Development of a ‘smart surgical instrument’

Abstract

Energy-based surgical instruments are increasingly used in laparoscopic surgical procedures. For example, the ultrasonic scalpel enables tissue coagulation and -cutting by transferring a mechanical vibration to the tissue. Additionally, real-time sensing is implemented to improve the surgical procedures. Intraoperative ultrasonography is one of those real-time sensing techniques that allows the surgeon to visualize the anatomical surroundings of the surgical site. Previous literature research has shown that integration of ultrasonography into the ultrasonic scalpel would be a promising direction for the development of a ‘smart surgical instrument’. This research focusses on the integration of intraoperative ultrasonography into the ultrasonic scalpel. Based on detailed analyses of the currently existing technology, several integration directions are developed. The integration of an existing ultrasound probe into the ultrasonic scalpel is tested in a series of experiments. A functional prototype is designed and manufactured in which the Philips Eagle Eye Platinum ultrasound catheter is integrated into a LOTUS Torsion ultrasonic scalpel. The performance of the separate ultrasound catheter is assessed using tissue phantom with inserted silicone distortions. This is followed by experiments to test the performance of the integrated catheter. Based on the experiment results, an improved prototype design is proposed. The first proposed prototype design facilitates integration of the ultrasound catheter and the integrated Eagle Eye Platinum catheter covers the areas of interest in its field of view. It is shown that the tissue phantom that is grasped by the ultrasonic scalpel prototype can be assessed. Distortions in the tissue can be detected. Also sideward imaging, relevant during tumour-free margin measurements, is possible using the developed prototype. Several problems were encountered during the experiments. The underlying causes are analysed and multiple solutions are recommended, leading to the proposal of an improved prototype design. It can be concluded that the integration of ultrasound imaging into the ultrasonic scalpel is a feasible direction for the development of a ‘smart surgical instrument’.