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THE TEAK PROJECT: TRAVELING ENGINEERING ACTIVITY KITS

Laparoscopic Surgery

Partial support for this project was provided by the National Science Foundation's Course, Curriculum, and Laboratory Improvement (CCLI) program under Award No. 0737462. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the National Science Foundation.

TEAK Laparoscopic Surgery Lesson Plan

The TEAK Project

Rochester Institute of Technology

ACTIVITY OVERVIEW

Laparoscopic Surgery Kit Overview The Laparoscopic Surgery kit uses a hands-on competition to show students the importance of teamwork in the context of medical procedures and devices. Engineering problems often require the skills of many different types of engineers and non-engineers in order to solve them. Therefore, it is important that all engineers know the value of teamwork and practice it on a daily basis. The main focus of this kit is the challenge to complete a “laparoscopic surgery” where no single team member can complete the task without the help of the entire team.

Activity Time Description

Laparoscopic Surgery Activity

45 min

Work together as surgical teams to maneuver and manipulate items within a shoebox. The four roles that the students will assume are surgeon, mirror operator, timer, and lighting specialist. By allowing the students to rotate and perform each of the four roles, they will learn how to effectively communicate within a team environment.

Teamwork Activity 10-15 min

Teamwork is an intricate part of the both the surgical and engineering working environments. During this activity, the students will break into groups and complete an activity that will help them recognize teamwork. The activity will also prepare them to work as a surgical team in the next activity.

Laparoscopic Tool Design Activity

10 min

After completing the laparoscopic surgery activity, the students will get a chance to redesign their laparoscopic tool. Using the knowledge they gained from surgery, they will make changes to the tool to make it easier to use.

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

• Explain what teamwork is and why it is important • Explain what laparoscopic surgery is • Discuss the differences in laparoscopic tool designs

NYS Learning Standards Standard 1: Engineering Design

• Under supervision, manipulate components of a simple, malfunctioning device to improve its performance.

Standard 5: Tools, Resources, and Technological Processes

• Use a variety of tools and energy sources to construct things. • Develop basic skills in the use of hand tools. • Understand the importance of safety and ease of use in selecting tools and resources for a specific

purpose. Standard 5: Management of Technology

• Work cooperatively with others on a joint task.


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TABLE OF CONTENTS

Instructor Preparation Guide .................................................................................................................................. 4 Bioengineering Overview ....................................................................................................................................... 4 Laparoscopic Surgery Overview ............................................................................................................................ 4 Teamwork Overview .............................................................................................................................................. 4

Bioengineering Introduction .................................................................................................................................... 6 Background Information ......................................................................................................................................... 6 Bioengineering Group Discussion .......................................................................................................................... 6

Laparoscopic Surgery Introduction ........................................................................................................................ 7 Background Information ......................................................................................................................................... 7 Simplified Definitions ............................................................................................................................................ 7 Laparoscopic Group Discussion ............................................................................................................................. 7 Learning Objectives ................................................................................................................................................ 8 Materials for Each Group ....................................................................................................................................... 8 Procedure ................................................................................................................................................................ 8 Expected Results ..................................................................................................................................................... 9 Laparoscopic Concluding Discussion .................................................................................................................... 9

Teamwork Introduction ......................................................................................................................................... 10 Background Information ....................................................................................................................................... 10 Teamwork Group Discussion ............................................................................................................................... 10 Learning Objectives .............................................................................................................................................. 11 Materials for Each Group ..................................................................................................................................... 11 Procedure .............................................................................................................................................................. 11 Possible Teamwork Examples .............................................................................................................................. 11 Learning Objectives .............................................................................................................................................. 12 Materials for Each Group ..................................................................................................................................... 12 Procedure .............................................................................................................................................................. 12 Expected Results ................................................................................................................................................... 13 Concluding Discussion ......................................................................................................................................... 13

Laparoscopic Intrument Design Introduction ..................................................................................................... 14 Background Information ....................................................................................................................................... 14 Laparoscopic Intrument Design Group Discussion .............................................................................................. 14 Learning Objectives .............................................................................................................................................. 15 Materials for Each Group ..................................................................................................................................... 15 Procedure .............................................................................................................................................................. 15

Laparoscopic Surgery Activity Handout .............................................................................................................. 16 Laparoscopic Design Activity Handout ................................................................................................................ 17 Laparoscopic Design Activity Handout (Answers) .............................................................................................. 18 Surgical Instrument Pictures ................................................................................................................................. 19 Image Sources ......................................................................................................................................................... 20 Revisions .................................................................................................................................................................. 20

Signifies Group Discussion Signifies Activity


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INSTRUCTOR PREPARATION GUIDE

Bioengineering Overview Bioengineering is the application of engineering principles to address challenges in the fields of biology and medicine. Bioengineering also encompasses engineering design to the full spectrum of living systems.

Laparoscopic Surgery Overview Laparoscopic surgery is a minimal invasive surgery that is performed through small incisions rather than large incisions needed in traditional surgeries. Laparoscopic surgery belongs to the larger field of endoscopy. The 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, and 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.

Teamwork Overview Teamwork is a joint act completed by two or more people, in which the individuals put aside their own goals and opinions for the common goal and unity of the group. While the emphasis of teamwork is on the team and the goals of the team, it does not mean that the individual is unimportant. Especially in engineering, the knowledge and values that an individual person has can add great value to the work done by the team. Many engineering teams are multidisciplinary, meaning they involve different types of engineers. Since the knowledge and skill set acquired by one type of engineer is different from that of another type of engineer (i.e. mechanical to electrical), it is beneficial to have a team with many different engineers.

Figure 1: Laparoscopic Instruments Figure 2: Laparoscope


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Laparoscopic Surgery

DURATION 60 – 70 Minutes

CONCEPTS Bioengineering

Biomedical Applications Teamwork

Laparoscopic Tool Design


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BIOENGINEERING INTRODUCTION

Background Information Bioengineering is the application of engineering principles to address challenges in the fields of biology and medicine. Bioengineering also encompasses engineering design to the full spectrum of living systems.

Bioengineering Group Discussion (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.)

Q: 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.

Q: 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 other living systems.

• Examples of products that have been bioengineered for Laparoscopic Surgery are: o Laparoscopic Tools/Instruments o Laparoscope


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LAPAROSCOPIC SURGERY INTRODUCTION

Background Information Laparoscopic surgery is a minimal invasive surgery that is performed through small incisions rather than large incisions needed in traditional surgeries. Laparoscopic surgery belongs to the larger field of endoscopy. The key elements in laparoscopic surgery are the use of a laparoscope and laparoscopic instruments.

Simplified Definitions Laparoscopic Surgery – A minimal invasive surgery that is performed by utilizing small incisions (cuts). Laparoscope – An instrument through which structures within the abdomen and pelvis can be seen.

• 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.

Laparoscopic Instruments - Tools that the surgeon uses to work on the patient. These tools allow the surgeon to move, cut, and stitch organs during the operation.

Laparoscopic Group Discussion (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.)

Q: What do you think the advantages of Laparoscopic Surgery are?

• Reduced blood loss • Smaller incisions • Shorter recovery time • Shortened hospital stay • Less pain

Q: What do you think the disadvantages of Laparoscopic Surgery are?

• Injury to blood vessels • Surgical burns • Excess CO2 gas in the abdomen • Longer surgeries


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

• Explain what a laparoscopic device is • Explain what laparoscopic surgery is

Materials for Each Group • 1 Surgical Box with Lid • 1 Laparoscopic Device • 1 Stopwatch • 1 Mirror/Webcam • 1 Surgical Activity Package

** Do NOT hand out activity sheet at this time! **

Procedure 1. Have the students get into 5 groups (DO NOT assign them team roles at this point).

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 introduction discussion to save set up time.)

4. Instruct the students not to pick up or move the surgical boxes.

5. Turn off the lights in the classroom and let the students begin the activity. The goal is to collect as many

animals as possible in under 4 minutes. The TEAK instructor will keep track of the time through the use of the provided stopwatch. At 4 minutes, the instructor will stop the activity (whether the surgeons have collected all the animals or not).

6. After the team has finished the activity within the surgical box, the students will count the number of

animals they collected.

7. Have each group share how many animals they collected. Write these numbers on the board.

Laparoscopic Surgery Activity (Part 1) – 8 Minutes

End Laparoscopic Surgery Activity (Part 1)


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Expected Results • Without given roles, it is expected that there will be some discrepancies over who gets to be the

“surgeon.” The other students may just stand and watch the surgeon work, because they don’t know what to do to help out.

• A lack of communication and teamwork will cause the team not to collect as many animals.

Laparoscopic Concluding Discussion Q: Do you think this activity was hard?

• (This is a very open ended answer. Whatever they think will be correct.) Q: What would have made this activity easier? (Write answers on the board; will use them for the teamwork discussion.)

• A job for each team member to do • Talking to one another • Working together • Listening to one another • Teamwork!

Q: Why do you think teamwork is an important part of Laparoscopic Surgery?

• Need people to help the surgeon (he/she can’t do all jobs) • The procedure is more complex than regular surgery • It’s harder to see what is going on • It’s a new procedure so training is needed from more experienced people • There are more technical things that can go wrong and needs to be monitored


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TEAMWORK INTRODUCTION

Background Information Especially in engineering, the knowledge and values that an individual person has can add great value to the work done by the team. Many engineering teams are multidisciplinary, meaning that they involve different types of engineers. Since the knowledge and skill set acquired by one type of engineer is different from that of another type of engineer (i.e. mechanical to electrical), it is beneficial to have a team with many different engineers.

Teamwork Group Discussion (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.)

Q: What do you think teamwork is?

• A joint act completed by two or more people, in which the individual puts aside their own goals and opinions for the common goal and unity of the group.

• The emphasis of teamwork is on the team and the goals of the team, but it does not mean that the individual is unimportant.

• The combined actions of a group or team. • Work produced by a group or team.

Q: Think back to the things you said you would have made this activity easier. Can you think of anything else that would have helped your team collect more animals? (There may be more correct answers than the ones listed.)

• Working together • Listening to the opinions of other teammates • Everyone getting assigned a job

Label this list “GOOD” teamwork. Q: Think about the surgery activity again. What kinds of attitudes would have made your teammates easier to work with? (There may be more correct answers than the ones listed.)

• Positive • Helpful • Encouraging • Happy

Label this list “GOOD” attitude.


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• Define teamwork • Identify examples of teamwork • Explain why teamwork is important in engineering

Materials for Each Group • (1) Blank sheet of paper per group

Procedure 1. Get the students into 5 groups. 2. Have the group write down 4-5 activities that involve teamwork. (For example, have them think of places

they have been in the past week where they may have seen teamwork).

3. After 2-3 minutes, have the groups stop writing.

4. Have one student from each group go to the board and write down a teamwork example.

5. Discuss the teamwork examples, and ask students what make them good/bad examples of people working together.

Possible Teamwork Examples • Sports teams – different positions because people have different strengths, all positions needed to be

successful, team members all work together to try to win, direct teamwork (one person’s decision will immediately impact the team)

• Mail men/women – everyone needs to complete their route in order to be successful, less direct than sports teams (one person’s success/failure doesn’t impact another person’s, but it affects the team as a whole)

• Restaurant – everyone works together to make sure that the guest receives the food he/she ordered, a chain of teamwork (one person needs to do their job successfully before the next person has a chance to do theirs)

End Teamwork Activity

Teamwork Activity – 5-‐10 Minutes


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• Explain what a laparoscopic device is • Explain what laparoscopic surgery is

Materials for Each Group • 1 Surgical Box with Lid • 1 Laparoscopic Device • 1 Stopwatch • 1 Mirror/Webcam • 1 Activity Worksheet per Engineering Team • 1 Surgical Activity Package • 1 Bag with Team Role Labels

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 teamwork activity to save set up time.)

4. Instruct the students not to pick up or move the surgical boxes.

5. Once all of the team roles have been determined, turn off the lights in the classroom and let the students

start 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 stopwatch. At 4 minutes, the instructor will stop the activity (whether the surgeons have collected all the animals or not).

Laparoscopic Surgery Activity (Part 2) – 25 Minutes


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6. After the team has finished the activity within the surgical box, the timekeeper 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.

7. Steps 5 & 6 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 • 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. • 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.

Concluding Discussion Q: What was hard about performing the laparoscopic surgery?

• Working with a multi-member team. • Manipulating the objects. • (This is a very open ended answer. Whatever they found to be difficult will be correct.)

Q: Did talking/communicating with your teammates make the activity easier?

• Yes, because communication allowed the surgeon to instruct the other team members so he/she could see what they were doing and capture more animals.

Q: Do you think a real laparoscopic surgery is harder than the activity you just did? Why? • YES. People have more things inside them than the activity boxes did. • Blood makes visibility harder. • You need to be careful not to damage the person’s organs.

Q: 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.

End Laparoscopic Surgery Activity (Part 2)


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LAPAROSCOPIC INTRUMENT DESIGN INTRODUCTION

Background Information A laparoscope is an instrument through which structures within the abdomen and pelvis can be seen. A laparoscopic instrument is a tool used by the surgeon to work on (move, cut, stitch) the organs. The laparoscopic instrument used during the previous activity is much different from the instrument used during a real surgical procedure.

Laparoscopic Intrument Design Group Discussion (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.)

Q: Do you think the Alligetter is different from the laparoscopic instruments that real surgeons use? How?

• Yes, they are different. • Materials • Shape of the handle • Size of the grabbing section/teeth • Size of the body

Q: Do you think the Alligetter (surgical tool) was easy to use? Would it have been easier if it were designed differently?

• (Open-ended question. Whatever they think will be right.)


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• List the parts of a laparoscopic instrument • Discuss the differences between a real laparoscopic tool and the one used in the activity

Materials for Each Group • Alligetter • Picture of Surgical Instruments • Activity Handout

Procedure 1. Have students put everything into the surgery box except for the Alligetter.

2. Make sure that each team has a photograph of a laparoscopic tool and the activity handout.

3. Tell students to complete the worksheet. Give them 5 minutes to discuss and write down their answers

before calling everyone back to attention.

4. Go over the design changes that each group came up with. Make notes/charts on the board (if possible) to list the changes and show which ones were common among the groups.

End Laparoscopic Design Activity

Laparoscopic Design Activity – 10 Minutes


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LAPAROSCOPIC SURGERY ACTIVITY HANDOUT

Trial A

Team Member Role Team Member

Name

Surgeon

Time Keeper

Lighting Specialist

Camera Operator

Number of Captured

Animals

Time

Trial C


Name

Surgeon

Time Keeper

Lighting Specialist

Camera Operator

Number of Captured

Animals

Time

Trial B


Name

Surgeon

Time Keeper

Lighting Specialist

Camera Operator

Number of Captured

Animals

Time

Trial D


Name

Surgeon

Time Keeper

Lighting Specialist

Camera Operator

Number of Captured

Animals

Time

Name(s) __________________________ Group #__________


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LAPAROSCOPIC DESIGN ACTIVITY HANDOUT

What are some differences that you can see between the surgical laparoscopes and the Alligetter?

Alligetter Surgical Laparoscopic Tools

What parts of the Alligetter would you change in order to make the surgery easier?

Part to be changed What it would be changed to Why it would be changed

Name(s) __________________________ Group #__________


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LAPAROSCOPIC DESIGN ACTIVITY HANDOUT (ANSWERS)

What are some differences that you can see between the surgical laparoscopes and the Alligetter? Can be more answers than those listed.

Alligetter Surgical Laparoscopic Tools

Plastic Just metal OR metal and plastic

Has trigger to move teeth Has scissor-like handles to move teeth

Teeth section is long and fat Teeth section can be changed

Body is wide and square Body is round and skinny

No adjustment knob Has an adjustment knob

What parts of the Alligetter would you change in order to make the surgery easier? Can be more answers than those listed.

Part to be changed What it would be changed to Why it would be changed

Body Make it skinnier To make it easier to move around

in the holes


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SURGICAL INSTRUMENT PICTURES


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IMAGE SOURCES

[1] Stryker. Laparoscopic Tools. 2013. JPEG file. http://www.stryker.com/en-us/products/Endoscopy/Laparoscopy/LaparoscopicInstrumentsOld/index.htm [2] China Medical Devices. Laparoscope. 2013. JPEG file.

http://www.chinamedevice.com/ChinaSuppliers/5276/Laparoscope-456154.html

[3] Speedlock. Laparoscopic Instruments. 2013. JPEG file. http://www.aed.md/3-SpeedLock.html

[4] IAHCSMM. Laparoscopic Handle Components. 2013. JPEG file.

http://www.iahcsmm.org/Recertification/LessonPlans/CIS_lessonPlans/CIS_Lessons/CIS_210.html

REVISIONS

Date Changes Made Changes Made By

9/23/2009 Replaced biomaterials section with teamwork, added laparoscope design section, basic changes to order of lesson plan and formatting

Heather Godlewski

9/28/2009 Rearranged the order of lesson plan and made the laparoscopic surgery activity into two parts.

Heather Godlewski

4/16/2013 Edited for grammar and syntax issues. Reorganized the format.

Todd Jackson

laparoscopic surgery - rit.edu · laparoscopic surgery belongs to the larger field of endoscopy....

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