Daniel Kalanovic

Artificial tactile sensing in minimally invasive surgery - a new technical approach

The loss of tactile sensation is a commonly known drawback of minimally invasive surgery (MIS). Since the advent of MIS, research activities in providing tactile information to the surgeon are still ongoing, in order to improve patient safety and to extend the indications for MIS. We have designed a tactile sensor system comprising a tactile laparoscopic grasper for surgical palpation. For this purpose, we developed a novel tactile sensor technology which allows the manufacturing of an integrated sensor array within an acceptable price range. The array was integrated into the jaws of a 10mm laparoscopic grasper. The tactile data are transferred wirelessly via Bluetooth and are presented visually to the surgeon. The goal was to be able to obtain information about the shape and consistency of tissue structures by gently compressing the tissue between the jaws of the tactile instrument and thus to be able to recognize and assess anatomical or pathological structures, even if they are hidden in the tissue. With a prototype of the tactile sensor system we have conducted bench‐tests as well as in‐vitro and in‐vivo experiments. The system proved feasibility in an experimental environment, it was easy to use, and the novel tactile sensor array was applicable for both palpation and grasping manoeuvres with forces of up to 60N. The tactile data turned out to be a useful supplement to the minimal amount of haptic feedback that is provided by current endoscopic instruments and the endoscopic image under certain conditions.

Microsystems in medicine – results of an international survey

The utilization of microsystems technology (MST) in medical applications is instrumental in opening up new market segments, in the creation of novel, more effective diagnosis and therapy options in medicine, as well as in the further development of MST. However, the players in the healthcare industry are faced with technical and non‐technical difficulties. The present study analyzes this emerging field from the viewpoint of medicine, market, and MST. It identifies applications of medical devices with microsystems components and analyzes their potentials in great detail. Thus, especially the creation of new market segments is expected from a broad use of MST in medicine. Furthermore, problems and conditions during the entry of microsystems into medical products are illuminated, in particular considering the specific market features of the healthcare industry. The high expenditure necessary for establishing this technology in healthcare industry is the most significant obstacle, since this market is dominated by small and medium‐sized enterprises (SMEs). But there are non‐technical difficulties as well. This article presents selected results of the study, which was carried out in the scope of the EU project netMED (virtual institute on micromechatronics for biomedical industry).

Innovation requirements for telemetric sensor systems in medicine: results of a survey in Germany

Although first telemetric microsystems have been marketed for medical applications, the entry into the healthcare market represents a considerable challenge for many companies working in the field of microsystems technology. The Institute of Healthcare Industries (IHCI) at the Steinbeis University Berlin has conducted a study among experts in medicine, technology, and industry. The goal of the study was to investigate on innovation requirements and the market for telemetric microsystems in medicine. This article reviews selected results of the “Study on market and innovation requirements for telemetric microsystems in medicine”. It was performed in context with the project IMEX (Implantable and Extracorporeal modular microsystem platform), funded by the German ministry of science and research.

Development of a transoral fundoplication device and related experimental research

This paper describes a device and surgical techniques developed between 1999 and 2003 to enable an entirely transoral approach to fundoplication. The Endofundoplication System (EFS) system consisted of a multifunctional flexible tube for oral introduction (18 mm) as the key component, with a specially designed retroverted grasper that was used to grasp the lower esophageal sphincter (LES) area of the esophagus, for invaginating the LES into the stomach and folding the gastric wall onto the wall of the intraabdominal esophagus. The EFS system was finally studied in a consecutive series of animal experiments in the domestic pig (n = 10). In nine out of the ten cases the procedure could be successfully completed and the animals survived six weeks according to the study protocol. The clinical follow‐up of the nine animals went without problems. The animals behaved normally the first day after the procedure and tolerated regular diet very well. No signs of pain or any abdominal pathology were found in the clinical follow‐up. Follow‐up by endoscopy and fluoroscopy showed a subsequent postoperative migration of fasteners within the tissue. After autopsy and macroscopic inspection of the gastroesophageal junction (GEJ), we found firm tissue indurations around the fasteners. This may indicate that the fastener as a foreign body leads to a sufficient amount of scar tissue formation to contribute to permanent fixation of the tissue layers. The basic advantage of the EFS technique was seen by our group in the fact that it comes closer to the shape and function of a classical fundoplication than any other techniques proposed at the time we did our development. The nipple valve created by the EFS technique is, however, geometrically not identical to any existing fundoplication technique and is not directly comparable to any such procedure.