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LUMIKNOWS

                                                                                         LUMIKNOWS
                                                                                          Experience Design & Development




                      Universal Surgical Complex for
                      Different Types of Invasive Operations
                      and Endoscopy.
                      Case sudy of Russian Design Research




1   ©2008 LUMIKNOWS. Promoting World Class Design Research. September 2008. Proprietary & Confidential.
LUMIKNOWS


    Name of Research Project
    Universal Surgical Complex for Conducting Different Types of Invasive Operations and Endoscopy

    Name of Lead Researcher
    Vyacheslav Bondarev

    Institution
    Lumiknows

    Clients
    Optimed, Efa - at the time of the project (2004), the largest in Russia makers of invasive surgery
    equipment who decided to join their efforts to design a universal surgical complex.

    Research Aims and context:
    There are different types of invasive operations and endoscopy. It depends on the particular target
    organ, and also varies between different hospitals and even within surgical crews. Each type has its own
    peculiarities in the ways the surgery is performed, but also in the methods and consecution of actions
    surgeons are used to following.

    The key research aim was to develop a universal multifunctional complex allowing conducting different
    types of invasive operations and endoscopy in any Russian hospital by any surgical crew. Another
    challenge of the project was that the complex, at the time consisting of several modules, should have
    been compatible with modules being produced by various certified makers of medical equipment – both
    Russian and foreign.

    Research activities and methods:
    The project was divided into three phases: design research resulted into design brief, development
    phase and creating a pre-production model.

    The focus of the research was on the analysis of different types of surgical processes and the
    surgeon’s workplace. The phase has become a combination of the two approaches: a four-week video
    ethnographic observation in several St.-Petersburg hospitals (p.1) with a following processes-orientated
    value analysis (p.2). At the core, a holistic approach to the complex under development lied: the complex
    was approached as a part of the larger system – an environment and, at the same time, as a container
    for smaller systems (control interfaces, communications between devices etc.). Such methodology
    allowed identifying problem issues concerning the structure of the complex, antagonistic relationships
    between the complex parts and even rules for the further evolution of similar sophisticated medical
    equipment.

    Research Outcomes:
    The research phase has resulted into two design concepts. The first one was realized and is now serially
    produced in two modifications: by Optimed for hospitals and by Efa for air-mobile hospitals deployed by
    the Russian Ministry of Emergency Situations.

    The complex designed has allowed to solve the following critical for such operations issues: optimize the
    surgeon’s workplace which resulted in the preventing possible errors; make the process of preparing the
    complex to work and control during the surgery much easier; reduce the duration of the surgery which,
    in turn, decreases negative impact on patient of being under a long anesthesia; reduce the number of
    medical staff who were in charge of adjusting the complex during the operation (usually, one-two people)
    which reduces the costs of operations and medical treatment as a whole.

    The other concept required serious modification of the surgical environment and, thus, changing of an
    established chain of suppliers including special medical furniture makers. Due to significant investment
    needed to accomplish the project in this way, the concept was not realized. In the meantime, some of the
    principles in the evolution of such complexes formulated during the project have proved its correctness
    in the da Vinci Surgical System.

2   ©2008 LUMIKNOWS. Promoting World Class Design Research. September 2008. Proprietary & Confidential.
LUMIKNOWS



    The main findings of the observation phase resulted in identifying
    the four problem areas: (1) Supporting elements,
    (2) Connections, (3) Apparatus, (4) Tools:

                                                                                                    A. Supporting elements (post, rests,
                                                                                                    table)
                                                                                                    1.    Supporting elements occupy a considerable
                                                                                                          amount of space near surgical table, but to
                                                                                                          move them away is impossible since, in this
                                                                                                          case:
                                                                                                    •     connections with devices are getting longer;
                                                                                                    •     reading of information from monitors is
                                                                                                          worsening;
                                                                                                    2.    Supporting elements accumulate dust,
                                                                                                          especially its horisontal surfaces which is a
                                                                                                          problem for a surgical environment;
                                                                                                    3.    To adjust the surgical table during the
                                                                                                          operation an additional person is needed

                                                                                      1
                                                                                                          (image 1).

                                                                                                    B. Connections (wires, hoses, light pipe)
                                                                                                    1.    A large length of connections (from 2 to
                                                                                                          2,8m) results in considerable losses of
                                                                                                          information;
                                                                                                    2.    Connections are a problem since on its
                                                                                                          way they sag, touch the floor, become
                                                                                                          unsterilized, are pressed down by the
                                                                                                          personnel which, all in all, may cause an
                                                                                                          emergency situation (image 2);
                                                                                                    3.    Connections create a 'dead zone' near
                                                                                                          surgical table not allowing an access to
                                                                                                          patient from the complex's side;
                                                                                                    4.    Connections block reading information and
                                                                                                          devices control;
                                                     2                                 3            5.    Connections require considerable amount of
                                                                                                          time to connect up and disconnect before,
                                                                                                          during and after the operation (image 3).

                                                                                                    C. Apparatus (monitor, devices)
                                                                                                    1.    To adjust devices during the operation, an
                                                                                                          additional person is needed (image 4);
                                                                                                    2.    Due to the lack of space between surgical
                                                                                                          table and devices, access to adjusting
                                                                                                          devices is difficult;
                                                                                                    3.    It is almost impossible to read information
                                                                                                          from the modules locating in the lower part
                                                                                                          of the complex;

                                         4                                            5
                                                                                                    4.    Lack of flexibility in the monitor location
                                                                                                          results in inconvenience of following
                                                                                                          critical information from monitor during the
                                                                                                          operation (image 5).

                                                                                                    D. Tools
                                                                                                    1.    Since TV camera and its wire are not
                                                                                                          sterilized, they require a sterile case with a
                                                                                                          lenght of 1 m which makes connecting up
                                                                                                          of laporoscope and adjusting the camera's
                                                                                                          sharpness difficult (image 6).
                                                                                                    2.    Light pipe is connecting up to laporoscope
                                                                                                          under an inconvenient 90 degree angle

                                         6                                            7
                                                                                                          (image 7).




3   ©2008 LUMIKNOWS. Promoting World Class Design Research. September 2008. Proprietary & Confidential.
LUMIKNOWS



                                     Processes-orientated value analysis:



                                                                                                          I. Initial Situation




     II. Analysis of operationa zone                                                                      II. Analysis of Operational
                                                                                                          Zone:
              9                7                                                                          1.    Surgeon
     10                                                 4                                                 2.    Patient
                                                                                                          3.    Surgical Table
                                         5                                                          1     4.    Tools
                                                                               2                          5.    Connections
                                                                                                          6.    Modules
                                                                                                          7.    Monitor
                       6       8                                                                          8.    Control Panels
                                                                               3                          9.    Supporting Elements
                                                                                                          10.   Additional Equipment


     III. The Priority of Tasks
                                                                                                          III. The Priority of Tasks
                                                                                                          The main task of the complex
                                                                                                          is to receive and trasmit full
                                                                                                          informationato make a decision.

                                                                                                          Rating in accordance with the
                                                                                                          main task:

                                                                                                          F1. The Operation Information
                                                                                                          F2. The Tool of Performing the
                                                                                                          Decisions
    F7       F6               F5               F4           F3                     F2          F1
                                                                                                          F3. The Devices Information
                                                                                                          F4. Modules to Maintain the
                                                                                                          Devices Work
                                                                                                          F5. Connections to Transfer
                                                                                                          Materials and Energy to Devices
                                                                                                          F6. Supporting Elements
                                                                                                          F7. Others



                                                                                                          IV. Desirable Outcome




4   ©2008 LUMIKNOWS. Promoting World Class Design Research. September 2008. Proprietary & Confidential.
LUMIKNOWS




              Research Outcomes in a Form of Comparative Analysis
              of Problem Issues in All Three Modifications of the
              Complex:

                Problem Issues                   Initial Sitution             Realized Concept            Advanced Concept
                                                 (1)                          (2)                         (3)



                 Bulky
                 Equipment




                 'Dead Zone'                                                                                      abs




                 Connections
                 Zone




                 Convenience
                 of Observing                          950




                 Convenience
                 of Control                                                        Remote Control           Remote Control




5   ©2008 LUMIKNOWS. Promoting World Class Design Research. September 2008. Proprietary & Confidential.
LUMIKNOWS


                                                              Initial Complex




                                      Serially Produced Complex since 2006




6   ©2008 LUMIKNOWS. Promoting World Class Design Research. September 2008. Proprietary & Confidential.
LUMIKNOWS




                                             LUMIKNOWS

                                                 Lumiknows is a Russia based innovation
                                                 consumer experience consultancy with a
                                                 subsidiary in Asia.

                                                 With a focus on People, Research and
                                                 Innovation, our aim is to provide deep
                                                 insights into drivers, lifestyle and mindset
                                                 of gaining in sophistication Russian
                                                 customers.




7   ©2008 LUMIKNOWS. Promoting World Class Design Research. September 2008. Proprietary & Confidential.

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Design Research Russia. Medical equipment

  • 1. LUMIKNOWS LUMIKNOWS Experience Design & Development Universal Surgical Complex for Different Types of Invasive Operations and Endoscopy. Case sudy of Russian Design Research 1 ©2008 LUMIKNOWS. Promoting World Class Design Research. September 2008. Proprietary & Confidential.
  • 2. LUMIKNOWS Name of Research Project Universal Surgical Complex for Conducting Different Types of Invasive Operations and Endoscopy Name of Lead Researcher Vyacheslav Bondarev Institution Lumiknows Clients Optimed, Efa - at the time of the project (2004), the largest in Russia makers of invasive surgery equipment who decided to join their efforts to design a universal surgical complex. Research Aims and context: There are different types of invasive operations and endoscopy. It depends on the particular target organ, and also varies between different hospitals and even within surgical crews. Each type has its own peculiarities in the ways the surgery is performed, but also in the methods and consecution of actions surgeons are used to following. The key research aim was to develop a universal multifunctional complex allowing conducting different types of invasive operations and endoscopy in any Russian hospital by any surgical crew. Another challenge of the project was that the complex, at the time consisting of several modules, should have been compatible with modules being produced by various certified makers of medical equipment – both Russian and foreign. Research activities and methods: The project was divided into three phases: design research resulted into design brief, development phase and creating a pre-production model. The focus of the research was on the analysis of different types of surgical processes and the surgeon’s workplace. The phase has become a combination of the two approaches: a four-week video ethnographic observation in several St.-Petersburg hospitals (p.1) with a following processes-orientated value analysis (p.2). At the core, a holistic approach to the complex under development lied: the complex was approached as a part of the larger system – an environment and, at the same time, as a container for smaller systems (control interfaces, communications between devices etc.). Such methodology allowed identifying problem issues concerning the structure of the complex, antagonistic relationships between the complex parts and even rules for the further evolution of similar sophisticated medical equipment. Research Outcomes: The research phase has resulted into two design concepts. The first one was realized and is now serially produced in two modifications: by Optimed for hospitals and by Efa for air-mobile hospitals deployed by the Russian Ministry of Emergency Situations. The complex designed has allowed to solve the following critical for such operations issues: optimize the surgeon’s workplace which resulted in the preventing possible errors; make the process of preparing the complex to work and control during the surgery much easier; reduce the duration of the surgery which, in turn, decreases negative impact on patient of being under a long anesthesia; reduce the number of medical staff who were in charge of adjusting the complex during the operation (usually, one-two people) which reduces the costs of operations and medical treatment as a whole. The other concept required serious modification of the surgical environment and, thus, changing of an established chain of suppliers including special medical furniture makers. Due to significant investment needed to accomplish the project in this way, the concept was not realized. In the meantime, some of the principles in the evolution of such complexes formulated during the project have proved its correctness in the da Vinci Surgical System. 2 ©2008 LUMIKNOWS. Promoting World Class Design Research. September 2008. Proprietary & Confidential.
  • 3. LUMIKNOWS The main findings of the observation phase resulted in identifying the four problem areas: (1) Supporting elements, (2) Connections, (3) Apparatus, (4) Tools: A. Supporting elements (post, rests, table) 1. Supporting elements occupy a considerable amount of space near surgical table, but to move them away is impossible since, in this case: • connections with devices are getting longer; • reading of information from monitors is worsening; 2. Supporting elements accumulate dust, especially its horisontal surfaces which is a problem for a surgical environment; 3. To adjust the surgical table during the operation an additional person is needed 1 (image 1). B. Connections (wires, hoses, light pipe) 1. A large length of connections (from 2 to 2,8m) results in considerable losses of information; 2. Connections are a problem since on its way they sag, touch the floor, become unsterilized, are pressed down by the personnel which, all in all, may cause an emergency situation (image 2); 3. Connections create a 'dead zone' near surgical table not allowing an access to patient from the complex's side; 4. Connections block reading information and devices control; 2 3 5. Connections require considerable amount of time to connect up and disconnect before, during and after the operation (image 3). C. Apparatus (monitor, devices) 1. To adjust devices during the operation, an additional person is needed (image 4); 2. Due to the lack of space between surgical table and devices, access to adjusting devices is difficult; 3. It is almost impossible to read information from the modules locating in the lower part of the complex; 4 5 4. Lack of flexibility in the monitor location results in inconvenience of following critical information from monitor during the operation (image 5). D. Tools 1. Since TV camera and its wire are not sterilized, they require a sterile case with a lenght of 1 m which makes connecting up of laporoscope and adjusting the camera's sharpness difficult (image 6). 2. Light pipe is connecting up to laporoscope under an inconvenient 90 degree angle 6 7 (image 7). 3 ©2008 LUMIKNOWS. Promoting World Class Design Research. September 2008. Proprietary & Confidential.
  • 4. LUMIKNOWS Processes-orientated value analysis: I. Initial Situation II. Analysis of operationa zone II. Analysis of Operational Zone: 9 7 1. Surgeon 10 4 2. Patient 3. Surgical Table 5 1 4. Tools 2 5. Connections 6. Modules 7. Monitor 6 8 8. Control Panels 3 9. Supporting Elements 10. Additional Equipment III. The Priority of Tasks III. The Priority of Tasks The main task of the complex is to receive and trasmit full informationato make a decision. Rating in accordance with the main task: F1. The Operation Information F2. The Tool of Performing the Decisions F7 F6 F5 F4 F3 F2 F1 F3. The Devices Information F4. Modules to Maintain the Devices Work F5. Connections to Transfer Materials and Energy to Devices F6. Supporting Elements F7. Others IV. Desirable Outcome 4 ©2008 LUMIKNOWS. Promoting World Class Design Research. September 2008. Proprietary & Confidential.
  • 5. LUMIKNOWS Research Outcomes in a Form of Comparative Analysis of Problem Issues in All Three Modifications of the Complex: Problem Issues Initial Sitution Realized Concept Advanced Concept (1) (2) (3) Bulky Equipment 'Dead Zone' abs Connections Zone Convenience of Observing 950 Convenience of Control Remote Control Remote Control 5 ©2008 LUMIKNOWS. Promoting World Class Design Research. September 2008. Proprietary & Confidential.
  • 6. LUMIKNOWS Initial Complex Serially Produced Complex since 2006 6 ©2008 LUMIKNOWS. Promoting World Class Design Research. September 2008. Proprietary & Confidential.
  • 7. LUMIKNOWS LUMIKNOWS Lumiknows is a Russia based innovation consumer experience consultancy with a subsidiary in Asia. With a focus on People, Research and Innovation, our aim is to provide deep insights into drivers, lifestyle and mindset of gaining in sophistication Russian customers. 7 ©2008 LUMIKNOWS. Promoting World Class Design Research. September 2008. Proprietary & Confidential.