Engineering Improvements in Surgery: Optimisation of Surgical Graspers

*Overview:
This research will improve the surgical instruments used in key-hole surgery so that they cause less damage to the patient while helping the surgeon to operate more efficiently. These valuable goals will be achieved through a close partnership between the project's lead engineer and a surgeon, bringing together precise experimental methods, novel materials and design and clinical expertise. The outcomes of this exciting research will help scientists, engineers and clinicians in their research, and has significant potential to bring improvements to society and the economy.

*Background:
Modern surgery increasingly uses minimally-invasive surgical (MIS) techniques (or 'keyhole surgery'). In MIS the surgeon operates on tissues using a camera and long instruments inserted into the body though small access 'ports'. The advantages of MIS are substantial including faster recovery and lower complications for the patient. However, the long instruments make it difficult for the surgeon to 'feel' the tissues inside the body. This is a particular problem with surgical graspers, plier-like instruments used in place of the surgeon's hand to hold and move tissues. Appropriate use of the graspers is crucial, but difficult, for the surgeon to achieve; grasping or pulling too hard causes tissue damage with potentially fatal consequences for the patient, but grasping too lightly risks the tissue slipping - complicating and lengthening the operation.
The applicants lead the Surgical Technologies research group and have a strong background in using engineering techniques to measure and understand the behaviour of surgical instruments and their interaction with tissues. They have supervised research to develop grasper systems with can record and control the gripping forces they apply to tissues. The group also has expertise in developing novel bio-adhesive materials that use microscopic patterns to grip tissue while avoiding damage.

*Research Plan:
There is a clear need for better surgical grasping instruments and a definite opportunity to use engineering methods to improve the situation.
The aim is to optimise the surgical grasper's performance so that they grip securely while minimising/eliminating damage to the patients' tissues. This comes in two parts; 1) an experimental study to increase our understanding of grasper performance 2) integrating our bio-adhesive materials in a grasper to improve grip at lower grasping forces.
Experimental Study: Through our previous work we will develop a system to reproduce surgical grasping in the lab using samples of model tissue. This will be used to investigate grasper performance in an experimental study, providing detailed data on how the system responds as both grasp and pulling forces are varied. This information will be linked with clinical measures of tissue damage (showing how tissue cells are effected) to determine which grasping conditions which are unsafe for use.
Optimised Grasper: Using knowledge from the study, an improved grasper system will be developed by selecting an appropriate bio-adhesive material that can be integrated onto the grasper's jaws. This will use our expertise in the area to provide a grasper that offers enhanced grip at lower grasping forces to prevent tissue damage.

*Outcomes:
This research offers to provide exciting advances in healthcare through the application of engineering science to a surgical application. The outcomes from the research will have benefits locally (developing the research and group led by the early-career applicants) and nationally (in science, engineering and clinical research). They will inform surgical training and are highly valuable to the medical device industry. To ensure these benefits reach their broad audience the work will be 1) published in multidisciplinary journals 2) discussed at academic and industry conferences/seminars 3) prepared for future commercialisation using expert resources at the host university.

This project brings together work in fundamental science and engineering to make improvements in surgical healthcare. To achieve this, the work must span a range of fields, bringing academic researchers together with clinicians and the medical device industry, all of whom stand to benefit from the outcomes of the research.

The project has particular relevance to the following groups:

1) UK Society: The ultimate goal of this research is to achieve improvements in surgical graspers to minimise the damage they cause to the patient's tissues and improve their performance for the surgeon. This will help reduce operation times (by preventing mistakes such as tissues slipping), speed recovery and help to minimise the occurrence of severe complications that can result in morbidity (e.g. perforation of the bowel).

2) The medical device industry: Despite historic strengths in medical and surgical device manufacture, a recent report by the Royal College of Surgeons highlighted that research in surgical technologies is critically underfunded - this has led to a decline in the UK's contribution to a hugely valuable world market. This research will help to counter this by encouraging innovation. The scientific advances in understanding mechanically-induced tissue damage, and using novel materials science to avoid it, are directly relevant to surgical instrumentation manufacturers (and the medical device sector as a whole).

3) The healthcare system and community: The improvements in surgical instrument performance offered by this research have the potential to improve both clinical outcome (reducing morbidity and mortality) and efficiency (shortening operative times and hospital stay). Given that a quarter of NHS procedures involve surgery, this has the potential to significantly help towards the resource challenges faced as the UK population ages. Interaction with the healthcare community will also serve to identify new clinical applications for the underlying knowledge generated by the research so its benefit can be broadened.

4) Surgical training practice: Working-time legislation currently limits the time that trainee surgeons can spend developing their skills in theatre. Consequently there is a need to maximise the impact of the training they do receive. The knowledge developed through this research can improve surgical training practices, helping surgeons (and those training them) to understand how tissue damage occurs through misuse of graspers and how it can be avoided. In addition, surgical simulation systems can exploit this understanding, building it into the next generation of training systems.

5) The education system: UK society, and the education system in particular, faces challenges in promoting STEM subjects to children. The research in this project provides a clear example of how basic science and engineering can be applied to have real-world benefit in improving the lives of others. Highlighting the relevance of STEM subjects to children early in their education has the potential to increase their popularity in higher education and ensure that the UK remains competitive in these critical fields.