Medical Design Briefs - October 2021 - 13

recovery times, which usually means
reduced healthcare costs. However, the
need to perform highly skilled actions
using specialized tools with limited visibility
and ranges of motion has introduced
higher levels of expertise for the
surgical team, from endoscopic surgeons
and robotic procedure specialists
to interventional radiologists. Support
equipment includes endoscopic cameras,
visualization scanners, contrast
injectors, nonmagnetic monitors, specialized
instruments and catheters, and
expensive robotic systems. Despite the
setup overhead for MIS, there is no disputing
the value these advances in sur -
gical procedures bring to the industry,
and today's MIS infrastructure is pronounced
and widespread in every sector
of healthcare.
MIS Device Design Trends
The devices required to support MIS
techniques continue to proliferate at
impressive levels. Instruments have
become highly specialized to do a specific
task swiftly without requiring too
much technique from the user such that
the number of individual designs available
today to surgeons is quite daunting.
It is not uncommon for power users (key
opinion leaders or KOLs) to develop
their own version of a device based on
their specific technique, which then be -
comes a unique offering by a partnering
manufacturer. Miniaturized sensors and
electronics can be integrated into the
tips of these handheld instruments or
within tiny catheters to monitor pressure,
blood flow, and electrical fields,
providing clinicians with vital anatomical
feedback while working virtually
blind. Combined with these sensors,
some devices even provide synthesized
feedback to the user, which may be in
the form of haptic vibration and me -
chanical resistance, as well as visual and
audible instructions.
Robot-assisted surgery has become a
fast-moving technology that enhances
the accuracy of complex surgeries while
reducing patient trauma and recovery
time because robots do not need direct
visualization of the surgical site. Robots
may be as simplistic as a smart guidance
fixture for probes and cannula insertions,
or as complex as a floor-standing
multi-tool device that can operate
remotely on patients from across the
globe, controlled by skilled surgeons via
advanced telemetry. Military leadership
has aggressively
pursued technology
to enable
this in -
ter operability to vastly enhance the survivability
of wounded servicemen in the
field. Robots are now commonplace for
orthopedic procedures such as knee and
hip replacements, as well as prostate surgery
where the level of precision provided
by the robotic guidance far exceeds
even the most skilled surgeon.
Combined with 3D imaging and realtime
interpolated anatomical modeling,
robot-assisted surgical efficacy is driving
the proliferation of targeted robotic
platforms into most surgical and oncologic
procedures.
MIS has its challenges - the cost of
capital equipment such as imaging systems
and robots can be prohibitive, and
specialized training of personnel re -
quires a team of dedicated clinicians and
facilities. Cath labs have replaced many
operating rooms as the value and effectiveness
of interventional procedures
has proven itself in the treatment of
coronary disease. It is simply extraordinary
to understand that today we can
have our aortic
valves replaced via
femoral artery-accessed catheter delivery,
requiring
no thoracic surgical
access. Tiny pumps integrated into the
ends of catheters can help us pump
blood from ventricle to atrium until our
hearts can heal from a procedure and
operate normally.
Visualization Technology
Electronics and
higher-definition optics
can provide even greater
remote functionality at the
end of a laparoscopic cannula.
(Credit: BlackHägen Design)
Visualization requirements associated
with MIS relies on sophisticated technology
to enable the clinician to see
through anatomy. Without
these advances, most
MIS procedures
would be
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Medical Design Briefs - October 2021

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