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Showing posts from October, 2017

Manufacturers of Medical Simulators

I did some research into companies that manufacture training devices for surgery procedures, some of which are the likes of:

Creaplast
Virtamed
Kindheart
Lifelike Bio Tissue
Intuitive
3D systems
The Chamberlain Group
Limbs + Things
Deltec
CAE
Simulab
Medical X

to name a few..... But observing some of the products on display has given us a few insights. First of all is the look, the colours used and the so called "medical branding" that is associated with such products, this is a great inisght to keep in mind for the future when we are designing our model.

But also, a really cool insight into how training devices only really cover 1 specific task. What happens if something goes wrong? Why isnt so called scenario based training used in medical training simulators, i mean after all, they are performing surgery on human beings, surely they need to be prepared for the unknown. As the saying goes, "fail to prepare, prepare to fail".

Maybe an interesting avenue to explore…

Facts about appendectomies

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- open appendectomies are a lot shorter in time compared in laparoscopic.

- Open appendectomies are more prominent in paediatrics.... Is this a route for us to take?

 - Laparoscopic procedures however have a way shorter and less painful recovery for the patient.

- Both laparoscopic and open techniques are considered emergency procedures

- Figures show that the laparoscopic technique is becoming more the industry standard. As the below table shows:



source: http://ec.europa.eu/eurostat/statistics-explained/index.php/File:Selected_high_growth_procedures_performed_in_hospitals,_2009_and_2014_(per_100_000_inhabitants).png



First stumbling block

Where is our project going?

This is the question thats been on our minds. We have a pretty great grasp on what the open appendectomy curtails but why is there a need for it and in what context?

its something that has been a little bit of an elephant in the room hopefully we can sort it out soon


Visualizing Information

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Although its early days yet, we decided to keep as a side project, a bit of investigation into how our information will be displayed in the task analysis. Ryan cleverly set up a Pinterest account and folder where we can pin anything that inspires us.


we plan to keep updating this as we move along the process of the project so if you want to track what inspires us you can do so here:

https://www.pinterest.ie/paetzold/visualized-information/


Layer of the abdomen

From our initial research, we have established that these are the layers of the abdomen that are in this procedure:

Skin
Subcutaneous fat
Campers Fascia
Scarpus Fascia
External Oblique
Internal Oblique
Transversalis Fascia
Peritoneum
Bowel
Taenie Coli
Caecum
Terminal ileum
Large Intestine

Appendix

These are hopefully the layers we can recreate in our model further down the line.

Med Tech Galway 2017

A nice little break presented itself when myself and Ryan got the opportunity to travel down to galway for the day and check out the Med Tech Ireland conference in the Radisson Blu in Galway. Bright and early, we hoped on the 7.30am train to Galway, I wouldnt consider myself that much of a morning person,( I had forgotten people wake up as such ungodly hours since my return to college) however it was nice to get a change of scenery for the day and take our minds off the project (albeit for a brief few hours).

Once we arrived, we soon found ourselves surrounded by professionals of the medical world, surgeons, manufacturers, sales reps and the likes. First up on the agenda was a talk on the the future of health care. As we sat down in the conference room, in the most irish way possible, it seemed the organiser of the even hadnt bothered keep to the schedule of what was listed in the programme at the allocated time and decided to let another speaker make his presentation. This was a nice…

First Digital Draft of Task Analysis

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So following on from our last step, we digitized our analog task analysis, this was really beneficial because not only did the information really start to take shape, the ideas around how we could visually represent our task analysis were starting to form. When doing this up, I kept it as simple as possible, followed a timeline structure and used a very basic grid to house the information, which I think helped make the information read nicely from left to right. Hopefully as time progresses we will start to develop even further. Exciting times.


Below are some zoomed in screenshots of the digital task analaysis



Analog draft of Task analysis

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After we collaborated our research and had a discussion about what we had found, we then pieced together a rough analog draft of our task analysis.



In the end, we laid this tasks out, step by step, with each step having a serious of methods or actions that needed to be completed before progressing onto the next step.

this is very much the root of the tree stuff, but none the less it was great to finally see our work on a page in front of faces. It left us with a lot of unanswered questions but effectively it gave our project a bit of focus for the future.

Collaboration

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So after investigating seperately on the step by step process of completing the open appendectomy procedure, we collaborated our research together to investigate, and piece by piece start assembling the key tasks that are required to perform this operation.


This collaboration was really beneficial because it allowed ourselves to find new interesting insights that we might have missed in our intial investigation. I for one learned some new facts like the number of possible incisions, which Ryan had found in his research, and the different names of tools used in the differnt steps which Cristina had found in her research. 
Moving on from this step we aim to piece together a rough draft of the steps which we think  are the process of performing the open appendectomy.

Step by step of appendectomy

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"Touch Surgery" Open Appendectomy

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Recently came across this app called "Touch surgery". Its an interact software that teaches the user the step by step process of performing certain surgical procedures. So naturally, I decided to give it a go with the open appendectomy and understand the steps. Heres out it went.



so as you can see from the above screenshot, the app uses 3d visuals and short step by step descriptions to guide you through the process.

Section 1 Patient Prep:

1) Patient is placed supine on the operating table

2) tuck patients arms by his/her side

3) apply compression stockings

4) shave abdomen

5) prep the patient with 2% chlorhexidine

6) Drape the patient and ensure the appropriate antibiotics are given

Section 2 Identify Anatomy:

1) Anterior superior iliac spine, umbilicus and mcburneys point are used to locate the point of incision

Section 3 Approach to the appendix

1) Make an oblique incision in the skin crease over mcburneys point.

tip: an oblique incision allows easy extension laterally fo…

Materials for the real feel..

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Were progressing through the research and the fleshing out of the task analysis and arrived at the point we're experimenting and exploring materials for our analogue. A far less scientific approach than one would expect as our approach is what we have donned as a 'blind test'.

Blind being poignant as one can cosmetically make a material realistic in appearance, but it is the feel in operation that we are looking for.Its surprising how a box of elastics now looks like a bundle of muscle fibres, a household sponge a potential for subcutaneous fat so on and so forth. What we hope to achieve in preparing these samples is to get feedback from our research participants as to what feels real. Only then will we cross over into the cosmetics - a whole different set of skills..

The humble elastic band is soon to become a muscle analogue

In an open appendectomy procedure it is better to separate the muscle as opposed to cutting the muscle. It is in this example where the elastics rep…

Jobs to be done theory

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Jobs-to-be-done Theory
Jobs-to-be-done theory is an interesting innovation process that was made popular by Clayton Christensen (the author of The Innovator's Dilemma). Here's a good video which explains it at high level (the Milkshake video):

This article goes into more in-depth and has some good case studies on how to apply the theory: https://hbr.org/2016/09/know-your-customers-jobs-to-be-done

We should keep it in mind for all the design projects that we'll work on throughout the year.

STEPS IN AN OPEN APPENDECTOMY
1. Mark incision site The position of the incision is based upon the location of the McBurney point.  Skin incision is based on McBurney point, which lies one third of distance along imaginary line between right anterior superior iliac spine (ASIS) and umbilicus. Incision is made through this point perpendicular to this line (McBurney-McArthur) or horizontally (Lanz). Incision extends 3-5 cm along skin creases. 2. A scalpel with No. 10 blade is used to incise the epidermis and the dermis. 3. A Bovie electrocautery is used to incise through both the superficial Camper (the fatty outer layer) and the deep Scarpa fascia (more membranous inner layer) See Figure 2 4. Use retractors to hold aside camper and scarpa fascia 5. External oblique aponeurosis is exposed and incised in a superolateral to inferomedial direction along the direction of its fibers to expose the internal oblique muscle. 6. External oblique aponeurosis is held aside with retractors 7. The internal …

Case Study: Open Appendectomy simulator

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When we went to the RCSI to visit the Wet lab and talk to leonie Heskin, we were introduced to to the Deltec open appendectomy model that they were currently using to teach students. It is because of this model that inspired Leonie to create the open appendectomy brief, as she feels someone can create a more efficient, cheaper,  higher fidelity model that can be used to teach her students.
So, naturally we decided to have a look at the step by step process that this model teaches the students, and pick away at what was going on.

This video on YouTube demonstrates the step by step process of performing the open appendectomy and this is what it says:

1) Incision
- use a grid iron incision to open up the skin in line with the fibres of the external oblique.

- Divide subcutaneous fat, scarpus fascia, and underlying tissue, to expose the upper oblique upperneurosis.

- use scissors to cut through layer

- Upper oblique upper neurosis should be divided by the line of its fibres

- Reposition s…

Researching the Procedure

So an appendectomy sounds fairly routine, or so I thought. I then also though I had a fairly strong constitution, I mean I've seen a few gory movies and enough murder and mayhem from the news to have considered myself to be resilient - click - play on the first in the selection of videos on YouTube on the procedure and well.. not so much.

An open appendectomy is the procedure in which a surgeon removes a problematic appendix, that in a healthy state should be a worm shaped organelle at the base of your large intestine, but now infected and ripe for removal, a now plump sausage shaped mass which has ruined your appetite, probably given you a fever and acute abdominal pain.

An appendix that is to be removed is generally part the point of no return and hence the reason why you're under the knife of a seasoned surgeon. The question is how does a surgeon get to this point, the point of confidence to operate, at least in the beginning.

Let me give you a brief overview of what is entail…

locating the point of incision using mcburneys point

Citing the point of incision for an open appendectomy relies on the surgeons knowledge of mc burnies point.

McBurneys Point
- Name given to the point over the right side of the abdomen that is one third of the distance from the anterior superior iliac spine to the umbilicus.
- This point roughly corresponds to the most common location of the base of the appendix where it is attached to the caecum.

umbilicus = belly button for any plebs out there.

Additional Points:
- Tenderness suggests the evolutuon of acute appendicitis to a later stage, thus the increasd likelihood of rupture.
- other abdominal processes can also sometimes cause tenderness at mcburneys point.
- Therefore, this sign is highly useful but neither necessary nor sufficient to make a diagnosis of acute appendicitis.

Incision:
- A lance incision crosses mcburneys point in the skin crease ( used more in women as a bikini mark for those who are conscious of cosmetic appearance
- A grid iron incision which in line with the fibe…

What is an appendectomy? : A Guide for Dummies.

- An appendectomy is surgery to remove the appendix when it is infected. This condition is called appendicitis.

- An appendectomy is a common emergency procedure. It can be performed laparoscopically (key hole) or Open( this is our focus)

An open appendectomy
- A cut or incision 2-4 inches long is made in the lower right hand side of your belly or abdomen.

- If your appendix has been burst and infection has spread you may need an open appendectomy

Risks of an appendectomy
- Bleeding
- Wound infection
- Infection, redness and swelling of the belly can occur if the appendix has burst during surgery
(peritonitis)
- Blocked bowels
- Injury to nearby organs

Patient steps
- Your healthcare provider will explain the surgery to you
- You will be asked to sign a consent form that gives your permission to do the surgery
- Your provider will ask questions about your past health. He or she will also give you a physical exam. This is to make sure you are in good health before surgery. You may also ne…

welcome

First Post

For newcomers, Welceome! This blog was set up by Robert Wylie, Cristina Purtill and Ryan Patzoeld, 3 Medical Design Masters students, to document our process on a project exploring the operating procedure of an open appendectomy.

In the coming weeks, we aim to display our process, from research through to final concept, highlighting our landmark insights along our project journey.

Aim of this project is to understand the process of permorming an open appendectomy so we can create a task analysis, showing step by step the process of performing the operation. This will then lead us to create a high fidelity simulator that can be used to train student surgeons on performing the operation.

Main Outcomes.

We aim to provide address the key learning objectives in our high fidelity simulator neccessary for completing the operation. What makes this procedure particularly difficult to perform? What tools are used? What problems are there with current simulators on the market at the m…