Surgineering: a new type of collaboration among surgeons and engineers
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Today, progress in surgery is mainly driven by technological advances. Accordingly, technological research and development gain a growing influence on all medical interventional disciplines. In the past, this has seemingly been different, since many minor and major breakthroughs were initiated by technically inspired surgeons (hypobaric chamber or suture staplers, just to name a few). Today, however, this has changed.
Biomedical engineering issues as well as their technical solutions have become too sophisticated and specialized for today’s surgeons to significantly contribute to new technical solutions in detail. Too often, the role of the surgeon is limited to accompany the development process, or more frequently, to evaluate a product already commercially available.
Nonetheless, the surgical partnership is still fundamental in biomedical engineering, starting with the very beginning of a new project. Only the surgeon himself, as the user, is able to define the medical problem or to identify a deficit in surgical practice that is supposed to be overcome by a new technical development. As soon as the engineer has come to a first solution or is able to provide a first prototype, the surgeon is called up again to evaluate the suitability and may contribute fresh ideas for its improvement.
Finally, it is a surgical task to prepare and to perform preclinical and clinical trials to find out whether the new product/solution is mature for practical medical care and to confirm or rule out its superiority over conventional solutions and current medical standards.
This typical modern role of a surgeon is, to some extent, comparable to that of a race driver. The task of a formula 1 pilot is to use the car in the best way in order to gain the victory. Of course, he may also give some valuable practical advice, but design and construction of the bolide is the domain of the development team.
At our institutions, an interdisciplinary team of surgeons and engineers looks back at many years of successful collaboration. During these years, a particular phenomenon of cooperation evolved which is beyond the scope of the classical distribution of roles as described above.
We coined the term “surgineering” as a neologism to describe this new type of a collaboration . It is an abbreviated combination of Surgery and Engineering. Surgineering results in more flexibility and allows for a modification of the original requirement and target specifications. It opens the floor to real and substantial innovation and to ground-breaking changes revisions of our daily surgical work.
A practical application of surgineering may be illustrated by the development of a new type of single-port sigmoid resection. With a first prototype of a telemanipulation system (“platform”), we were able to do relatively simple surgical operations such as the removal of the appendix or gallbladder. More complex operations such as colonic resections, however, were impossible to perform. Though many steps of a standard sigmoid resection could be realized, resection of the respective colonic segment and specimen removal proved to be unsurmountable hurdles.
They were mainly of a technical nature, but one of them also included another “surgineering” step. In our single-port sigmoid resection, the distal stump of the rectum has to be perforated by the pin of the stapler. This is facilitated by a plastic mandrel which is temporarily mounted to the tip of the pin. As soon as the perforation is achieved, the mandrel has to be removed to unite the anvil with the pin of the stapler. This, however, was extremely difficult when using the new platform since it was very difficult to grasp the plastic mandrel with the rather small jaws of the grasping forceps. If we succeeded, the force was often too low to extract the plastic part out of the pin.
Surgineering is an iterative process model during the development process. After an analysis of the initial state, several optimization cycles are performed. An analysis of both technical aspects and surgical procedures is carried out in each cycle. These analyses result in modifications and thus form the basis of the next operation cycle.
“Surgineering” is not confined to mechanical engineering. Another example may be given from computer science. A part of our scientific activities is the reconstruction of the surgical workflow. A suitable model is the removal of the gallbladder. One part is to separate the distinct phases of the operation from each another. This can be done by identifying the sequence of instruments. In our work, one phase was very difficult to detect: the part of the operation when the cystic duct and the cystic artery were occluded by clips and severed. Originally, six clips were applied (3 × cystic artery and 3 × cystic duct), and then, both tubular structures were dissected by the scissors.
Surgery is a very traditional discipline, and most surgeons are educated and trained to reproduce and apply exactly the same surgical techniques as their proctors. Distinct parts of the same operation may vary from hospital to hospital, since evidence-based and obligatory common standards are rare. Modifications are avoided. Only a handful of innovators are open to the integration of new principles and technologies into their work. This is a main barrier for a fast transformation of surgery. With the aim of improving upon today’s level of surgery, surgeons should open their minds to innovative technical approaches. If they comprehend at least a spark of improvement and the chance to revolutionize surgery, they should be ready to modify traditional approaches if necessary.
We are firmly convinced that the principle of our approach—bilateral flexibility both on the sides of the engineers and the surgeons—is already practiced in many biomedical engineering workgroups all over the world, but to the best of our knowledge, it has never been defined explicitly. The dissemination of this idea of “surgineering” could hopefully promote the concept of translational research and shorten the way from “bench to bedside.” CARS has always been the herald of interdisciplinary collaboration among clinicians and engineers/computer scientists/basic research and, therefore, should be the natural protagonist of the idea of “surgineering” .
This work was supported in part by DF6.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Feussner H The role of technology in minimally invasive surgery: “Surgineering” Department of Surgery/Research Group Minimally invasive Interdisciplinary Therapy. https://www.nct-heidelberg.de/fileadmin/media/das_nct/. Accessed 1 July 2017