Hamza Hamad

Our first week in the Operating Room (OR) felt like something out of a TV show. Our group of medical and engineering students had the privilege of shadowing Dr. Mehta in the neurosurgery OR. Initially, it took some time to adjust to the fast-paced environment and understand the complex procedures we were witnessing.

Throughout the week, I spent Monday, Wednesday, and Thursday in the OR, observing spinal procedures such as TLIFs, a craniotomy for aneurysm clipping, and a transsphenoidal adenomectomy. On Tuesday, I joined the morning neurosurgery rounds before observing a cranial angiogram. I had the unique opportunity to follow the patient from the angiogram to the OR and witness the subsequent procedure. Given my limited background in neuroanatomy, the clinical reasoning was often difficult to follow, but this allowed me to take a more holistic perspective on the entire process.

As the week progressed, our team focused on understanding the technologies, workflows, and designs we encountered, identifying those that were efficient and well-engineered, and noting areas that seemed cumbersome. Shadowing Dr. Mehta offered a deep dive into the world of neurosurgery, with new and fascinating insights each day.

Good Design: Stryker DuraMatrix + DuraSeal Closure

Activity

During the transsphenoidal adenomectomy, after the tumor was carefully removed through the nasal passage, the neurosurgeons faced the critical task of securing the entryway to prevent future cerebrospinal fluid (CSF) leaks. This is a significant risk in such surgeries. To address this, the surgeons opted for a Stryker collagen-based DuraMatrix layered over a titanium mesh plate. They then sealed this with a blue spray called DuraSeal, ensuring no CSF would leak.

Environment

The procedure took place in an OR specifically designed for transsphenoidal surgeries. This OR was equipped with advanced imaging and navigation systems tailored for these delicate operations, providing the ideal environment for such complex procedures.

Interactions

Throughout the surgery, there were crucial interactions between the neurosurgeons, who meticulously explained the procedure and emphasized the importance of preventing CSF leaks, and the nurses and surgical techs, who prepared and handed over the necessary materials for the closure. This seamless coordination was essential for the procedure’s success.

Objects

I observed the use of specialized instruments required for tumor removal, noting the precise and delicate handling needed. The closure process involved essential materials such as the Stryker DuraMatrix, titanium mesh plate, and DuraSeal spray, all critical in preventing CSF leakage.

Users

The neurosurgeons were the primary users, focusing on the tumor’s removal and the meticulous closure of the entryway. Nurses and surgical techs played vital supporting roles, ensuring that all materials and instruments were readily available and assisting throughout the procedure.

Bad Design: Prone Pillow for Duraplasty

Activity

During a duraplasty procedure, I observed the neurosurgeons attempting to use a prone pillow to support the patient’s head. However, the pillow was designed in a fixed size and was not adjustable. As a result, it covered the surgical closure area, making it impractical for use. The surgeons had to resort to using a face rest instead, which was less than ideal for providing stable support during the procedure.

Environment

The procedure took place in an OR tailored for neurosurgical interventions. Despite the advanced equipment and setup, the limitation of the prone pillow design became evident during the critical phase of the surgery.

Interactions

There were interactions between the neurosurgeons and the OR staff, where the impracticality of the fixed-size prone pillow was highlighted. This led to an improvised solution using a less suitable alternative, affecting the overall efficiency and comfort during the procedure.

Objects

The prone pillow, designed in a non-adjustable single size, posed challenges during the duraplasty. Its inability to accommodate varying patient needs and surgical requirements underscored its poor design for such delicate neurosurgical procedures.

Users

The neurosurgeons encountered difficulties using the fixed-size prone pillow, which hindered their ability to perform the duraplasty effectively. This design flaw necessitated reliance on a face rest instead, impacting both the surgical team’s workflow and patient positioning during the procedure.