Background
Vulvar squamous cell carcinoma accounts for 90% of vulvar cancers and is primarily treated by surgical excision. To reduce the risk of recurrence, surgeons aim to remove tumor-free margins of 2–3 mm, which can lead to extensive tissue loss, among others. Accurate intraoperative margin assessment is critical, but it currently relies on the surgeon’s experience and judgment, as well as time-consuming frozen section analysis, both of which are limited in precision.
Hyperspectral imaging offers a promising solution. This technique captures both spatial and spectral tissue information. It is a non-contact, non-invasive technique that is based on the interaction of light with the target object. However, implementation remains limited, as the current systems are restricted to image capture only.
This study aims to bridge the gap between hyperspectral imaging data and its practical use in surgery. The primary goal is to design and evaluate an interface that supports intraoperative decision-making for gynecological oncologists, ensuring the medical specialist remains in control. Since interpretability is essential, the second goal is to enhance the transparency of the HSI classification model by applying an explainable AI method.
Design Process
Research was conducted concerning the user, the context in which the user operates, existing medical interfaces, and optimal visualization of clinical data. A user survey and usability test were conducted to evaluate the prototype, which was developed through an iterative design process. The research produced a user persona, a context and task analysis, insights into medical interface layouts, and guidelines for visualizing clinical data. These aspects formed the basis for the requirements and wishes for the interface, in conjunction with the principles of the design frameworks applied. The user survey (n = 40, with a medical background) provided design direction and recommendations. The usability test was designed to evaluate the overall workload of the designed interface and its intuitiveness. The test was performed on nine participants.
The mean accuracy of all the tasks performed was 88%, indicating that the interface is straightforward to use. NASA-TLX scores ranged from 6.7 to 24 across six parameters, suggesting low to moderate cognitive load. Semantic differential results showed high ratings for user-friendliness (7.8), logical structure (8.2), and color aesthetics (7.9). However, improvements are still needed in visualizing classification outcomes and tissue parameters, which were partially addressed in the redesign.
Data Analysis
As a first step in distinguishing healthy from tumor tissue, hyperspectral data was collected intraoperatively before tumor excision. The data was then preprocessed by data calibration, glare removal, and data extraction. The preprocessed data was classified with a Support Vector Machine. This classification model was first optimized by tuning the kernel type and then validated through different evaluation metrics. To interpret the model’s decision-making, SHapley Additive exPlanations was applied to identify which features contributed most to the classification. Three types of input features were assessed: wavelengths (500–1000 nm), visual fractions, and tissue parameters.
The tuning of the kernel type yielded the Radial Basis Function kernel as the optimized model, with an average area under the curve of 1 and an accuracy of 99%. The SHapley Additive exPlanations analysis of the spectral dataset showed that all wavelengths consistently support the prediction for healthy tissue and oppose in predicting tumor. Suggesting that the model is biased toward classifying samples as healthy, and tumor is identified primarily by the absence of features associated with healthy tissue. Notably, the 500–595 nm range and the near-infrared region were most influential in supporting prediction for healthy tissue and opposing tumor.
Using spectral fractions and tissue parameters as input features did not yield accurate enough results(macro AUC = 0.65 and accuracy is 10%) to apply SHAP. This suggests that these features alone do not provide sufficient discriminatory information. This displays the need for additional spectral data to improve model performance for these input features.
Conclusion
The results of this study indicate that the initial probabilistic interface design is relatively intuitive, requiring only low to medium cognitive effort and workload. The application of explainable AI revealed that the 500–595 nm range and the near-infrared region are most influential in predicting healthy tissue versus tumor. This improves the transparency and interpretability of the classification model for gynecological oncologists. Together, the intuitive probabilistic interface and explainable AI support the integration of hyperspectral imaging into surgical practice.

Introduction: Negative pressure wound drainage (NPWD) systems are widely used in postoperative care to promote wound healing and reduce complications. However, current commercial solutions exhibit several key limitations, including pressure loss during transport, a limited shelf life due to factory pre-evacuation, and poor regulation of suction pressure, posing risks to both device performance and patient safety. Methods: This thesis aims to redesign Van Straten Medical’s NPWD system to overcome these challenges. Multiple concepts were developed by exploring various mechanisms for vacuum generation, container types, materials, and activation methods. These concepts were evaluated using a weighted criteria matrix. The winning concept, a bottle-based system activated by a constant-force spring pulling a plunger, was prototyped using 3D printing. Simulations and mechanical calculations were conducted to validate the design’s structural integrity. Performance testing compared the prototype with three existing commercial systems. Results: The prototype achieved a stable negative pressure within the target range (100–150 mmHg) and demonstrated superior pressure consistency as the container filled. Although 3D printing enabled rapid prototyping, surface imperfections led to minor air leakage and seal instability. Despite this, the prototype outperformed commercial systems in maintaining therapeutic pressure throughout use. Conclusion: This thesis presents a promising mechanical NPWD solution that enhances pressure stability, removes the need for pre-evacuation, and supports the use of recycled materials, addressing clinical, logistical, and sustainability challenges. Future refinement through injection moulding and clinical evaluation is recommended to improve sealing and manufacturability. The design holds potential to enhance patient safety while aligning with industry trends towards circular, low-waste medical products.

This thesis presents the development of an anatomically accurate and cost-effective training model for cesarean section (CS), specifically designed to meet the needs of junior doctors in low- and middleincome countries (LMICs). The primary objective is to reduce iatrogenic injuries, especially to the bladder and ureters, by providing trainees with hands-on experience in a safe and structured learning environment. The Salama CS training phantom simulates all essential steps of a primary planned CS following the Modified Misgav-Ladach method, including peritoneal entry, bladder flap mobilisation, and uterine suturing with lateral extension. Its modular design, potential realistic haptic feedback, and focus on high-risk
steps make it a valuable educational tool, particularly in settings where surgical supervision is limited. Fieldwork conducted in Tanzania provided key insights into local clinical practices and training gaps. Interviews with clinicians informed design choices and confirmed the model’s relevance for medical students, interns, and junior residents. Technical validation suggests that the silicone uterus may be reusable and indicates that the model is capable of simulating repeated needle penetration while maintaining a realistic level of feedback. Compared to existing training models, the Salama CS phantom stands out by addressing injury prevention
explicitly and by balancing fidelity with affordability. Recommendations for future development include the addition of fetal delivery and simulation of secondary CS involving adhesions, to further enhance training realism and clinical relevance.

Index terms: Cesarean section, LMICs, iatrogenic injury, maternal care, surgical training

While developing a breast thermotherapy device to facilitate MR-guided thermo-chemotherapy for the intact breast, it is crucial to ensure effective breast immobilization. It is critical that the device provides consistent positioning throughout the procedure, thereby enabling accurate treatment delivery. In addition, it is equally important that the device provides sufficient comfort to enable patients to endure the procedure.

To quantify these aspects, a design evaluation was conducted (METC approved, N-WMO, MEC-2024-0767). Ten healthy female participants were assessed in the prone position using a clinically established breast MR imaging setup. This provided baseline data and a framework for designing a new breast immobilization method, which was subsequently evaluated using the same approach and healthy volunteers. The breast was submerged in water, and its immobilization (i.e. intra- and inter-positioning displacement) was monitored with Electromagnetic Tracking (EMT) sensors for a duration of 90 minutes. Afterwards, participants were asked to assess comfort in terms of perceived (dis)comfort, local perceived discomfort, local perceived pressure points, and positioning complaints by completing a questionnaire.

Eight out of the 10 participants completed the evaluation for the full treatment duration of 90 minutes on the MR setup. The prone position held with the MR setup was scored with a median discomfort score of 5.0 (IQR 4.0-6.0). The newly developed immobilization method made it feasible for all 10 participants to maintain the prone position for 90 minutes, reporting a median discomfort score of 4.5 (IQR 2.3-5.0). The immobilization results obtained with the new immobilization method showed intra-positioning displacements of the nipple within a margin of 8 mm, whereas intra-positioning displacements of the nipple using the MR imaging platform were recorded within a margin of 9 mm. Inter-positioning displacements of the breast with the new immobilization method were recorded within a margin of 36 mm, while results with the MR setup were recorded within a margin of 51 mm.

Thus, the new immobilization method improved comfort and facilitated that all the volunteers endured the 90 minutes evaluation. However, a reduction in breast displacement was not necessarily observed. Further studies with a larger sample size are needed to support generalizable findings.

Every year, 14 to 41 cases per 100,000 infants under 1 year old are diagnosed with inflicted head injury (IHI), primarily resulting from shaking trauma (IHI-ST) or blunt force trauma. Without reliable structural bending stiffness data of the infant’s neck, injury predictions using physical infant surrogates in shaking simulations remain highly uncertain, undermining both forensic and preventive studies. Due to ethical constraints, biomechanical properties of infant necks are scarce, limiting the biofidelity and validation possibilities for existing infant surrogates, such as anthropomorphic test dummies (ATDs). Currently, infant neck surrogates suffer from inadequate biofidelity concerning stiffness and validated range of motion, necessary to accurately simulate shaking trauma simulations.
This thesis aims to address the gap by exploring the design of a durable, adjustable stiffness surrogate neck, improving the accuracy of shaking experiments. Experimental stiffness values obtained from functional spine units (FSU) by Luck et al., extrapolated by Sullivan et al. were used as target values, suggesting stiffness ranges of 0.2 Nm/rad in flexion and 0.4 Nm/rad in extension for a 1.5-month-old infant. The design aims for a 90-degree ROM in flexion and extension, essential for accurate simulation of chin-to-chest and occiput-to-back contacts, both critical for assessing injury mechanisms.
A compliant monolithic hinge mechanism from Fowler et al. was proposed as the core mechanism, able to achieve large angular displacements through flexures. Finite element analysis was performed to optimize material and geometric parameters. Parametric modeling in ABAQUS identified the relationships between stiffness, stress, material properties, and hinge geometry. Based on these relationships, feasible prototype geometries were extracted, varying in flexure thickness, length, and width. Manufacturing was done using 3D printing with polylactic acid (PLA) and carbon fiber-reinforced polyethylene terephthalate glycol (PETG-CF).
Static experimental validation demonstrated achievable stiffness values at the lower boundary of target ranges while the upper bound was not reached, primarily due to anisotropy from 3D printing and material limitations. Despite these limitations, prototypes successfully reached the targeted ROM. Future research should incorporate dynamic testing to validate durability and head kinematics and should consider multi-degree-of-freedom designs to fully replicate infant neck biomechanics. Further challenges remain in replicating infant neck viscoelasticity and obtaining experimental infant data for validation.

Increased capabilities of additive manufacturing technologies have opened up numerous possibilities in mandibular reconstruction surgery. For example, 3D scans can be used to design patient-specific reconstruction plates, resulting in designs that are tailored to prevent plate fracture, wound dehiscence, and malocclusion. However, screw loosening as a result of stress shielding is still an issue. This phenomenon is caused by the mismatch in stiffness between the bone and implant material. The stiff- ness of the titanium in these reconstruction plates can be reduced by using porous microstructures in the proximity of the remaining mandible. However, this makes intuition-based design impossible. This work applies computational tools to optimize the design of a mandibular reconstruction plate with varying microstructure porosity. To achieve this, Topology Optimization (TO) is used that accurately re- solves boundaries utilizing the Interface-enriched Generalized Finite Element Method (IGFEM), which results in a smooth representation of the design. In this work, this methodology is enhanced to result in an even smoother and more accurate boundary. Moreover, additions are made to account for varying material properties in the analytical sensitivities of the compliance objective. The functionally graded designs exhibit significantly higher compliance that should reduce stress shielding. Also, they feature a more porous microstructure near the bone, providing a basis for bone ingrowth. Thus, it is established that enriched TO can be used to optimize the design of mandibular reconstruction plates made out of functionally graded materials that could reduce the risk of screw loosening.

In recent years, there has been growing interest in the magnetocaloric effect (MCE) which is a magneto-thermodynamic phenomenon observed in certain magnetic materials. MCE materials undergo temperature changes when subjected to magnetic fields. Researchers are now exploring the possibilities of utilizing this material in biomedical application technologies, as they offer the potential for non-invasive control of their properties through external magnetic fields. However, there is a lack of research on suitable magnetic compositions that exhibit desired magnetic properties for medical purposes, while ensuring no adverse effects on the cells.

This master project explores the potential of a magnetocaloric (Mn,Fe)2(P,Si)-based compound as a biodegradable membrane for multi-cell separation in organ-on-chip platforms. Mn0.65Fe1.30Si0.37P0.65 compound was selected due to its sharp phase transition characteristics and tunable Curie temperature (Tc), which enable self-regulation of temperature within the therapeutic range, thus preventing potential damage to living cells. The synthesized Mn0.65Fe1.30Si0.37P0.65 compound exhibited a transition temperature of 316 K (43°C) with particle sizes ranging from 1-5 µm. A magnetocaloric wax-based composite was synthesized by integrating these particles with a wax component. Characterization under alternating magnetic fields (AMF) showed a significant temperature rise with higher magnetic concentrations and field amplitudes. At an applied AMF of 9 mT and a frequency of 244 kHz, a sample containing 15 vol.% magnetic particles stabilized at 44°C, effectively maintaining controlled temperatures within the therapeutic range (42-47°C) and efficiently melting the wax without harming living cells. Water absorption tests and SEM imaging further demonstrated the composite's low water permeability and minimal development of microcracks over time. These findings validate the potential of magnetocaloric materials with adjustable Curie temperatures for precise self-regulation of temperature in biomedical applications. The observed high heating efficiency and prevention of overheating offer promising opportunities for controlled thermal activation processes across various biomedical fields.

The dorsal root ganglion (DRG) is an interesting target for neurosurgical pain treatments since it contains the somata of sensory neurons and is relatively accessible, just outside of the central nervous system. Current interventions, such as radiofrequency ablation or neurostimulation, target the DRG with rigid instruments, only tangenting the structure. The goal of this project was to increase the area of influence for neurosurgical instruments by expanding the contact area between the instrument and the DRG. A mechanical solution was designed, consisting of a pre-bend nitinol leaf spring and a rigid injection needle as delivery device. Multiple prototypes were made with various pre-bend diameters and tip shapes. The prototypes with a backbend at the tip and a pre-bend diameter of 5-6 mm were the most successful in curving around a phantom of the L5 DRG in an experimental setup. Future research is needed to incorporate treatment modalities such as neurostimulation and radiofrequency ablation into the mechanical design.

This study explores the impact of different bicycle saddle designs on saddle pressure distribution and comfort in female cyclists suffering from medical conditions affecting the groin area, including Lichen Sclerosus, Lichen Planus, and Vulvar Carcinoma. These conditions can cause discomfort and pain during cycling, leading to a decrease in physical activity and quality of life. The research involved a comparison of four distinct saddle designs, each aimed at reducing pressure in specific areas through partial cutouts or surface depressions. Participants were divided into a case group, comprising 23 women with the aforementioned medical conditions, and a control group of 50 women with no such conditions. Pressure measurements were collected using a stationary bicycle and a pressure mapping saddle cover containing 64 sensors. Additionally, participants completed questionnaires to evaluate perceived comfort and symptom severity. The quality of life (QoL) score was significantly lower in the case group (0.83 ± 0.09) compared to the control group (0.96 ± 0.09, p < 0.001). No significant differences were found between the case and control group in terms of cycling habits. Complaints during cycling were reported by 100% of the participants in the case group and only 8% of the participants in the control group. Pain and numbness were the most reported symptoms for cycling at home. The results indicated significant differences in loaded weight per saddle between the case and control groups (p = 0.001, p = 0.010, p = 0.003 & p = 0.013). In the case group, participants experienced higher pressure. Saddle 2 was favored by 44% of the case group participants for home testing. These findings underscore the need for specialized saddle designs to improve cycling comfort and potentially alleviate pain for women with medical conditions in the groin area.

Treatment methods for spinal disorders involving spinal fusion surgery often entail lengthy and expensive procedures, with a risk of damage to surrounding tissues. Breach detection tools aid in precise pedicle screw placement, thereby reducing the risk of complications or misalignment, and minimizing the need for follow-up surgeries. Accurate placement of pedicles in the vertebrae is crucial in spinal fusion surgery, as improper positioning can result in breaches that potentially harm neural tissues. This study proposes a handheld bone sensing device capable of measuring real-time reflected light from tissue using carefully selected optical elements. The selection of these optical elements was guided by analyzing porcine absorption spectra and conducting Monte Carlo light reflectance simulations. The device is designed to provide consistent real-time feedback by incorporating an electronic circuit optimized to minimize environmental signal interference. A prototype, named the optics-based bone quality sensing device, was developed using electrical discharge machining parts, 3D printed parts, an Arduino Uno, a custom-made printed circuit board (PCB), and off-the-shelf optical components such as laser and photodiodes coupled into optical fibers. Experimental validation with ex vivo porcine vertebrae revealed that the device could not detect sufficient reflected light to differentiate between cortical and cancellous bone. Despite this, the study marks significant progress in creating a handheld bone sensing device that utilizes real-time reflected light sensing minimizing interference. This device represents an important step towards developing tools to assist in precise pedicle screw placement for the treatment of spinal disorders.

Introduction- The global incidence of thyroid cancer has risen significantly, prompting the development of innovative surgical techniques. Transoral thyroidectomy offers a scarless alternative, with the transoral endoscopic thyroidectomy vestibular approach (TOETVA) showing promising results. However, CO2 insufflation during TOETVA can lead to fatal complications. To address these issues, researchers have explored gasless TOETVA methods. Our study introduces a modular articulating retractor integrated with a 5mm camera system, aimed at minimizing CO2-related complications while preserving the benefits of the conventional procedure.
Method- Through a design process comprising problem definition, ideation, and solution creation. A detailed digital CAD design is developed based on force measurements obtained from a preliminary cadaver study. Subsequently, a functional prototype is created and subjected to pre-clinical testing using Thiel-embalmed and fresh frozen cadavers.
Result- Force tests determined a mean force of 4.73N across cadavers, with 5.29N necessary for optimal skin elevation. SolidWorks simulation indicated maximum stresses of 128.10 MPa and 113.80 MPa in articulated and horizontal positions. Backdrivability of articulation occurred at approximately 4N applied force. Assembly and disassembly tasks demonstrated mostly normal distribution, with significant differences observed between initial and final assembly attempts. Despite successful procedure performance, challenges included endoscope removal limitations and partial functionality constraints during articulation within cadavers. Overall removal time averaged 3.2s, with a maximum of 4.1s.
Conclusion- The gasless TOETVA procedure was performed successfully with sufficient visualization for the surgeon. While achieving three of our four objectives, including the design and compatibility with standard endoscopic cameras, limitations prevented direct comparison with conventional CO2-based TOETVA methods. Despite this setback, the initial incorporation of our instrument into surgical procedures demonstrates promise. However, further research is imperative to compare its performance against conventional methods, validating its efficacy and potential in clinical practice.

Accurate placement of screws in spinal surgery is vital to mitigate risks like instability, nerve damage, or spinal cord injury, which can lead to various complications such as pain, sensory loss, muscle weakness, or paralysis below the injury site [33]. However, success rates in screw placement vary widely, ranging from 27.6% to 100% [56].

Advanced techniques, like pedicle screw placement (PSP) with enhanced guidance systems, aim to provide surgeons with better spatial awareness to prevent cortical breaches. Various guidance methods,
such as fluoroscopy, computer-assisted techniques, neurophysiological monitoring, and Electrical Impedance Spectroscopy (EIS) enabled by the PediGuard, have been developed and utilized in spinal fusion surgeries [18]. Despite their efficacy in reducing complications, these systems have limitations such as increased radiation exposure, prolonged surgery time, or lack of real-time feedback.

This study compares two sensing techniques, Electrical Impedance Spectroscopy (EIS)) and Diffuse Reflection Spectroscopy (DRS), for spinal fusion surgery. Both methods are employed to detect cortical
breaches during PSP by distinguishing between cancellous and cortical bone. Before experimentation, certain gaps in understanding must be addressed, including exploring the working principle of EIS for
vertebrae tissue and developing classifiers for both single and multiple frequencies. Additionally, efforts are made to create a vertebrae phantom with realistic electric and optical properties. EIS demonstrates an increase in impedance for cortical bone compared to cancellous bone due to the latter’s weblike structure with highly vascularized yellow bone marrow. Single-frequency analysis outperforms multiple-frequency analysis in distinguishing between vertebrae tissues. However, the development of a better model or the use of multiple single-frequency classifiers may enhance predictive
accuracy. Despite attempts to create an accurate vertebrae phantom, limitations in adjusting dielectric properties result in the utilization of the best-fit recipe.

Comparison between EIS and DRS reveals both are effective in detecting cortical breaches and tissues, with DRS exhibiting a longer look-ahead distance. EIS operates more like a step function, making it susceptible to distortions, suggesting DRS outperforms EIS in spinal fusion surgeries.

Minimally invasive medical procedures often require catheters, endoscopes and other devices to maintain position at a specific site in the body, to cut and remove tissue or for diagnostic purposes. Due to tool force exerted by the surgeon or the natural processes of the body, such as the activity of the heart or the lungs, the inserted device can dislodge or migrate from its intended location. Existing solution focus on stabilizing the tip, following high localized pressure, this can create tissue damage or even perforation. Hence, it can be beneficial to create stabilization over the full length of the catheter. I investigated the use of electroadhesion i.e. using electricity to adhere to the tissue wall. I created a scaled-up, flexible, electroadhesion stabilization proof of concept, consisting of two opposite-charged electrodes in a helical pattern, embedded in silicone rubber. Friction experiments were performed on the catheter proof of concept on two copper half-tube substrates. One of the three flexible scaled-up catheter samples showed an increase in the average dynamic friction coefficient of 10.2% between 0 and 2500 V for the 22 mm diameter substrate. The two other samples showed no or limited increase in friction, attributable to manufacturing differences. Predicting coating thickness is essential, as the coating is the determining factor for the performance of the electroadhesion device. The catheter showed potential, however, improved adhesion performance is required for feasibility on a smaller scale.

This graduation project is part of a double degree program for the master’s in Biomedical Engineering and Communication Design for Innovation, conducted at the Cardio-Respiratory Engineering And TEchnology laboratory (CREATElab) in Melbourne, Australia.

Cardiovascular diseases remain the leading cause of death globally, with out-of-hospital cardiac arrests often resulting in poor outcomes due to prolonged periods of compromised blood flow. Prehospital extracorporeal cardiopulmonary resuscitation (pECPR) offers a promising rescue intervention to reduce treatment delays. This design study improved the RApidly DEployable (RADE) ECPR kit prototype 1.0, which demonstrates full ECPR equipment compatibility for prehospital settings while streamlining the treatment workflow. Based on clinical insights, prototype 2.0 aimed to optimize the RADE ECPR kit’s speed and performance. Testing with clinicians at the Alfred Hospital in Melbourne showed significant improvements in deployability, equipment organization, and overall usability compared to the conventional pECPR suitcase and prototype 1.0.

Additionally, this study examined the impact of leadership absence on innovative scientific performance. While the effects of leadership gaps on research teams remain underexplored, the departure of the CREATElab’s Director provided a unique opportunity to evaluate the challenges and consequences of such disruptions. Using a mixed-method approach, the findings revealed that leadership absence hindered collaboration and motivation, shifting lab dynamics toward task-oriented isolation. Shared decision-making and distributed leadership were identified as communication strategies to sustain innovation during such gaps, with The CREATElab Challenge offering a gamified solution to strengthen connectivity and morale.

The studies highlight the critical role of engineering design optimization in improving outcomes for cardiac arrest patients and underscore the importance of adaptive communication strategies in sustaining scientific innovation, particularly in challenging circumstances.

Background: Laparoscopic surgery has improved patient outcomes and reduced healthcare costs in high-income countries but faces implementation barriers in low -and middle-income countries due to reliance on carbon dioxide insufflation, expensive equipment, and specialized personnel. Gas Insufflation-Less Laparoscopic Surgery (GILLS) provides an alternative by lifting the abdominal wall without carbon dioxide; however, expensive laparoscopes and assisting staff to operate those remain necessary. Hence, the need for a device that substitutes for the gas insufflation and laparoscope was identified.

Methods: This thesis aimed to integrate an abdominal wall lift (AWL) device and imaging system to enhance GILLS and Single-Incision Laparoscopic Surgery (SILS). Using a context-driven approach, the design focused on surgeon visibility, patient safety, cost-effectiveness, and user-friendliness. The device was developed using inexpensive, readily available components and conventional production techniques. The validation included seven verification tests and an expert user evaluation.

Results: The lifting device consists of a stainless steel tubular hook with LED lighting and a $5$ MP camera module. It can be inserted in the abdomen through a small incision, lifts the abdominal wall, and creates a clear view inside the abdominopelvic cavity. An aluminum prototype had sufficient structural strength, was cost-effective, lightweight, and compatible with existing AWL systems, but it generated excessive heat, was not waterproof, and lacked a functional imaging system. Evaluation by a GILLS expert highlighted design strengths while emphasizing three areas for improvement: the frame's shape, the imaging system, and the sealing technique.

Conclusion: This study illustrated the potential of integrating an abdominal wall lift device and imaging system despite the substantial constraints of the current tubular design. The cost-effective alternative eliminates the reliance on carbon dioxide gas, expensive laparoscopes, general anesthesia, and untrained assisting staff. Therefore, development should continue to improve access to laparoscopic surgery worldwide.

The prevalence of chronic and complex wounds is high in low- and middle-income countries (LMICs). Due to the lack of adequate treatment wound conditions are likely to worsen. Improving access to wound care in LMICs is crucial for enhancing the quality of life for the people living there. Vacuum- assisted closure (VAC) therapy is an effective treatment for chronic and complex wounds. By applying a negative pressure to the wound the healing process is promoted. However, due to the high cost of VAC devices, their availability in LMICs is limited. A. Knulst works as a biomedical engineer at GPH and recognized this problem. In GPH the AquaVAC, a converted aquarium pump, is used to be able provide VAC therapy to patients. The use of the AquaVAC is not meeting the users’ requirements. Recognizing this problem, A. Knulst initiated the WOCA project to develop a VAC device tailored for LMICs. Over the past three years, the project has progressed to creating three simple yet functional prototypes using locally available materials in GPH. Based on the findings of A. Knulst a suitable next step for the WOCA is determined to conduct a clinical trial to evaluate the WOCA’s effectiveness in wound healing.
Designing the goal of this graduation project; preparation of the WOCA for the performance of a clinical trial conducted in GPH. Based on analysation of this goal preparation of the WOCA consists of veri- fication, and validation of the design requirements, verification of the applicable ISO-criteria, and the performance of a risk assessment. By making a redesign the current WOCA at GPH will also be made compatible with these stated requirements.
By making a redesign during this graduation project the canister is implemented and the noise is re- duced for the WOCA. This new version of the WOCA is verified for its design requirements as well as validated, also the applicable ISO-norms are verified and a risk assessment is performed.
Based on this performed effort it is shown that the WOCA is exceeding the allowed noise level deter- mined to be reached before the WOCA can start the clinical trial. Furhtermore, recommendations have been given for additional validation and verification of the WOCA before conducting the clinical trial.
Steps have been taken during this graduation project to improve the access to wound care in LMICs by a contribution to the open-source-publication of the WOCA device, and the development of a study protocol for the performance of a clinical trial.

Introduction - Surgical robotic systems are increasingly valued for their precision and benefits to patients and surgeons, yet traditional designs rely on costly, limited-use, cable-driven instruments that require frequent replacement and specialised cleaning equipment. To address these issues, the Sustainable Surgery & Translational Technology group MI & BITE developed the Advanced Laparoscopy Robotic System (AdLap-RS) with modular shaft-actuated tip articulation (SATA) instruments. Their modular design allows for disassembly, easy cleaning, and part replacement, enhancing reuse potential and lowering operational costs. With the substantial environmental impact of surgical activities, reusable SATA instruments also offer promising sustainability benefits. However, inconsistencies in life cycle assessments (LCAs) applied within the surgical field raise concerns about their reliability, complicating accurate environmental assessments of this innovative technology.
Goal - This research aims to assess the environmental impact of the reusable SATA instrument technology for robotic surgery through a robust comparative LCA while simultaneously informing sustainable design choices during the SATA instrument technology’s ongoing development.
Method - The initial phase of this research included a literature review and a survey among European Association of Endoscopic Surgery (EAES) members to identify reliability challenges in applying LCAs to surgical instruments. Insights from this phase informed a robust comparative LCA, assessing the environmental footprint of one of the reusable SATA instruments against its traditional limited-use counterpart, which also functioned as an eco-design evaluation by applying a circular eco-design approach.
Results - Findings from the first part showed a significant gap in LCA usage in surgical decision-making, largely due to limited familiarity and trust in LCA findings. The absence of a standardised, user-friendly LCA methodology tailored to the complexities of surgical instruments further complicates accurate assessments in this specialised domain. Comparative LCA results revealed that the reusable SATA instrument reduces climate change and energy impacts by over 50% compared to its limited-use counterpart. For both instruments, the use phase represented the largest contributor to environmental impact, primarily due to the energy-intensive disinfection and sterilisation cycles required before each reuse. The eco-design evaluation recommends prioritising modularity and disassembly improvements to optimise tray load capacity and reduce reprocessing impacts.
Conclusion - While this study robustly indicates the sustainability benefits of the innovative reusable SATA instrument technology for robotic surgery, capturing the full complexity of surgical instruments in LCAs remains challenging. Addressing this will require stakeholder engagement, targeted LCA training, refined LCA methodologies, and comprehensive review processes tailored to this specialised field.

Background: The global overuse of Caesarean sections (C-sections), especially in high-resource settings, and the underuse of assisted vaginal deliveries in low-resource regions highlight the need for improved Vacuum-Assisted Delivery (VAD) training tools. Existing phantoms, such as "Lucy and Lucy’s Mum," suffer from anatomical inaccuracies and limited biomechanical realism, restricting their effectiveness. This project aimed to design a new, cost-effective VAD training phantom that addresses these limitations by providing more accurate anatomical structures and biomechanical responses.

Design and Manufacturing: The final phantom design utilised Polylactic Acid (PLA) and FDM 3D printing techniques for solid parts and Ecoflex™ 00-30 silicone reinforced with 20 Denier nylon fabric for simulating the pelvic floor muscles and their biomechanical behavior during childbirth. The fetal head was constructed using PlatSil® Gel-25 silicone for the inner deformation core, and Ecoflex™ 00-30 reinforced with 80 Denier nylon fabric for realistic scalp deformation. Additionally, the phantom's modular design and aluminum-made supporting frame allowed easy replacement of parts for long-term use and more flexible phantom deployment.

Validation Results: Two validation phases were conducted. In the first phase, 5 gynecologists provided feedback, identifying issues with vacuum cup application and some biomechanical behaviors. These issues were fully addressed in the final design. The final validation, conducted by one single expert, confirmed that the vacuum cup application issue had been resolved. However, a new issue related to the palpation of the ischial spine was identified. Quantitative testing measured traction forces and pulling angles during VAD, confirming that the phantom accurately replicated clinical behaviors. The overall performance was highly rated.

Conclusion: This newly developed VAD training phantom mostly overcomes the critical limitations of existing models by enhancing both anatomical accuracy and biomechanical realism. The modular and cost-effective design ensures flexibility and allows for use in a wide range of obstetric training settings. However, the cost per training has yet to be fully evaluated, and further research is needed in this regard. Both qualitative expert feedback and quantitative testing confirmed the phantom’s effectiveness in improving VAD training. While the palpation issue identified in the final validation remains to be addressed, the lack of comprehensive data on specific anatomical and biomechanical properties continues to hinder the development of even more accurate models.