Building a Better Medical Mousetrap
Two Bioengineering Students Build a Less Expensive Surgical Trainer
Dr. Nicole Fearing, right, assistant professor of surgery, operates the controls of a box trainer built by MU biological students to practice laparoscopic surgery. Carrie Schmitt, left, who helped build the trainer, looks on.
Video Feature:- Surgical Trainer (WMV)
Patients sometimes forego buying expensive medical devices. The high cost of certain medical trainers can also prevent medical students from getting enough opportunities to practice their technical skills.
Two University of Missouri bioengineering students recently took up a challenge to design and build a cost-effective simulator to train surgical residents and medical students to perform laparoscopic surgery.
Using wood, screws and a small surveillance camera, the students produced a device that works as well as the state-of-the-art machines, but at a third of the cost.
Developing the trainer was a semester-long senior capstone project in biological engineering. Capstone courses allow students to apply what they learned in classrooms to real-world situations.
Luciano Alleruzzo, a senior from Baldwin, Mo., and Carrie Schmitt, a senior from Desoto, Mo., started the project when the MU Laparoscopic Surgery department came to senior engineers for help.
"It immediately intrigued me," Alleruzzo said. "Every time I learned more about the project, I became more interested in helping future patients have successful surgeries."
Surgical residents spend hours using such devices—called box trainers—to hone their skills for performing delicate, minimally invasive procedures by inserting thin instruments into a patient's body. These trainers resemble large breadboxes, the inner dimensions approximating a patient's body cavity. Surgeons insert instruments through small openings. A video feed from a laparoscope appears on a monitor, allowing surgeons to direct the instruments in complex tasks such as suturing.
The students coordinated with both medical and bioengineering faculty. Steven Borgelt, director of undergraduate students-biological engineering, oversaw the effort. John Viator, assistant professor of biological engineering, was the faculty mentor. Dr. Nicole Fearing, assistant professor of surgery and medical director of MU's Russell and Mary Shelden Simulation Center, was the surgery department's liaison who discussed problems with current devices and described what the new trainer should accomplish.
"I thought this experience was one of the best ones I've experienced in college," Alleruzzo said. "I wish that more courses were designed like this one. We showcased our device to surgery residents and other doctors after the final model was created. I was excited with their responses. Every student was fond of our device and the doctors thought it was an excellent prototype."
The biggest challenge for the students was designing and constructing the physical structure to hold the electronic equipment. "My group researched ways to have a device constructed by an outside source or ways to modify a previously created structure, but these methods were expensive," Alleruzzo said. "We decided we should build the physical structure ourselves. This was extremely time consuming and difficult, but by working as a team, we finished the designed and creation within a couple of months."
The student used readily available, off-the-shelf material from a hardware store. The trainer's frame and camera mounting are made of wood and screws. Students assembled it using their own power tools.
Some trainers on the market provide only a fixed point of view. Others require two operators: one to manipulate the instruments and another to adjust the video camera's point of view. The students' trainer uses a small, inexpensive surveillance camera with a remote control attached with Velcro to the handle of the instruments. Camera images appear on an LCD display.
"Ours is better than the ones on the market," Alleruzzo said. "One operator can manipulate the instruments and the camera, which can pan, tilt and zoom."
"The device is especially helpful because it allows students to practice without someone holding the camera," said Fearing.
Total cost for parts including camera was under $500, or about a third of commercially produced models, Schmitt said. "We wanted to make it as inexpensive as possible. Medical students can build their own," she said. The trainer can be hooked to any television or computer monitor, allowing medical students to practice anywhere.
"We are seeing that simulation is more and more important in all aspects of medical training," said Fearing. "If we get students trained before they get in the operating room, they will be safer, more efficient and provide better care for the patients."
Schmitt hopes the prototype can be mass-produced, making inexpensive trainers available to more residents and medical students. The University of Missouri Health Sciences Center has an extensive laparoscopic surgery division. The students' trainer has joined an array of other simulation devices.
Developing the device was a great career confidence builder.
"Before I began this project, I was unsure of how a couple of college seniors could accomplish the task at hand; but as the semester progressed, I discovered our true potential," Alleruzzo said. "I learned that when we put our heads together, we could find a solution to every problem we encountered. I know that during my career I will encounter issues every day, but I know that I can overcome anything successfully and patiently."
Just because the laparoscopic project has been officially completed doesn't mean the students have ended their affiliation with it, or other projects.
"I do have other ideas for a different device, which I am working on this semester," Schmitt said. "It will have interchangeable dimensions and be able to change directions, mimicking different torso sizes."
