The rising cost of surgery has put pressure on manufacturers to innovate in the design of surgical tools. This project explores a new design methodology for instruments that are safer and easier to use and less costly to make.
As the cost of surgical procedures rise, manufacturers and health service providers alike are looking afresh at the design of surgical instruments, many of which would benefit from redesign to reflect advances in new materials, new technologies, ergonomic practice or surgical technique. In some cases, instruments cannot perform the functions they were originally designed for, forcing the surgeon to improvise in the operating theatre.
This project in partnership with orthopaedic systems company DePuy, part of Johnson & Johnson, set out to generate new design ideas against the background of rising cost pressures and changes in surgical practice and legislation. The market for orthopaedic surgery is growing by 12 per cent a year but the cost of instrumentation pushes up the cost of any surgical procedure.
The study focused on user need and application as a route to innovation. Both surgeon and patient were considered as primary users since the design of the surgical tools affects the surgeon’s skill, stress level and precision as well as patient comfort and recovery time. The team of supporting staff and scrub nurses were also included since they transport, prepare, store, handle and remove the tools and have to be considered as important secondary users.
Workshops were held with surgeons in the UK, USA and India to tap into their tacit knowledge and learn about what they want and expect from their instruments. This approach was supplemented with hospital visits to see live surgery, carry out individual interviews with surgical staff and gain firsthand experience of using the tools on ‘sawbone’ models.
Some key design criteria emerged from the study. Each surgeon has their own way of performing surgery so tools would need to compensate for this. Cultural differences and the relationship between nurses and surgeon had to be considered, as the tools are subject to human error. Multiple ergonomic factors come into play and affect efficiency of assembly, use and disposal. More implicit aspirations were also uncovered. The feeling and look of tools have a direct influence on the surgeon’s confidence and frame of mind, and the function can allow them to achieve better accuracy and efficiency, an important factor when surgeons look to improve on previous operating records.
These criteria were exemplified in the design of two surgical tools that use improvements in plastics technology to cut manufacturing costs and time spent in the operating room. The tools improve accuracy and simplify the controls so that the process involves less risk to the patient. Preparation and disposal were also addressed as the instruments come preassembled, have fewer working parts and can be made from disposable and recyclable materials. Both tools allow for one-handed operation and enable surgeon and nurse to work side-by-side.
Extensive feedback from surgeons and nurses led to the design of second-generation tools, which then went into cadaver trials. The design methodology employed here is set to become a blueprint for the redesign of more surgical tools at DePuy, adding value to operating procedures, enhancing surgeon comfort and improving patient safety.