"Seeing is believing" capturing images of an open operation for in the operative note

"Seeing is believing" capturing images of an open operation for in the operative note

Maas, J.A.M.

Freudenthal, A. (mentor)
Wauben, L.S.G.L. (mentor)

Industrial Design Engineering

Industrial Design

Master specialisation Medisign

2010-03-01

In the field of colorectal anastomosis the occurrence of anastomotic leakage is a main problem. The risk of colorectal resections lie within the post-operative complication anastomotic leakage, which is very dangerous for the health of the patient. Anastomotic leakage occurs between 2% and 24% of all patients and mortality rates can be as high as 33% [1-2]. The cause of anastomotic leakage is not clear, but technical insufficiency is considered to be one of them [2]. In this respect, the handwork of the operator (i.e. the way the anastomosis is made) is a crucial factor to minimize the chance of anastomotic leakage. This Master thesis contributes to predicting the likelihood of anastomotic leakage. In this respect, per-operative information of the anastomosis in the operative note will be provided in this thesis as per-operative information is a valuable source for predicting the likelihood of anastomotic leakages. In this respect, the workflow in the OR, the colorectal resection, the way of generating the operative note, the market of surgical cameras and the medico-legal issues have been analyzed with literature and user researches. This analysis contributed to the formulation of the design goal: To design a system that visually records critical moments of the open operation colorectal resection, for physicians on the hospital ward in order to deal with post- operative complications more adequate and may research anastomotic leakage better. The created concept idea is a system where the operator can make per-operative images (i.e. photo or film) of critical events and can add audio comments to these images. Post-operative, the operator will generate a digital operative note with the help of speech recognition software. Finally, the note exist of text embedded with the per-operative images. The conceptualization of this system is divided in six design steps (i.e. tests). The focus of the optimization lies with the two main parts of the concept idea: the type and usage of camera (i.e. endoscope) and the user interface for the note-generating software. The design steps are conducted according to different research methods as among other things tests and observations in the dissecting room and the OR, and interviews. The outcome of these design steps had an impact on the workflow of the operating team and the requirements of the concept idea. This impact was documented in a workflow with requirements scheme. The final concept, DigiNote Production System, exits of five parts: scope, peripheral equipment, local and main hospital server, DigiNote, and protocols. Two scopes can be used to film the anastomosis around: a video scope for hand sutured, high anastomoses and a flexible scope for all stapled and low anastomoses. Furthermore, DigiNote is a software program where per-operative images can be embedded into the operative note to provide more information to the physicians on the hospital ward and to researchers. To conclude, the results of this Master thesis suggest that it is possible to provide more per-operative information of the anastomosis in the operative note. The results of the tests showed the possibility to film the anastomosis and ability of DigiNote to embed per-operative images into the operative note. However, DigiNote Production System is still in the concept phase, more research need to be done in the OR on the usage of the scope and on how to implement the peripheral equipment of the DigiNote Production System in the OR, on the OR department, and at the hospital ward.

Black box
operative note
imaging
flexible scope

http://resolver.tudelft.nl/uuid:3ecae6ba-46bd-4f8b-a7e7-f1c5f410769c

Campus only

Student theses

master thesis

(c) 2010 Maas, J.A.M.