Bipolar electrosurgical vessel sealing is commonly used in human and veterinary medicine. This method of vessel sealing is often preferred over traditional suturing or clipping of blood vessels because it comes with the advantages of reducing intraoperative blood loss and operation time. Most bipolar vessel sealers are disposable. The high costs of the devices often lead to unrightful reuse in LMICs, increasing the risk of postoperative infection. Next to that, many existing vessel sealing devices operate using a scissor-like clamp that exerts a larger clamping pressure at the proximal end than at the distal end of the clamp. Studies have shown that an unevenly distributed clamping pressure negatively affects the burst pressure of the seal [1][2][3]. The aim of this thesis is to redesign the conventional bipolar vessel sealer to a reusable version that exerts a uniformly distributed pressure across the clamping surface. A design goal and a set of design requirements were constructed to clarify the objectives. This was followed by a creative design process which was executed to generate solutions for the problems of disposability and uneven pressure distribution. The concept for reusability was verified by mechanical analysis of forces and by rapid prototyping. For the pressure distribution, three concepts were made and tested for performance during an experiment. A redesign of the conventional bipolar vessel sealer was made in CAD containing the innovations for reusability and the pressure distribution mechanism that performed best. A mechanism has been designed that allows the closing of the upper jaw to be actuated by forward motion of the blade. This eliminates the need for a separate jaw actuator hence promotes cleanability and reusability. The pressure distribution experiment demonstrated which mechanism performed the best. These innovations together with other design considerations have been incorporated into a CAD model of the redesigned bipolar vessel sealer. The design goal has been met successfully. All design requirements have been met except for one. The removability of the blade lacks in the redesign because it was hindered by other innovations. A list of recommendations has been made to highlight potential future opportunities and shortcomings.

Access to safe and affordable surgery is nothing short of a basic human right and people from all walks of life are entitled to it. But, five people from resource-constrained low and middle-income countries are vulnerable and left to fend for themselves when the need for surgery is a life governing event. Inhabitants of these regions are scourged by high mortality and morbidity due to surgical infection caused by the use of unclean and unsterile surgical instruments. Reduction in infections can be achieved by using clean and sterile surgical instruments. Laparoscopy, is a promising technique of surgery developed to efficiently perform complex abdominal surgeries with the use of small and minimum incisions on the patient. Laparoscopy’s minimally invasive nature allows complex surgeries to take place without the need of an absolutely sterile operating room, although the sterility of the surgical instruments cannot be compromised. The added benefit of faster recovery from smaller wounds makes it even more desirable for this context. The Minimally Invasive Surgery and Interventional Techniques Lab of the TU Delft has initiated projects addressing the health and well-being of resource-constrained, underdeveloped communities like rural India through frugal innovation. Rural Indian hospitals are grossly underfunded, under-maintained, and understaffed. Sterile processing practices in rural India are rudimentary compared to high-income hospitals like the ones in the Netherlands. In high-income hospitals, all used surgical instruments are cleaned and sterilized in dedicated central sterile processing departments (CSSD) by highly trained and well protected sterile processing technicians. However, rural India usually employs small teams of local undertrained and semi-literate nurses to carry out every primary and ancillary duty in the hospital. The lack of dedicated CSSDs exacerbates the nurse’s workload and exposure to harmful pathogenic surgical instruments. Laparoscopic instruments developed in high-income nations are seldom designed keeping low resource contexts in mind. The geometrical complexity of instruments keeps increasing but cleaning methods in rural India have stagnated. Resource constraints are a major reason as to why proper international and national guidelines for reprocessing cannot be followed. Hence hospitals cannot guarantee 100% safe and sterile instruments as compared so standardized outcomes in high-income hospitals. In this graduation project, the distinct reprocessing journey of surgical instruments for the two diverse economic contexts were studied. A comparative analysis of both reprocessing journeys uncovered severe unsafe and unfavorable practices in rural India. Significant data and insights from the research have hence paved the way for focusing on the “Cleaning” stage of the laparoscopic instrument reprocessing journey in rural India. This MSc graduation project aims at designing a frugal solution for cleaning and repurposing laparoscopic instruments, dedicated to hospitals in rural India where the demand for laparoscopy is high but surgeries are less due to resource constraints like lack of laparoscopic instruments and repurposing devices. The involvement of an Indian nurse and laparoscopic surgeon provided first-hand information about the problems and requirements in the rural Indian context. Prototyping and testing of various cleaning setups were conducted to extract the most viable design solution. Insights from the research and testing were combined into the concept design of a frugal mechanical washer and subsequently an “Envisioned Reprocessing Journey” for rural Indian hospitals to suggest a standard protocol for keeping most of their existing infrastructure in mind. Evaluations with the Indian nurse revealed that this device could indeed be a game-changer to the existing practices of reprocessing laparoscopic instruments in rural India.