Key-hole Precision: Sensor Guided Laparoscopic Abdominal Entry

ABSTRACT
Safety credibility of manually performed laparoscopic abdominal entry techniques has long been debated and although advances have been attempted, these have not produced the desired exactness requisite for surgical precision. In the era of increasingly digitised surgical processes, adaptation of these traditional methods to finely guided approaches would augment surgical practise and improve patient safety.
Keywords: laparoscopy, entry, impedance, sensor
INTRODUCTION
Minimally invasive surgery has improved post-operative outcomes immensely (Xu et al., 2015) but primary entry during abdomino-pelvic laparoscopic procedures which largely proceeds 'blindly', is frought with complications that have to this day, remained inadequately addressed (Ahmad et al., 2019).
RESEARCH QUESTION
Can the manually performed laparoscopic entry techniques be assisted through an intelligent electronic device sensitive to abdominal tissue anatomy and incorporating multimodal sensors?
CLINICAL NEED
Because laparoscopic surgery in specialties like benign gynaecologic surgery is superior to laparotomy, improving entry techniques from where most of the complications arise would unarguably bring major benefit. Current techniques of ensuring correct placement of the primary entry device and avoiding entry related visceral or vascular injuries have not proven faultless.
NOVEL RESEARCH CONTENT
This project brings various disciplines in examining the problem from different angles. The mechanical properties of the soft tissues of the abdominal wall and their electrical conductivity alongside the intrapelvic air content, pressure and temperature will be examined in detail to produce new knowledge in this area. The current state of surgical safety will be examined as well as preferred abdominal entry technique by surgical specialty. Furthermore, the role of human error in surgical systems as a 'fallible entity' will be explored alongside the working theory that appropriate surgical device design respectful of human tissue types can prevent a large number of complications. Such information may guide prototype development of a suitable sensing system. The material requirements and design of a device that interacts with the topographical anatomy of the abdominal wall will be a novel approach. Eventually and truly novel, will be experiments to automate the process of abdominal entry through mathematical algorithms in order to eliminate surgical anxiety during laparoscopic entry and most importantly, to reduce entry related errors.
METHODOLOGY
The project will be split into various phases which are subject to amendment. Surveys, laboratory experiments and virtual design will be amongst the means by which this project will be conducted. Data gathered will be processed accordingly and new information will be published. I will be working with the various supervisors and drawing on their expertise to learn necessary background subjects (sensing technologies/mechanical and electronic processes specific to the project) as well as testing the technology through artificial systems, animal models and time-allowing, clinically.
0.1 Project Phases
The project will span across theoretical work such as Literature Reviews and Hypothesis formulation. This will enable fine tuning of the research question and methods.
REFERENCES
Ahmad, G., Baker, J., Finnerty, J., Phillips, K., and Watson, A. (2019). Laparoscopic entry techniques.
Cochrane Database Syst. Rev.
Xu, T., Hutfless, S., Cooper, M., Zhou, M., Massie, A., and Makary, M. (2015). Hospital cost implications
of increased use of minimally invasive surgery. JAMA Surg, (150(5)):489-490.

Impact on Health and Care
The CDT primarily addresses the most pressing needs of nations such as the UK - namely the growth of expenditure on long term health conditions. These conditions (e.g. diabetes, depression, arthritis) cost the NHS over £70Bn a year (~70% of its budget). As our populations continue to age these illnesses threaten the nation's health and its finances.

Digital technologies transforming our world - from transport to relationships, from entertainment to finance - and there is consensus that digital solutions will have a huge role to play in health and care. Through the CDT's emphasis on multidisciplinarity, teamwork, design and responsible innovation, it will produce future leaders positioned to seize that opportunity.

Impact on the Economy
The UK has Europe's 2nd largest medical technology industry and a hugely strong track record in health, technology and societal research. It is very well-placed to develop digital health and care solutions that meet the needs of society through the creation of new businesses.

Achieving economic impact is more than a matter of technology. The CDT has therefore been designed to ensure that its graduates are team players with deep understanding of health and social care systems, good design and the social context within which a new technology is introduced.

Many multinationals have been keen to engage the CDT (e.g. Microsoft, AstraZeneca, Lilly, Biogen, Arm, Huawei ) and part of the Director's role will be to position the UK as a destination for inwards investment in Digital Health. CDT partners collectively employ nearly 1,000,000 people worldwide and are easily in a position to create thousands of jobs in the UK.

The connection to CDT research will strongly benefit UK enterprises such as System C and Babylon, along with smaller companies such as Ayuda Heuristics and Evolyst.

Impact on the Public
When new technologies are proposed to collect and analyse highly personal health data, and are potentially involved in life or death decisions, it is vital that the public are given a voice. The team's experience is that listening to the public makes research better, however involving a full spectrum of the community in research also has benefits to those communities; it can be empowering, it can support the personal development of individuals within communities who may have little awareness of higher education and it can catalyse community groups to come together around key health and care issues.

Policy Makers
From the team's conversations with the senior leadership of the NHS, local leaders of health and social care transformation (see letters from NHS and Bristol City Council) and national reports, it is very apparent that digital solutions are seen as vital to the delivery of health and care. The research of the CDT can inform policy makers about the likely impact of new technology on future services.

Partner organisation Care & Repair will disseminate research findings around independent living and have a track record of translating academic research into changes in practice and policy.

Carers UK represent the role of informal carers, such as family members, in health and social care. They have a strong voice in policy development in the UK and are well-placed to disseminate the CDTs research to policy makers.

STEM Education
It has been shown that outreach for school age children around STEM topics can improve engagement in STEM topics at school. However female entry into STEM at University level remains dramatically lower than males; the reverse being true for health and life sciences. The CDT outreach leverages this fact to focus STEM outreach activities on digital health and care, which can encourage young women into computer science and impact on the next generation of women in higher education.

For academic impact see "Academic Beneficiaries" section.