Big scars are a thing of the past for gall bladder operations. The surgeon makes four small incisions in the stomach: one for a camera, three for his instruments.
Using a Delft camera system, the endo-periscope, more complex stomach operations are also possible.
An operation assistant can operate the endo-periscope from the side. He doesn’t have to put his arms around the surgeon from behind to get an image in the eye-hand line of the surgeon.
The tip of the Delft endo-periscope is flexible because of the combination of a spring and three pulling threads. The tip can be turned to the side (left) and up and down (right). This enables the surgeon to look at a bile duct
”What are those surgeons making all the fuss about?” Dr. Paul Breedveld wondered, when he first witnessed a gall bladder operation. ”It all looks very effective. But after a few conversations I understood that that’s because the surgeons have practised the operation countless times. They are trained.” It’s been some years since a gall bladder operation gave a patient a scar of fifteen centimetres. The surgeon makes four small incisions in the stomach. Three for the surgical instruments, one for a small camera: the endoscope. Looking at the screen above the bed, the doctor squeezes the bile duct closed, after which the infected bladder is removed. The patient can go home the same day.
It’s of utmost importance that the surgeon completely closes the bile duct and not the connection between liver and intestines that runs behind it. Through practice, surgeons learn to make that distinction. But because a surgeon is less sure of getting the right tube with a camera than when looking at it directly, not all stomach operations are performed using the endoscope. Mechanical engineer Paul Breedveld, of the Man-Machine department, is trying to improve the control of the surgical camera. The result is the endo-periscope, a patented miniature camera that will improve depth perception.
Escher
”A lot of people think that they can see three dimensionally because they have two eyes,” Breedveld begins a crash course ‘Whatis perspective?’. ”But if you cover one eye, you really don’t bike into every tree. Stereovision isn’t really all that important.”
The mechanical engineer proceeds to conjure up a picture on his laptop: a bird of prey floating above a field. ”How high is the bird flying?” … ”Tough, isn’t it? And how about now?” Suddenly there’s a shadow on the field and the animal is clearly hovering close above the golden stalks.
The researcher has more examples of visual clues, hints that allow us to estimate forms. A tree in front of a mountain in a vacation photo helps tell how high it is. And the Escher engraving behind Breedveld, in which a pillar shows that one staircase is running above another. ”And just try to thread a needle without turning it around a bit first. Viewing an object from different angles helps judging depth.”
The ‘traditional’ endoscope unfortunately doesn’t produce a lot of shadows in the stomach. The reason for this is that the lamp is right above the lens. Because of this the quality of the image is more aptly compared to pictures taken at a train station photo booth than those done by a professional photographer. Another drawback is that the endoscope provides a ‘turned’ picture. The camera is looking into the stomach from a different angle than the surgeon would be doing during a standard operation. If you were to stick the endoscope into the stomach right in front of the surgeon, it would be in the way. Also the surgeon isn’t looking at his hands like he would do during a normal operation, but at a television screen above his head. A good surgeon is already used to these ‘deviations’, having practised a lot, but it’s still unnatural hand-eye co-ordination.
Breedveld’s endo-periscope has a few tricks that make it easier for the surgeon. The head containing the lens is much more flexible (see picture). The little camera can bend to the side and up and down to look at an object from different sides. This is possible because of a clever combination of a spring with three pulling threads. That also ensures that the position of the tip is exactly the same as the position of the control handle, making the movement ‘logical’.
It’s also possible to stick this endoscope into a patient’s stomach right in front of the surgeon. An assistant can control the camera from the side. Finally, a higher location of the lamp produces more indirect light and therefore more shadows.
Pigs
A prototype of the endo-periscope is gleaming in a velvet box in Breedveld’s room. It hasn’t yet been tested on patients. Breedveld: ”This is the very first one. While we were making it, we were already thinking up ways to make it better. For instance, when this design is at rest, the tip is bent, which isn’t handy for insertion of the machine.”
In the meantime, the parts of a new prototype have arrived. They originate at the Tokyo Institute of Technology, where the researcher also made the first specimen. During the coming weeks Breedveld will assemble the prototype, after which real tests can begin. First will be a test in a plastic artificial stomach, thentests in a pig. But before that can happen the sterile latex cases that were ordered need to arrive to be able to cover the machine during an operation. After successful animal tests, it will be tested on the real thing.
Breedveld won’t experience this up close. ”We’re looking for a company that is willing to buy the patent and develop the idea further. For me the work stops after the first tests on animals.” By now the interest of companies has been aroused, but no definite commitments have been made yet.
Isn’t Breedveld interested in commercialising his discovery himself? ”No, I’m a real scientist. I’m fascinated by the work in this group. I’m already thinking about other projects. For instance I’d like to improve the equipment for intestinal exploration. The existing cameras have great difficulty sliding through the strongly folded large intestine.”
Virtual operation
Although his research might, at first glance, make one think otherwise, Breedveld is not at all charmed by recent futuristic stories about ‘long-distance operating’ and ‘joystick operations’. ”An American operating on a Japanese via a satellite connection? I don’t really believe in that. The risk is too large. What if the connection is suddenly lost. And the time-delay in the images can also produce a few problems. Real time operating is much less risky. The surgeons I talk to agree with me. If it’s such a special operation, then have the surgeon get on a plane.” The idea of ‘virtual operating’, Breedveld says, originates from battlefield surgery. In this way doctors could treat their patients at a safe distance from the violence of war by means of robots. ”Those robots are, of course, very handy for delicate surgery, like eye and brain operations. Fingers and usual instruments are really much too crude for that kind of work. But for general surgery I don’t see much point in it. Even though a lot of companies are actively pursuing it.”
The researcher is of the opinion that the research for biomedical equipment should be driven by clinical need, just like in the case of his endo-periscope. ”That’s where the task is for the technical universities. Talk to a doctor or surgeon about his problems and think up a fundamental solution. They don’t do that themselves. They are, after all, doctors and not engineers.”
Snooping
The endo-periscope might make it possible to perform more complex stomach operations without opening up the whole stomach. Also simply snooping around the stomach, looking for, for instance, the spread of cancer is made a lot easier, Breedveld believes.
”You never know with a hundred percent certainty whether the camera will be used in practice later on. That is largely dependant on the interest of companies. But the great thing about this job is that you get the chance to help people. My last research was about an international space station. A fun, fantastic subject. But in this case the benefit is unquestionable.”
Translation by Katy Gerstner
Big scars are a thing of the past for gall bladder operations. The surgeon makes four small incisions in the stomach: one for a camera, three for his instruments. Using a Delft camera system, the endo-periscope, more complex stomach operations are also possible.
An operation assistant can operate the endo-periscope from the side. He doesn’t have to put his arms around the surgeon from behind to get an image in the eye-hand line of the surgeon.
The tip of the Delft endo-periscope is flexible because of the combination of a spring and three pulling threads. The tip can be turned to the side (left) and up and down (right). This enables the surgeon to look at a bile duct
”What are those surgeons making all the fuss about?” Dr. Paul Breedveld wondered, when he first witnessed a gall bladder operation. ”It all looks very effective. But after a few conversations I understood that that’s because the surgeons have practised the operation countless times. They are trained.” It’s been some years since a gall bladder operation gave a patient a scar of fifteen centimetres. The surgeon makes four small incisions in the stomach. Three for the surgical instruments, one for a small camera: the endoscope. Looking at the screen above the bed, the doctor squeezes the bile duct closed, after which the infected bladder is removed. The patient can go home the same day.
It’s of utmost importance that the surgeon completely closes the bile duct and not the connection between liver and intestines that runs behind it. Through practice, surgeons learn to make that distinction. But because a surgeon is less sure of getting the right tube with a camera than when looking at it directly, not all stomach operations are performed using the endoscope. Mechanical engineer Paul Breedveld, of the Man-Machine department, is trying to improve the control of the surgical camera. The result is the endo-periscope, a patented miniature camera that will improve depth perception.
Escher
”A lot of people think that they can see three dimensionally because they have two eyes,” Breedveld begins a crash course ‘Whatis perspective?’. ”But if you cover one eye, you really don’t bike into every tree. Stereovision isn’t really all that important.”
The mechanical engineer proceeds to conjure up a picture on his laptop: a bird of prey floating above a field. ”How high is the bird flying?” … ”Tough, isn’t it? And how about now?” Suddenly there’s a shadow on the field and the animal is clearly hovering close above the golden stalks.
The researcher has more examples of visual clues, hints that allow us to estimate forms. A tree in front of a mountain in a vacation photo helps tell how high it is. And the Escher engraving behind Breedveld, in which a pillar shows that one staircase is running above another. ”And just try to thread a needle without turning it around a bit first. Viewing an object from different angles helps judging depth.”
The ‘traditional’ endoscope unfortunately doesn’t produce a lot of shadows in the stomach. The reason for this is that the lamp is right above the lens. Because of this the quality of the image is more aptly compared to pictures taken at a train station photo booth than those done by a professional photographer. Another drawback is that the endoscope provides a ‘turned’ picture. The camera is looking into the stomach from a different angle than the surgeon would be doing during a standard operation. If you were to stick the endoscope into the stomach right in front of the surgeon, it would be in the way. Also the surgeon isn’t looking at his hands like he would do during a normal operation, but at a television screen above his head. A good surgeon is already used to these ‘deviations’, having practised a lot, but it’s still unnatural hand-eye co-ordination.
Breedveld’s endo-periscope has a few tricks that make it easier for the surgeon. The head containing the lens is much more flexible (see picture). The little camera can bend to the side and up and down to look at an object from different sides. This is possible because of a clever combination of a spring with three pulling threads. That also ensures that the position of the tip is exactly the same as the position of the control handle, making the movement ‘logical’.
It’s also possible to stick this endoscope into a patient’s stomach right in front of the surgeon. An assistant can control the camera from the side. Finally, a higher location of the lamp produces more indirect light and therefore more shadows.
Pigs
A prototype of the endo-periscope is gleaming in a velvet box in Breedveld’s room. It hasn’t yet been tested on patients. Breedveld: ”This is the very first one. While we were making it, we were already thinking up ways to make it better. For instance, when this design is at rest, the tip is bent, which isn’t handy for insertion of the machine.”
In the meantime, the parts of a new prototype have arrived. They originate at the Tokyo Institute of Technology, where the researcher also made the first specimen. During the coming weeks Breedveld will assemble the prototype, after which real tests can begin. First will be a test in a plastic artificial stomach, thentests in a pig. But before that can happen the sterile latex cases that were ordered need to arrive to be able to cover the machine during an operation. After successful animal tests, it will be tested on the real thing.
Breedveld won’t experience this up close. ”We’re looking for a company that is willing to buy the patent and develop the idea further. For me the work stops after the first tests on animals.” By now the interest of companies has been aroused, but no definite commitments have been made yet.
Isn’t Breedveld interested in commercialising his discovery himself? ”No, I’m a real scientist. I’m fascinated by the work in this group. I’m already thinking about other projects. For instance I’d like to improve the equipment for intestinal exploration. The existing cameras have great difficulty sliding through the strongly folded large intestine.”
Virtual operation
Although his research might, at first glance, make one think otherwise, Breedveld is not at all charmed by recent futuristic stories about ‘long-distance operating’ and ‘joystick operations’. ”An American operating on a Japanese via a satellite connection? I don’t really believe in that. The risk is too large. What if the connection is suddenly lost. And the time-delay in the images can also produce a few problems. Real time operating is much less risky. The surgeons I talk to agree with me. If it’s such a special operation, then have the surgeon get on a plane.” The idea of ‘virtual operating’, Breedveld says, originates from battlefield surgery. In this way doctors could treat their patients at a safe distance from the violence of war by means of robots. ”Those robots are, of course, very handy for delicate surgery, like eye and brain operations. Fingers and usual instruments are really much too crude for that kind of work. But for general surgery I don’t see much point in it. Even though a lot of companies are actively pursuing it.”
The researcher is of the opinion that the research for biomedical equipment should be driven by clinical need, just like in the case of his endo-periscope. ”That’s where the task is for the technical universities. Talk to a doctor or surgeon about his problems and think up a fundamental solution. They don’t do that themselves. They are, after all, doctors and not engineers.”
Snooping
The endo-periscope might make it possible to perform more complex stomach operations without opening up the whole stomach. Also simply snooping around the stomach, looking for, for instance, the spread of cancer is made a lot easier, Breedveld believes.
”You never know with a hundred percent certainty whether the camera will be used in practice later on. That is largely dependant on the interest of companies. But the great thing about this job is that you get the chance to help people. My last research was about an international space station. A fun, fantastic subject. But in this case the benefit is unquestionable.”
Translation by Katy Gerstner
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