to transfuse blood because of the knots that kept forming in the tube. He had to tape the end of the tube and monitor the blood bag to ensure that an effective transfusion was happening. He told me that this is a common issue during surgery, especially since blood transfusion does not happen with a pump and is free-flowing through a warming device. I thought that this is an essential need that has to be addressed in the future.

Week 2

One of the procedures I observed this week was a neurosurgery that utilized a microscope. To maintain sterility, the microscope had to be draped, adding a plastic layer over it, which then had to be repositioned by the surgeon. However, this repositioning often leads to ergonomic issues for the surgeons. The microscope provides two visual fields, making it challenging for both surgeons to position it ergonomically. The microscope must be height-adjusted to accommodate the leading surgeon. In one surgery, a shorter resident struggled to use the microscope because it was too tall for her. They required a step stool to adjust for the height. One of the surgeons was directing the resident on how to improve her posture when dealing with the microscope and how to position its visual field better.

Another challenge I observed was the glare from the microscope draping. During the surgery, the surgeon frequently asked the scrub tech for assistance to reduce the glare by adjusting the plastic or changing the microscope’s focus. The glare not only made it difficult to see but also caused delays as adjustments were made to improve visibility. This issue underscores the need for better design or materials in the draping to minimize glare and enhance the surgeons’ visibility and comfort.

In addition to these ergonomic and visibility challenges, I also noticed the importance of effective communication and teamwork in the operating room. The attending surgeon’s guidance to the resident on posture and positioning was crucial for maintaining efficiency and ensuring the resident’s learning. The teamwork between the surgeon and the scrub tech to manage the glare also highlighted the collaborative effort required to address real-time issues during surgery.

A comprehensive review of surgical microscopes highlights these issues, including the glare from the plastic covering [1].

References: Ma L, Fei B. Comprehensive review of surgical microscopes: technology development and medical applications. J Biomed Opt. 2021 Jan;26(1):010901. doi: 10.1117/1.JBO.26.1.010901. PMID: 33398948; PMCID: PMC7780882.

Needs Statement 1

Neurosurgery surgeons need microscopes that offer improved ergonomics to enhance their comfort and efficiency during procedures.

Explanation:

Primary Observation:

Surgeons often experience ergonomic issues when using current microscopes, leading to discomfort and awkward positions.

Glare from the plastic draping of the microscope interferes with visibility, requiring frequent adjustments.

Technical Secondary Research:

Research indicates that ergonomic design in surgical equipment is crucial for reducing fatigue and improving performance. [1]

Business Secondary Research:

• Zeiss Medical Technology: A leading manufacturer of surgical microscopes known for their ergonomic designs.
• Leica Microsystems: Another major player offering advanced surgical microscopes with features to reduce glare and to have better ergonomics

Total Addressable Market (TAM) Calculation:

Number of neurosurgeons worldwide: 49,940 (estimated from global surgical statistics). (2) he key application segments include ENT surgery, dentistry, oncology, gynecology, urology, ophthalmology, plastic & reconstructive surgery, neurosurgeries, and spine surgeries. (3)

Average expenditure on surgical microscopes: 12,999.00

TAM=49,940×12,999=649,121,060

Iteration 1:

Surgeons require need better ergonomics of the microsurgery microscope.

Populations: Surgeons who use the surgical microscope

Opportunity: Better ergonomics of the surgical microscope

Outcome: Improve surgeons’ ergonomics during surgery

Iteration 2:

Scrub techs require better draping tools of the surgical microscope

Population: Scrub techs that drape the surgical microscope

Opportunity: Easier draping offered

Outcome: Decrease glare during surgery

References:

 Alaqeel M, Tanzer M. Improving ergonomics in the operating room for orthopaedic surgeons in order to reduce work-related musculoskeletal injuries. Ann Med Surg (Lond). 2020 Jun 23;56:133-138. doi: 10.1016/j.amsu.2020.06.020. PMID: 32637088; PMCID: PMC7327029.

https://codmansurgical.integralife.com/global-supply-of-neurosurgeons-challenges-around-the-world/

https://www.grandviewresearch.com/industry-analysis/us-surgical-microscopes-market

Needs Statement: Surgeons require better ergonomics of the microsurgery microscope.

To further assess this needs statement, I considered the IDEO model for innovation, which consists of three primary components: desirability, feasibility, and viability.

• Desirability:I spoke with our mentor, who believes that better microscopes are already available, but surgeons prefer to use older tools due to habit. Additionally, he mentioned that a surgeon’s experience can affect ergonomics, as more experienced surgeons can position the patient to provide a better visual field. The tools for better ergonomics are available but not for all types of surgeries.
• Feasibility and Viability:The feasibility and viability of developing a more ergonomic microscope depend on materials engineering and potential design improvements to reduce current neck strain. For example, one possible solution could be a shifting lens that can be moved rather than moving the entire microscope.

New Needs Statement: Suction devices need better anti-clogging mechanisms.

During multiple surgeries, I observed that the tip of the suction mechanism often gets clogged. To address this issue, the surgical tech would either remove and clean the suction tip or replace it with a new one. Another clogging point is in the suction tube itself, which requires the surgical scrub to insert a syringe with saline to clear the clog.

• Desirability: upon talking to our mentor he mentioned this might not be a very big issue during the surgery
• Feasibility and Viability: It would require the creation of different types of tips to improve the clogging issues.