Engineering for Patient Safety: Issues in Minimally Invasive Procedures Edited by Jenny Dankelman, Cornelius Grimbergen, and Henk Stassen, Lawrence Erlbaum Associates, 2005. ISBN: 0-8058-4905-X, xx + 300 pages, US$79.95. This text is the outgrowth of a program on minimally invasive surgery and interventional techniques, funded at Delft University by the board of the university. The text is a product of the collaboration of several clinicians, engineering faculty, and graduate students whose interests and studies coincided with the work reported here. The text is also the first of a patient safety series to be published by the Erlbaum Press. The series editor is Marilyn Susan Bogner. The series is off to a great start! The text consists of 12 chapters, each of which will be briefly described. Chapter 1, “Introduction to Minimally Invasive Surgery,” covers a brief history of minimally invasive surgery and contrasts the benefits and disadvantages of this technique with conventional surgery. An introduction to clinically driven research sets the stage for later analysis of various studies of techniques and devices. Chapter 2, “Evaluation of the Surgical Process,” discusses various methods and introduces the reader to different metrics used in quality analysis (postoperative measures, time constraints, timeaction analysis, flowcharting, and efficiency). This is a very good chapter to use for design or instrumentation class examples. Chapter 3, “Observation and Manipulation in Laparoscopic Surgery,” discusses the many problems that are apparent to the surgeon using these techniques (as opposed to standard surgical techniques). A few of the prototype devices developed at Delft to solve some of the indicated problems analyzed are discussed here (a pattern that occurs in may of the following chapters). Chapter 4, “Eye-Hand Coordination in Laparoscopy,” covers several methods used to make the surgical procedure more intuitive. The DaVinci surgical system is used as a very good example of a reasonable but expensive solution. “Force Transmission of Laparoscopic Graspers,” chapter 5, discusses the need to provide force feedback to the surgeon. One prototype to provide a useful feedback signal is discussed and evaluated. Chapter 6, “Safe Manipulation of Bowel Tissue,” discusses the design and testing of various grippers to be used for safe retraction of bowel tissues. Chapter 7 discusses “Design and Evaluation of Endoscope Positioners” and discusses measurements in the clinical environment. Chapter 8 discusses “Design of Arthroscopic Instruments,” reviewing the need for instruments that can flex to reach areas not easily reached with current instruments. Chapter 9, “Virtual Colonoscopy,” reviews current techniques using barium (with X rays) or optical methods and contrasts the results with those that can be obtained with three-dimensional computed tomographic (fly through) imaging of the bowel. Missing is a discussion of the newer techniques using a pill camera that can be swallowed. Chapter 10 discusses “Steering of Catheters,” making the point that using X rays to locate the catheter tip during a procedure results in unnecessary radiation doses to both patient and provider. The potential use of magnetic tracking of the catheter tip is discussed. Chapter 11, “Sensors for Catheters and Guidewires,” is a good general discussion of the types of sensors available and several of the design constraints that must be satisfied. Chapter 12, “The Future of Minimally Invasive Surgery and Training,” briefly recaps the design problems listed in earlier chapters and some of the research that needs to be done to solve them. It also initiates a discussion of the need for better training facilities. This text is very well written and superbly referenced. Therefore, it is a good text for anyone facing problems related to the development of equipment for minimally invasive surgery. It has some excellent sections that can be used for example discussions in a design or instrumentation class. It is an excellent reference text for investigators in this area. —Paul H. King Vanderbilt University

Introduction to Biomedical Engineering (2nd Edition) - [Book review]

The National Center for Health statistics estimates more than 300,000 individuals with major lower extremity amputation currently are living in the United States. Current healthcare climate mandates effective rehabilitation be provided in the most effective manner. An interdisciplinary amputee team approach to rehabilitation with active participation of the patient should be implemented early in the preamputation period to facilitate short hospital stays and earlier return to productivity with associated cost savings. This paper discusses preoperative assessment and education, postoperative intervention, and indications for inpatient rehabilitation. Gait training with prosthesis in simple and complex environments, assistive devices needed for effective functioning at home, and prosthetic modification for participation in recreational activities are reviewed along with issues related to vocational rehabilitation.

Daily functioning of patients with an amputated lower extremity : Amputation and new prosthetic devices

sIn this thesis, we presented a frugal product and methodology for customizing prosthetic socket for developing countries where an overwhelming number of prostheses are necessary, and the availability, accessibility and cost of prosthetics are significant concerns to limb deficient persons that without the assistance of a prosthetic device may not be able to function In order to design a frugal prosthetic socket, a design methodology is sought that will best achieve an appropriately designed, low-cost, with simple production method Through the study of modern design methodologies, a strategy is proposed that emphasizes the intersection of the mechanical design process (contemporary design tools), biomechanics, and low-cost design Key components of this methodology are previous research and frugal innovation in the design process Along with a review of the state of the art, provide the groundwork for both the proposed new methodology as well as generating a new concept of prosthetic socket The result of this study, using the generated concept and simple methodology, a frugal prosthetic socket (FPS) is developed to demonstrate the basic functionality of the concept and manufacturability of the proposed method Finally, Frugal Prosthetic Socket is found as a solution for the problems since it can reduce one heavy complex process for optimizing customization of the prosthetic socket and reduce 70 % of the cost of the prosthetic socket by using local material (rawhide), local manufacturing technique and implementing frugal innovation concept

Mesfin Asfaw Zewgw

Papers

Frugal innovation of prosthetic socket for developing countries