Laparoscopic Lesson Plan - EDGE

TEAK – Bioengineering Laparoscopic Lesson Plan Page 1

TEAK Traveling Engineering Activity Kits

Biomedical Engineering Kit: Laparoscopic Surgery Laparoscopic Surgery Activity


Instructor Preparation Guide: Laparoscopic Surgery Activity

Bioengineering Overview

Bioengineering is the application of engineering principles to address challenges

in the fields of biology and medicine. Bioengineering is the application of the principles

of engineering design to the full spectrum of living systems.

Biomaterials Overview

Biomaterials are any material that may be used within a living system or for a

medical device which performs, augments, or takes the place of a natural function.

Biomaterials are utilized in such fields as medicine, biology, surgery, and material

sciences. The most important property of a biomaterial is that it must be compatible with

the human body without causing inflation, infection, or the spread of disease.

Biomaterials are typically used in such applications as hip replacements, bone plates,

artificial ligaments, artificial organs, dental implants, skin repair devices, and contact

lenses. Typical metals that may be used as biomaterials are 316 and 316 L stainless

steels, cobalt-chromium based alloys, gold, mercury alloys, titanium, and titanium based

alloys. Ceramic materials that are often used for bioengineering applications are alumina

and zirconia. Aside from ceramics and metals, polymers represent a large class of

biomaterials. Typical polymers used in bio related applications range from high-density

polyethylene to softer elastomers such as silicones.

Figure 1.0: 316 Stainless Steel


Figure 1.1: Titanium Defibrillator

Laparoscopic Surgery Overview

Laparoscopic surgery is a minimally invasive surgery that is performed through

small incisions rather than large incisions as needed in traditional surgeries.

Laparoscopic surgery belongs to the larger field of endoscopy. They key element in

laparoscopic surgery is the use of a laparoscope. There are two types of laparoscopes.

The first type of laparoscope includes a telescopic rod lens systems that is connected to a

video camera. The second type is a digital laparoscope where a charge-coupled device is

placed at the end of the scope eliminating the need for the rod lens system. Some of the

advantages of laparoscopic surgery are reduced blood loss, smaller incisions, less

recovery time from surgery, and a shortened hospital stay. Disadvantages to this form of

surgery are injuries to blood vessels or the large bowel, electrical burns, and CO2 gas in

the abdominal cavity.

Figure 2.0: Laparoscopic Instruments


Figure 2.1: Laparoscope

Resources

• www.wikipedia.com

• Encyclopedia of Super Molecular Chemistry: http://books.google.com/books?id=6q479mQ8pfoC&pg=PA111&lpg=PA111&dq

=typical+biomaterials&source=web&ots=77jF2p7ZSC&sig=swKncMlbqhnRGZ

qo9AOBZ0flWo0&hl=en&sa=X&oi=book_result&resnum=1&ct=result#PPA115

,M1

Image Resources

• Figure 1.0: http://ecx.images-amazon.com/images/I/41rW9o-

lWDL._AA280_.jpg

Date: February 1, 2009

Time: 12:39 pm

• Figure 1.1: http://www.medtronic.com/wcm/groups/mdtcom_sg/@mdt/@crdm/documents/im

ages/crdm_virtuoso_d154awg_lres.jpg


Time: 12:45 pm


• Figure 2.0: http://www.stryker.com/en-

us/products/Instruments/EndoscopicInstruments/LaparoscopyInstruments/groups/

public/documents/web_prod/da_026674.jpg


Time: 1:15pm

• Figure 2.1: http://www.medifixinc.com/OP-LaparoscopeMFX45deg.jpg


Time: 1:17 pm


Activity Preparation Guide – Laparoscopic Surgery Activity

Overview

This kit contains activities for students to gain a better understanding of how

engineers must design instrumentation and tools so that form fits function. The activities

in this kit will teach students how engineers must design to fit their intended environment

and what type of materials and design considerations must be taken into account during

the design process. It further explains how engineers design and develop surgical

instrumentation to reduce and limit the number of invasive surgical procedures currently

practiced in order to improve the quality of human life. The main focus of this kit is

biocompatible materials, laparoscopic surgery, laparoscopic devices, engineering team

work, and practical applications.

Learning Objectives

By the end of this lesson, students should be able to…

• Describe biocompatibility and give an example of a biocompatible material.

• Explain why a particular material was chosen for its application.

• Explain what laparoscopic surgery is.

• Explain what a laparoscopic device is.

Engineering Connection

Engineers must be fully aware of the environment for which they are designing. The

overall design of surgical and biomedical instrumentation is focused on the form fitting the

function of the device, as well as the appropriate biocompatible materials being chosen for the

intended usable environment. New biomedical technologies developed by engineers are changing

how modern surgeries are performed and are drastically reducing patient recovery time by

limiting the number of invasive procedures required. This advancement in surgical technology

through innovative engineering designs is dramatically improving the quality of life for surgical

patients.

Activity Descriptions

A.) Class Discussion and Biomaterials Activity: 15 Minutes

This class discussion will focus around numerous concepts that biomedical

engineers must take into account when designing instrumentation for surgical

and medical applications. The main concepts discussed will focus on

biomaterials, biocompatibility, design considerations, and engineering team


work. The class discussion will also include how the form of engineering

designs must fit their intended application, laparoscopy, and laparoscopic

devices. At the conclusion of the class discussion, students will participate in

a biomaterials activity were the students must attempt to identify what they

believe to be acceptable materials suitable for medical and surgical

applications. This activity will be a design activity leading into the surgical

activity, were the students must identify and chose the most appropriate

biomaterial that is suitable for biomedical and surgical applications. From this

preliminary activity, the student will learn how to choose the correct material

for the intended design environment and how selecting the appropriate design

can optimize its intended function.

B.) Laparoscopic Surgery Activity: 35 Minutes

This activity allows the students to be laparoscopic surgeons for the day.

During this activity students will work together in their groups as surgical

teams to maneuver and manipulate items within a shoebox. During this

activity, students will assume one of four roles and then rotate to the next role

after the completion of the task within the box. Allowing the students to

rotate and perform each of the different roles within the team setting will

allow them to learn about affective communication skills within a team

environment and how to work together effectively as a team. The four roles

that the students will assume during this activity are surgeon, webcam

operator, timer, and lighting specialist. The students participating in this

activity may view this as a “challenge” between the other groups within the

class to see which group can perform the given task the fastest. The focus of

this activity is how engineers must design instrumentation based on

environmental considerations and how team work is an intricate part of the

both the surgical and engineering working environment.

C.) Student Engineering Team Roles:

Surgeon – Performs the given task within the surgical “black box”.

Webcam/Mirror Operator – Operates the webcam or mirror throughout the

surgery by working with the surgeon to properly position the camera or mirror as

directed by the surgeon.

Timer – Records the amount of time it takes for the surgeon to complete the

given task.

Lighting Specialist – Provides a light source in the black box for the webcam

operator to see the materials that the surgeon must manipulate.


New York State Learning Standards

MST 1 E Engineering

Design

Discuss how best to test the solution; perform the test under teacher supervision;

record and portray results through numerical and graphic means; discuss orally

why things worked or did not work; and summarize results in writing, suggesting

ways to

make the solution better

MST 1 E Engineering

Design

Plan and build, under supervision, a model of the solution using familiar materials,

processes, and hand tools

New York State Technology Learning Standards

a.) Standard 1: Engineering Design

1. Under supervision, manipulate components of a simple, malfunctioning

device to improve its performance.

b.) Standard 2: Information Systems

2. Use a variety of equipment and software packages to process, display, and

communicate information in different forms using text, pictures, and

sound.

c.) Standard 5: Tools, Resources, and Technological Processes

3. Use a variety of tools and energy sources to construct things.

4. Develop basic skills in the use of hand tools.

5. Understand the importance of safety and ease of use in selecting tools and

resources for a specific purpose.

d.) Standard 5: Computer Technology

6. Use the computer as a tool.


e.) Standard 5: Impact of Technology

7. Demonstrate that certain technologies have safety issues.

f.) Standard 5: Management of Technology

8. Work cooperatively with others on a joint task.

New York State Science Learning Standards

a.) Intermediate Standard 1: Analysis, Inquiry, and Design.

9. T1.1: Identify needs and opportunities for technical solutions to from an

investigation of situations of general or social interest.

10. T1.1a: Identify a scientific or human need that is subject to a

technological solution which applies scientific principles.

11. T1.3a: Identify alternative solutions base on the constraints of the design.

12. MST1: Students represent, present, and defend their proposed

explanations of everyday observations so that they can be understood and

assessed by others.

b.) Intermediate Standard 6: Interconnectedness

13. 1.2: Describe the differences and similarities between among engineering

systems, natural systems, and social systems.

14. 1.4: Describe how the output of one part of a system can become the input

to other parts.

New York State Math Learning Standards

a.) 6

th Grade Standards

15. Students will solve problems that arise in mathematics and in other

contexts.

16. Students will apply and adopt a variety of appropriate strategies to solve

problems.

17. Students will organize and consolidate their mathematical thinking

through communication.

18. Students will collect, organize, display, and analyze data.


Resources

A.) www.wikipedia.com

B.) http://www.laparoscopy.com/

C.) http://www.webmd.com/infertility-and-reproduction/guide/laparoscopic-surgery-

for-endometriosis

D.) http://www.mediflex.com/laparoscopic-surgery.asp

E.) http://www.stryker.com/en-

us/products/Endoscopy/Laparoscopy/LaparoscopicInstruments/index.htm

F.) http://www.nylearns.org/standards/browsestandards.asp


Laparoscopic Surgery

DURATION

45-50 Minutes

CONCEPTS

Bioengineering

Circulatory System

Blood Flow Characteristics

Biomedical Applications


Bioengineering Discussion: (2 Minutes)

Background Information:

Bioengineering is the application of engineering principles to address challenges

in the fields of biology and medicine. Bioengineering is the application of the principles

of engineering design to the full spectrum of living systems.

Group Discussion: Bioengineering Background

(Pose the following questions to the group and let the discussion flow naturally… try to give positive feedback to each child that contributes to the conversation)

What do you think bio (biology) means?

• The study of life and a branch of the natural sciences that studies living organisms

and how they interact with each other and their environment.

• The study of the environment.

• The study of living organisms and living systems.

What do you think engineering is? What do you think it means to be an engineer?

• A technical profession that applies skills in:

o Math

o Science

o Technology

o Materials

o Structures

Discuss with the students what bioengineering is and the broad scope of areas that

bioengineering includes. For this discussion, provide students with examples of

bioengineered products and applications.

• Bioengineering is the application of engineering principles in the fields of

medicine, biology, robotics, and any other living system.

• Examples of products that have been bioengineered for Laparoscopic Surgery

are:

o Laparoscopic Tools

o Laparoscope


Biomaterials and Biocompatibility Discussion: (5 Minutes)


Biomaterials are any material that may be used within a living system or for a

medical device which performs, augments, or takes the place of a natural function.

Biomaterials are utilized in such fields as medicine, biology, surgery, and material

sciences. The most important property of a biomaterial is that it must be compatible with

the human body without causing inflation, infection, or the spread of disease. The focus

of biocompatible materials is that these materials will not corrode over time due to an

exposure to body fluids. Biomaterials are typically used in such applications as hip

replacements, bone plates, artificial ligaments, artificial organs, dental implants, skin

repair devices, and contact lenses.

Simplified Definitions:

A.) Biocompatible Material - Biocompatible Materials are any material that does

not cause any adverse or biological reaction. If the Material is not biocompatible,

the body will reject them, causing inflammation and infection.

B.) Corrosion – The breakdown of material properties due to chemical reactions with

its surrounding environment.

C.) Rust – Chemical reaction of iron and oxygen which form iron oxide.

Group Discussion: Biomaterials and Biocompatibility


What are some different types of materials?

• Wood

• Metal (Steels, Aluminum, etc.)

• Ceramics

• Plastics

• Composites

How do materials rust or corrode?

• They are exposed to moisture for long periods of time

• They are exposed to salt mixtures (Salt trucks during winter time, etc.)

• Rust is the chemical reaction of iron and oxygen


Explain to the students the concept of biocompatibility and what makes a material

biocompatible with a living system. Give examples during this part of the discussion of

biomaterial applications. A biocompatible material and typical examples are:

• Biocompatible Material - Biocompatible Materials are any material that does not

cause any adverse or biological reaction. If the Material is not biocompatible,

the body will reject them, causing inflammation and infection.

• Metals such as stainless steel, titanium, and gold.

• Plastics

• Ceramics

What do you think are some biomaterials that you see or use everyday?

• Plastics

• Ceramics

• Stainless Steels

- There are numerous examples of these materials used in everyday life that may

also be biocompatible materials.

Why do you think it is important to use a biomaterial for medical applications or

instruments?

• To prevent infection, inflammation, and the rejection by the body of the material.


Biomaterials Brainstorming Activity – 8 Minutes

Learning Objectives

By the end of this exercise, students should be able to…

1. Describe biocompatibility and give an example of a biocompatible

material.

2. Explain why a particular material was chosen for its intended application.

3. Explain simple material properties that must be considered when

designing instruments for the human body.

Materials

1. 1 Biomaterials Brainstorming Worksheet per student.

Procedure

1. Get the students into 5 groups.

2. Have the students read the list of biomaterials.

3. The students should then mark the materials that are biocompatible and not

biocompatible and explain why.

4. Review the results with the class and discuss.

Expected Results

1. See Brainstorming Answer Guide.

End Biomaterials Brainstorming Activity


Biomaterials Brainstorming Activity Handout

Name______________________

Material Biomaterial Not a Biomaterial

Wood

Titanium

Stainless Steel

Iron

Bronze

Nickel

Aluminum

Composites

Glass

Ceramics

Gold

Plastics


Biomaterials Brainstorming Activity Answer Key

Material Biomaterial Not a Biomaterial

Wood (Is considered a biomaterial) X

Titanium X

Stainless Steel X

Iron X

Bronze X

Nickel X

Aluminum X

Composites X

Glass X

Ceramics X

Gold X

Plastics X


Laparoscopic Surgery Discussion: (5 Minutes)


Laparoscopic surgery is a minimally invasive surgery that is performed through

small incisions rather than large incisions as needed in traditional surgeries.

Laparoscopic surgery belongs to the larger field of endoscopy. They key element in

laparoscopic surgery is the use of a laparoscope.

Simplified Definitions:

A.) Laparoscopic Surgery – A minimally invasive surgery that is performed by

utilizing small incisions.

B.) Laparoscope – An instrument through which structures within the abdomen and

pelvis can be seen.

Group Discussion: Laparoscopic Surgery


For this section of the discussion, present to the students the topic of Laparoscopic

Surgery. During the discussion, describe to the students the advantages and

disadvantages of this form of minimally invasive surgery. Also, be sure to tie in the

topic of biocompatible materials when using surgical equipment.

• Laparoscopic Surgery - A minimally invasive surgery that is performed by

utilizing small incisions.

• Laparoscope – An instrument through which structures within the abdomen and

pelvis can be seen.

o The first type of laparoscope includes a telescopic rod lens systems that is

connected to a video camera.

o The second type is a digital laparoscope where a charge-coupled device is

placed at the end of the scope eliminating the need for the rod lens system

• Advantages of Laparoscopic Surgery:

o Reduced blood loss

o Smaller incisions

o Shorter recovery time

o Shortened hospital stay


• Disadvantages of Laparoscopic Surgery:

o Injury to blood vessels or the large bowel

o Surgical burns

o Excess CO2 gas in the abdomen

o Longer surgeries

Why do you think it is important for engineers to use biomaterials when designing

laparoscopic tools for surgeries?

• To prevent infections

• To prevent inflammation

• To prevent corrosion


Laparoscopic Surgery Activity – 30 Minutes

Learning Objectives

By the end of this exercise, students should be able to …

1. Explain what a laparoscopic device is.

2. Explain what laparoscopic surgery is.

Materials

1. 1 Surgical Box with Lid.

2. 1 Laparoscopic Device.

3. 1 Stopwatch.

4. 1 Webcam.

5. 1 Mirror.

6. 1 Activity worksheet per engineering team.

7. 1 Surgical Activity Package.

Procedure

1. Have the students get into 5 groups and assume one of the engineering team roles.

2. Set up the surgical activity package within the surgical box.

3. Once the surgical activity has been set up within the surgical box, place the lid

back over the surgical box and press fit. (If computers are available, one of the

TEAK instructors should set up the webcams during the biomaterials activity to

save set up time.)

4. Once all of the webcams have been set up and the team roles have been

determined, turn off the lights in the classroom and let the students begin the

activity. The goal of each surgical activity within the surgical box is to perform

the given task, through group communication, in under or around 4 minutes. The

TEAK instructor will keep track of the time through the use of the provided stop

watch. At 4 minutes, the instructor will stop the activity.


5. After the team has finished the activity within the surgical box, the time keeper

should record the time on the activity worksheet and how many animals were

captured within the 4 minutes. The students may now rotate roles, giving their

previous role to the student on their right hand side.

6. Steps 3 – 5 should be repeated until all of the students have had the opportunity to

participate in the activity as each of the different team roles.

Expected Results

1. The goal of each activity is to complete the task in less than two minutes. For an

adult, it takes approximately 1 min 45 sec to 2 minutes to complete the task.

2. At the completion of the activity, students within their engineering teams should

decide which arrangement of roles allowed them to complete the activity in the

least amount of time. This will be their optimal team.

End Laparoscopic Surger Activity


Laparoscopic Surgery Activity Worksheet

Team Member Roles

Trial A Trial B

Team Member Role Team Member Team Member Surgeon

Time Keeper

Lighting Specialist

Camera Operator

Number of Animals

Captured

Trial C Trial D

Team Member Role Team Member Team Member Surgeon

Time Keeper

Lighting Specialist

Camera Operator

Number of Animals

Captured

Trial Times

Trial A Trial B Trial C Trial D

Time (s)

Team Name


Concluding Discussion

(Pick and choose depending on student questions/responses to the activity worksheets)

What are some biomaterials that would be good to use when designing medical tools?

• Titanium.

• Stainless Steel.

• Aluminum.

• Plastics.

Why are biocompatible materials a must to use when designing medical tools?

• They don’t have adverse reactions with the body.

• Do not cause infections within the body.

• They do not rust or corrode.

What was hard about performing the laparoscopic surgery?

• Working with a multi-member team.

• Manipulating the objects.

• (This is a very open ended answer. What ever they found to be difficult will be

correct.)

Based on the surgery you performed, do you think engineers and surgeons must train a lot

at performing such a surgery and designing such laparoscopic instruments?

• Yes, lots of practice and lots evaluations and assessments of functional form

fitting instruments by engineers.

Documents

Laparoscopic Lesson Plan - EDGE