Keyhole surgery expert Jenny Dankelman: ‘You have to bump into people’

• In 2021, nine extra Medical Delta (MD) professors were inaugurated. These professors work at at least two of the five academic institutions represented within Medical Delta (TU Delft, Erasmus MC, Erasmus University, Leiden University and LUMC). The intake brought the total number of MD professors to 22. How does such a double appointment work in practice? That is the underlying question in this miniseries of research portraits.

 TU Delft researchers who work on medical technology do not always have it easy. There is a big culture difference between medical practitioners and engineers, experiences Professor of Biomechanical Engineering Jenny Dankelman, who has two appointments, one at TU Delft (Faculty of Mechanical, Maritime and Materials Engineering) and one at LUMC (Leiden University Medical Centre).

From the start of her academic career, the Professor has regularly visited operation rooms to look over the shoulders of surgeons. This exercise delivered unexpected, and sometimes sobering, information. “Once, soon after I started my career, I was watching the proceedings with a doctor who was finding it hard to reach the large intestine with his instruments.”

‘A patient that is cut open has to be stitched up quickly. This needs a certain mindset’

Keyhole surgery was still in its early days. Doctors had to get used to using long instruments to do operations through small incisions. The instruments still needed to be adapted.

“The spot in the large intestine which the doctor needed to work on was hard to reach with the existing instruments. The surgeon asked if we could help. I saw a potential student project in this request and worked out a plan. But a couple of months later he actually solved the issue himself by working in a completely different way.”

Dankelman advises new researchers to thoroughly familiarise themselves with how doctors work and their methods and to acquire a lot of medical knowledge about anatomy and physiology.

“Doctors have to act quickly. After all, a patient that is cut open has to be stitched up quickly. This needs a certain mindset. In contrast, we are used to endlessly finding optimal solutions through mathematical formulas. If we work on a problem, we put a PhD Candidate onto it. Four years later there is a prototype which still needs to be optimised. Doctors often think that we will come up with a solution within a few months. Expectation management is important if you work on the interface of medicine and engineering.”

Less trauma
Dankelman raised a furore with her research into techniques and equipment for keyhole surgery in which surgeons operate through small incisions in minimally invasive surgery. Compared to open operations, this technique leaves smaller scars, causes less trauma, less blood loss, results in faster recovery and there is a smaller risk of infection. She has been Professor of Minimally Invasive Surgery and Intervention Techniques since 2001.

But her collaboration with medical practitioners predates this. “I have worked on medical subjects for a very long time. I worked with doctors at LUMC, the Reinier de Graaf Gasthuis, Erasmus MC and the AMC. In around 2000 our group decided that all our postdocs and doctoral candidates should also have clinical supervisors on top of a TU Delft supervisor. We needed to be familiarised with the people that were were developing medical instruments for.”

One of her highly successful discoveries came about quickly when working with a gynaecologist called Frank Willem Jansen. Jansen also has two appointments: Medical Delta Professor at the LUMC and at TU Delft. They designed a training system in which a special mechanism allowed doctors to practice procedures and receive feedback. While simulating a procedure a feedback mechanism lets the doctors’ hands and fingers feel what they are doing. “This invention has since been further developed and has led to a product that was launched on the market.”

‘The double appointment is partly symbolic’

Dankelman’s appointment at LUMC dates back to 2007. In 2013, the appointment was turned into a Medical Delta professorship. How does a double appointment work in practice? Does it make for shorter lines of communication between the researchers, greater multidisciplinarity and more direct feedback?

“The double appointment is partly symbolic. However, it can help in applying for subsidies. It is a kind of confirmation of your close ties with medical practitioners. I saw that more and more doctors approached us as the Medical Delta became better known. That’s a good thing.”

This ‘approaching’ often happens over a drink during the Medical Delta Cafés, regular get togethers of members, where current issues in healthcare are discussed, and where there is much networking and exchanging of ideas.

“You need to meet people. Before the covid lockdowns a doctor from Erasmus MC and I started talking about patient safety. We hatched a plan to look into designing incubators for transplant surgery in which kidneys, livers or lungs could be kept.”

Dankelman needs these types of encounters for her newest projects too. “To give one example, we are working on reusable vacuum pumps for birthing for low-income countries. I am looking for surgeons who have expertise in low-income countries.”

Graduated in mathematics
That Dankelman would end up in the medical world was not written in the stars. She graduated in mathematics at the University of Groningen. Two years ago she explained in an interview in Delta – when she had just been awarded the Leermeesterprijs (Professor of Excellence Award) 2019, an award for professors who excel in teaching and research – that during her graduation work she heard about a doctoral degree place at Applied Mathematics at TU Delft.

“It seemed sensible to get some practice by applying for another vacancy. So I applied to the very next suitable vacancy that I saw. That happened to also be a vacancy for a research job at TU Delft. It was about research into the blood circulation of the heart muscle at Mechanical Engineering. I was invited for an interview and apparently made a good impression, even though I knew nothing about the subject. I had been sent articles that I could not read because I did not know the terms, but still I was accepted. It was an amazing way to start working here.” She has never regretted her choice.