Nebraska Engineering Fall, 2005
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Helping Hands and Wrists
By Kim Hachiya, University Communications

Susan Halbeck poses with the IntuiToolSusan Hallbeck poses with the IntuiTool™ (on the left) and a standard laparoscopic tool.
One of the problems with being an ergonomist is that one notices badly designed things and has an overwhelming urge to fix them. At least, that’s how Susan Hallbeck feels. An associate professor of industrial engineering, Hallbeck is particularly interested in designing tools that perform tasks with the least amount of stress and trauma on the arms and hands of those using them.

A prototype surgical tool designed by Hallbeck and a team of undergraduate and graduate engineering students, in collaboration with physicians at the University of Nebraska Medical Center, promises to be better than current models. Called the IntuiTool™, it’s an articulated grasping tool that can be used by surgeons performing minimally invasive surgeries. Often called laparoscopic or keyhole surgery, it is done through small incisions using specialized techniques and tools, miniature cameras with microscopes, tiny fiber-optic flashlights and high definition monitors.

Laparoscopic surgery, the fastest growing surgical technique, was developed about 1990, said Dmitry Oleynikov, assistant professor of surgery at UNMC. While this surgery has definite patient benefits—including faster recovery and less risk of infection—there are downsides for surgeons, including the tools they must use. “Current tools are essentially regular surgical tools on a long stick,” Hallbeck said. The handles look like toy scissors and are “one size fits all.” The tools also are commonly right-handed, forcing lefties to adapt.

Because the tools can grasp, but not rotate inside the body, surgeons manipulate the tools outside the body, often using both hands, forcing surgeons to hold the tools awkwardly and often causing stress and fatigue in the hands, arms and shoulders.

Hallbeck said many surgeons report numbness, tingling, pain and other problems when doing these surgeries. Over time, this repetitive stress could cause permanent damage. Because of pain or fatigue, surgeons might have to stop during a surgery to rest before resuming the task, lengthening the surgery. Training for the surgery is intensive, as surgeons must learn to work using long tools inside the body while watching a video monitor that shows the procedure in two dimensions. The breakthrough in the IntuiTool™ is in the articulation function—the grasper end rotates up to 120 degrees side to side using a roller ball the surgeon actuates using a thumb.

“Essentially, the IntuiTool™ gives you a wrist on the tool,” Hallbeck said.

This is an unprecedented, even revolutionary breakthrough,” Oleynikov said. “No one else has anything remotely similar. It absolutely excited the imagination of surgeons.”

The IntuiTool™, patented and trademarked by UNL, has been licensed to Gyrus Medical, based in Minneapolis, to develop, manufacture and market. It has yet to win approval by the Federal Drug Administration for use in humans, but Hallbeck is confident that will happen. The device won an honorable mention in the Third Annual User-Centered Product Design Award from the Human Factors and Ergonomics Society in 2004. Among the questions Hallbeck and her team had to answer once they settled on the roller ball design was how the grasping-end of the tool should respond to the ball. Do users expect the grasper to go up when the ball is pushed up, or down?

“Good design should be user intuitive,” Hallbeck said. “If I hand it to you, you ought to be able to figure it out intuitively.” Rather than looking to modify existing inadequate tools, they looked to start fresh. “We designed this thing from the ground up,” Oleynikov said.

Hallbeck said that while an articulated tool was a high priority for surgeons, the “holy grail” for laparoscopy tools would allow the ability to distinguish tissue textures.

Oleynikov agreed. “The ultimate tool for surgeons is our hands. Laparoscopic surgery took our hands out of the mix. A surgeon really feels the most comfortable with his or her own hands doing the work on tissues. We are as close as we can get with current technology and a tool with tactile sensation would be extremely important.”