Developed in 2016, thickness 5 mm, complex components made by 3D-printing.
Controlling blood loss is a major challenge during laparoscopic surgery. In an effort to control blood loss, electrosurgical tools are often used. In current electrosurgical instruments, a high frequency electrical sinusoidal wave is passed through the patient’s body from an active electrode to a return electrode to minimize bleeding. Depending on the exact configuration of the electrosurgical instrument, it can be used to coagulate, cut, or destroy the tissue.
Even though current bipolar electrosurgical instruments have proven effective in minimizing blood loss, advancement is needed to improve the dexterity and adaptability of these instruments. With current advances in 3D-print processes and its integration in the medical field it has become possible to manufacture patient- and operation-specific instruments. Furthermore, by combining 3D-print technology with smart joint designs, the dexterity of the instruments can be significantly improved.
In order to overcome these challenges, we have developed the first 3D-printed steerable bipolar grasper (5 mm), named Volt, for use in laparoscopy. This 3D-printed design allows for easy adjusting of the geometry of the shaft and tip based on the patient’s anatomy and operation requirements. The grasper significantly improves dexterity by the addition of two planar joints allowing for ±65° for sideways and ±85° for up- and downwards movement. Furthermore, due to smart joint design, high bending stiffness of 4.0 N/mm for joint 1 and 4.4 N/mm for joint 2 is achieved, which is significantly higher than that of currently available steerable instruments. The tip consists of two 3D-printed titanium movable jaws that can be opened and closed with angles up to 170° and allows for grasping and coagulating of tissues. In order to actuate the joint, tip, and electrosurgical system, as well as to tension the steering cables, a ring handle was designed similarly in design to the one of Dragonflex.
In a proof-of-principle experiment, Volt was connected to a electrosurgical unit (Erbe) and was able to successfully coagulate fresh pig liver. Tissue temperatures of over 75 °C were achieved with an activation time of ~5 s.
BRN Dutch News Radio
Presenter: Meindert Schut
Ewout Arkenbout, BITE-alumnus, was interviewed by BNR Dutch News Radio about his PhD-research on multi-branched surgical instrumentation, explaining his new “hands-off” design methodology to gain insight in intuitive interfaces for manual steering without constructing prototypes in hardware.
Listen to the interview (in Dutch) via the following link:
This research project is funded by the Netherlands Organization for Scientific Research NWO.
Crossing heavily calcified occlusions, such as Chronic Total Occlusions (CTOs), is challenging, resulting in undesirably low success rates between 50% and 90% depending on the operator’s experience and the characteristics of the CTO. The most common failure mode observed in the preferred treatment, the Percutaneous Coronary Intervention (PCI), is the inability to cross the occlusion due to buckling of the guidewire. The inability to cross the CTO often leads to procedural failure and can cause damage to the blood vessel wall.
In order to prevent buckling of the crossing tool and improve the procedural success rates of PCI, we developed a novel, well-working catheter prototype that can apply a mechanical impulse, defined as the integral of a peak force over a small time interval, on the CTO during the crossing procedure. Using an impulse to dynamically load the CTO is advantageous as the impulse strongly decreases the buckling effect and the static forces on the CTO and its environment, minimizing the risk of damage to the blood vessel wall and the surrounding tissues.
During this TTW demonstrator project we will develop our patented catheter prototype further into a handheld clinical prototype incorporating an adjustable tip section as well as a dedicated input mechanism allowing for generating a single impulse as well as continuously vibrating motions. The efficiency and effectiveness of the clinical prototype will be evaluated on CTO models and during ex-vivo and in-vivo animal evaluations.
Developed in 2016, diameter 1.2 mm (tip) & 0.75 mm (body).
A wasp ovipositor is a needle-like structure composed out of three elements, called valves. A female wasp uses this structure to drill into wood or fruit and deposit eggs inside a living host. The propagation of the ovipositor through the substrate is achieved by a push-pull mechanism, in which one of the valves is pushed while the other two are pulled.
Inspired by the ovipositor of parasitoid wasps, we developed a new Ovipositor Needle with a diameter of 1.2 mm at the tip and 0.75 mm along the body. The needle consists of six superelastic Nickel Titanium (NiTi) wires (Ø 0.25 mm, length 160 mm) concentrically arranged around a seventh NiTi wire. The seven wires are interconnected at the tip with a flower-shaped ring (Ø 1.2 mm, length 2.0 mm), manufactured for minimal resistance during propulsion. The ring has a central hole to which the central wire is glued and six holes through which the six other wires can slide back and forth.
Each proximal end of the six movable wires is connected to a stepper motor, in which a leadscrew-slider mechanism converts rotational motion into linear motion. During an experiment, the needle was inserted in a stationary tissue-mimicking phantom, placed on a cart with low-friction wheels. The wires were sequentially moved back and forth inside the phantom, generating a net pulling motion of the phantom towards the actuation unit, and resulting in the needle moving forward inside the phantom. Different sequences of wire actuation were used to achieve both straight, curved and S-shaped trajectories.
In a follow-up prototype we changed the shape of the interlocking ring from cylindrical to conical to investigate the effect of pre-curved wires. We found out that pre-curved wires facilitate steering, however, at the drawback of a slightly larger tip diameter due to the use of a conical flower-ring.
Ovipoistor Needle II is, to our knowledge, world’s thinnest self-propelled-steerable needle. Our novel bio-inspired steering and propulsion mechanism allows for the design of extremely long and thin needles that can be used to reach deep targets inside the body without a risk of buckling and with the possibility to correct the trajectory.
Ovipositor Needle II is part of the WASP project that focuses on the development of steerable needles for localized therapeutic drug delivery or tissue sample removal (biopsy). We are currently working on further miniaturization to diameters <0.5 mm.
In nature multiple animals have developed intriguing shooting mechanisms for food capture, defence, and reproductive reasons. Think for example on the amazing tongue shooting capability of the chameleon and the appendage strike of the mantis shrimp.
These shooting mechanisms can offer inspiration for new ideas on the technological development of fast acceleration mechanisms in medicine. High-speed shooting mechanisms can, for example, be used for the endovascular treatment of Chronic Total occlusions (CTOs). CTOs are heavily calcified and are thus difficult to puncture and cross with the small (0.36 mm) guidewire. The required force to puncture the CTO is often higher than the buckling force of the guidewire due to the low bending stiffness (EI) and long (unsupported) length (L). As a result, the guidewire often buckles. Buckling in turn causes procedural failure since the CTO cannot be crossed. Buckling of the crossing tool may be prevented by using a high-speed crossing tools as this increases the buckling resistance of the guidewire and potentially minimizes the puncture force of the CTO.
With this in mind an innovative high-speed crossing tool was developed using nature’s shooting mechanisms as inspiration. The crossing tool (OD 2 mm) incorporates an innovative spring-driven indenter and decoupling mechanism for high-speed puncturing of the proximal cap. First tests have been very promising. The prototype hit the CTO with an average speed of 3.4 m/s and was able to deliver a maximum force of 20 N (without buckling), which is well over the required 1.5 N to puncture the CTO. Additionally, the device was tested on CTO models made out of calcium and gelatine of different consistency. Puncture was achieved with on average 2.5 strikes for heavily calcified (77 wt% calcium) CTO models.
We feel that with continued development of this technique it will become possible to deliver high forces in ultra thin devices, such as guidewires, and as such increase the success rate of the the endovascular treatment of CTOs and other minimal invasive applications.
This research project is funded by the Netherlands Organization for Scientific Research NWO and the Dutch Foundation of Cancer Research KWF.
Ductoscopy is a minimally invasive micro-endoscopic technique that allows for direct visualization of the milk ducts of the breast through their natural orifices in the nipple. It can be performed under local anesthesia in daily outpatient routine and has proven to be safe with a very low risk on (mild) complications. In collaboration with the UMC Utrecht, the aim of this project is to develop novel instruments for ductoscopy to prevent women from getting breast cancer.
The FA3D hand is a 3D printed Hand printed with a flexible filament. The fingers of the hand have multiple joints, allowing for adaptive gripping. The fingers have elastic joints and can be printed as one part. Therefore assembly of the finger phalanxes is not necessary.
Due to its adaptive gripping, the FA3D Hand can hold a broad range of objects.
The FA3D Hand consists of 8 3D-printed parts. The parts can be connected with standard bolts and nuts. Steel cables are used to actuate the fingers.
The hand is body powered. It can be controlled by pulling the control cable, by using a shoulder strap.
Commercializing our squid-based steering technology, spin-off DEAM received an investment from the investment firm Carduso Capital in Groningen, the Netherlands. This will make it possible for DEAM to start-up the production phase, focusing on a market introduction second half of 2018.
In the television program “Het ei van Midas”, renowned Dutch biologist Midas Dekkers explores how ideas from Nature can inspire new technology. In this episode, he visited the BITE-group to learn more about our tentacle-like maneuverable instruments.
Renowned dutch biologist Midas Dekkers talks on Pauw about his new program “Het EI van Middas” that discusses nature-inspired technology, giving our octupus inspired steerable instruments as an example.