Smooth Operator

This lesson explores how surgical instruments are designed to assist medical professionals in conducting surgical procedures. Students work in teams to design and build their own surgical instrument out of everyday materials.

Design and build a surgical instrument.
Test and refine their designs
Communicate their design process and results

Age Levels: 8-18

Materials & Preparation

Build Materials (For each team)

Required Materials (Trading/Table of Possibilities)

Pencils
Popsicle sticks
Plastic spoons
Chopsticks
Construction paper
Brass fasteners
String
Paper clips
Rubber bands
Clothespins
Binder clips

Testing Materials

Shoebox
3 small differently shaped objects (e.g. marshmallow, eraser, grape, noodle)
Dominos or small rectangular blocks

Testing Materials & Process

Materials

Shoebox
3 small differently shaped objects (e.g. marshmallow, eraser, grape, noodle)
Dominos or small rectangular blocks

Process

Place three small objects in the shoebox and mark their location with a pencil. Surround each object with dominos (standing up lengthwise). The dominos should be close to the objects but not touching them. Mark the position of each domino.

Teams test their surgical instrument design by removing the 3 small objects from the shoebox without knocking over any of the dominos in the box.

Engineering Design Challenge

Design Challenge

You are a team of engineers who have been given the challenge to design a surgical instrument. This instrument will need to be able to perform very precise surgical procedures without disturbing any of the surrounding tissue or organs. All of the components of your surgical instrument must be physically connected. Materials such as pencils cannot be broken in half. All objects removed must remain intact for additional study by the medical team.

To test your surgical instrument you will need to remove 3 small objects from a shoebox without knocking over any of the dominos in the box.

Criteria

All components must be physically connected.

Constraints

Pencils cannot be broken in half.
Use only the materials provided.
Teams may trade unlimited materials.

Activity Instructions & Procedures

Break class into teams of 2-3
Hand out the Smooth Operator worksheet, as well as some sheets of paper for sketching designs.
Discuss the topics in the Background Concepts Section. Ask students to name surgical instruments they may know. Discuss the role of engineers in designing medical devices.
Review the Engineering Design Process, Design Challenge, Criteria, Constraints and Materials.
Provide each team with their materials.
Explain that students must design a surgical instrument that can perform careful surgical procedures without disturbing any of the surrounding tissue or organs. They must remove 3 small objects from a shoebox without knocking over any of the dominos that surround them. All of the components of their surgical instrument must be physically connected. Materials such as pencils cannot be broken in half. All objects removed must remain intact for additional study by the medical team.
Announce the amount of time they have to design and build (1 hour recommended).
Use a timer or an on-line stopwatch (count down feature) to ensure you keep on time. (www.online-stopwatch.com/full-screen-stopwatch). Give students regular “time checks” so they stay on task. If they are struggling, ask questions that will lead them to a solution quicker.
Students meet and develop a plan for their surgical instrument. They agree on materials they will need, write/draw their plan, and present their plan to the class. Teams may trade unlimited materials with other teams to develop their ideal parts list.
Teams build their designs.
Place three small objects in the shoebox and mark their location with a pencil. Surround each object with dominos (standing up lengthwise). The dominos should be close to the objects but not touching them. Mark the position of each domino.
Teams test their surgical instrument design by removing the 3 small objects from the shoebox without knocking over any of the dominos in the box.
As a class, discuss the student reflection questions.
For more content on the topic, see the “Digging Deeper” section.

Student Reflection (engineering notebook)

Did you succeed in creating a surgical instrument that could successfully remove the three objects? If not, why did it fail?
Did you decide to revise your original design or request additional materials while in the construction phase? Why?
Did you negotiate any material trades with other teams? How did that process work for you?
If you could have had access to materials that were different than those provided, what would your team have requested? Why?
Do you think that engineers have to adapt their original plans during the construction of systems or products? Why might they?
If you had to do it all over again, how would your planned design change? Why?
What designs or methods did you see other teams try that you thought worked well?
Do you think you would have been able to complete this project easier if you were working alone? Explain…
What kinds of issues do you think biomedical engineers need to consider when designing medical instruments?

Time Modification

The lesson can be done in as little as 1 class period for older students. However, to help students from feeling rushed and to ensure student success (especially for younger students), split the lesson into two periods giving students more time to brainstorm, test ideas and finalize their design. Conduct the testing and debrief in the next class period.

Engineering Design Process

Background Concepts

Evolution of Surgical Instruments

Engineering Biomedical Devices

Bioengineering or Biomedical Engineering is a discipline that advances knowledge in engineering, biology, and medicine — and improves human health through cross disciplinary activities that integrate the engineering sciences with the biomedical sciences and clinical practice. Bioengineering/Biomedical Engineering combines engineering expertise with medical needs for the enhancement of health care. It is a branch of engineering in which knowledge and skills are developed and applied to define and solve problems in biology and medicine. Those working within the bioengineering field are of service to people, work with living systems, and apply advanced technology to the complex problems of medical care. Biomedical engineers may be called upon to design instruments and devices, to bring together knowledge from many sources to develop new procedures, or to carry out research to acquire knowledge needed to solve new problems. Major advances in Bioengineering include the development of artificial joints, magnetic resonance imaging (MRI), the heart pacemaker, arthroscopy, angioplasty, bioengineered skin, kidney dialysis, and the heart-lung machine.

Brief History of Surgery

Surgery is the diagnosis and treatment of physical ailments or injuries by cutting bodily tissue with instruments. The word surgery comes from the Greek meaning “hand work”. Surgeries have been performed since prehistoric times. The first type of surgery to be performed was known as trepanation, or the process of making holes in the skull to relieve pressure and treat other types of ailments. Ancient Egyptians are believed to have performed dental and brain surgeries.

A man named Susrutha, who lived in 400 B.C. in what would be present day India, is often considered the father of surgery. He is believed to have performed several different types of surgical procedures, even rhinoplasty (cutting off the nose was a form of punishment during these times)! His writings known as the Susrutha Samhita have become a very important part of medical history.

Until the 16th century surgeries such as amputations and bone settings were performed by surgeons who were often also the town barber! During the 16th century the work of Leonardo da Vinci and Andreas Vesalius helped shed light on the human anatomy which was critical to the evolution of surgery. The introduction of anesthetics and sterilization in the 19th century helped make surgery much safer. Advancements such as blood typing, xrays and lasers during the 20th century helped shape surgery as we know it today.

Traditional Surgical Instruments

During surgery a number of different types of tools and instruments are utilized. Foam positioners may be used to get a patient’s body into the proper position for surgery. After anesthesia has been administered, different types of cutting instruments may be used to make incisions in the body or to get through bone. These may include instruments such as scalpels and drill bits.

Evolution of Surgical Instruments

After an incision has been made, an instrument known as a retractor may be used to hold open an incision while a surgical procedure is being performed. If surgery is being performed on a joint, an instrument known as a distractor may be used to open up the space between the two bones at the joint, giving the surgeon room to work. Other tools known as dilators and specula may be used to open up narrow passageways within the body so the surgeon is able to access these areas. A device known as forceps may be used during a surgical procedure to manipulate body parts.

Syringes and suction devices are used to introduce and remove fluids from the body respectively. Sometimes during surgery blood vessels or organs need to be clamped using devices known as clamps or occluders. If measurements of any kind need to be taken during surgery, instruments such as rulers or calipers may be used. After surgery has been completed, incisions are sewn shut with stitches or closed with instruments such as surgical staplers.

In addition to these basic surgical instruments a variety of technological equipment is also used during surgical procedures. Imaging systems may be used to guide the surgeon during a procedure. During certain surgeries, lasers may be used to close off nerve endings or blood vessels or remove tumors. A piece of equipment known as a cryotome may be used to freeze and preserve sections of tissue for later examination.

Minimally Invasive Surgical Instruments

During the 1980’s medical professionals began using minimally invasive techniques to perform surgeries on their patients. Minimally invasive surgery also known as endoscopy or laparoscopy was intended as a way to perform surgical procedures with the least possible amount of trauma to a patient. Minimally invasive surgery involves inserting small fiber optic cameras called endoscopes or laparoscopes into tiny incisions in the patient’s body to help guide surgeons during a procedure. A pointed cylindrical cutting instrument known as a trocar may be used to make small incisions and introduce laparoscopic instruments. Additional instruments may be used to guide and carry the cameras through the body.

Although laparoscopic surgery has numerous benefits, it has some limitations. One drawback is that a surgeon is only able to view images of the procedure on a two dimensional screen. Another limitation is that due to the kinds of instruments required for these procedures, the surgeon has a somewhat restricted range of motion when performing laparoscopic surgery.

Surgical Robots

Robots began to be used for surgical purposes during the mid-1980’s. The first robotic surgical procedure occurred in 1985 when a robot known as the PUMA 560 was used during a brain biopsy. Subsequent surgical robots were used to perform prostate surgery and hip replacements. In the late 1990s, the da Vinci Surgical System was introduced. The system is comprised of three main components: a console for the surgeon, 4 arms which can be controlled remotely, and a high definition 3 dimensional system. Each of the robotic arms possesses moveable surgical instruments which can be controlled by the surgeon. The instruments enter the body through flexible tubes known as cannulas.

The surgical system has the ability to scale the surgeon’s hand movements and filter out any tremors to create precise movements. A camera captures the surgery which is then shown on the surgeon’s console in 3D. The da Vinci system is used in the United States and Europe for hysterectomies, prostate cancer surgery, and mitral valve repair.

There are a number of benefits as well as drawbacks to robotic surgery. Robotic surgery can be performed remotely, which is useful when there may be a lack of skilled professionals in a particular location. Robotic surgery also has the benefits of using tinier incisions, resulting in faster healing time for patients. The surgical robot arm has much greater articulation than a surgeon would normally have giving the surgeon greater flexibility. The 3D imaging system also gives the surgeon enhanced visibility. Drawbacks to robotic surgery include the level of training needed to operate the system and the high cost of acquiring a robotic surgical system.

Vocabulary

Bioengineering or Biomedical Engineering: A discipline that advances knowledge in engineering, biology, and medicine — and improves human health through cross disciplinary activities that integrate the engineering sciences with the biomedical sciences and clinical practice.
Constraints: Limitations with material, time, size of team, etc.
Criteria: Conditions that the design must satisfy like its overall size, etc.
Dilators and specula may be used to open up narrow passageways within the body so the surgeon is able to access these areas.
Distractor: Instrument used to open up the space between the two bones at the joint, giving the surgeon room to work.
Engineers: Inventors and problem-solvers of the world. Twenty-five major specialties are recognized in engineering (see infographic).
Engineering Design Process: Process engineers use to solve problems.
Engineering Habits of Mind (EHM): Six unique ways that engineers think.
Forceps: Instrument used during a surgical procedure to manipulate body parts.
Iteration: Test & redesign is one iteration. Repeat (multiple iterations).
Prototype: A working model of the solution to be tested.
Retractor: Instrument used to hold open an incision while a surgical procedure is being performed.
Surgery: The diagnosis and treatment of physical ailments or injuries by cutting bodily tissue with instruments.
Surgical Instrument: Tool used to perform surgery.
Syringes and Suction: Devices used to introduce and remove fluids from the body respectively.

Dig Deeper

Internet Connections

Recommended Reading

New How Things Work: From Lawn Mowers to Surgical Robots and Everything in Between (ISBN: 978-0792269564)

Writing Activity

Create a technical sheet for your new surgical instrument.

Curriculum Alignment

Alignment to Curriculum Frameworks

Note: Lesson plans in this series are aligned to one or more of the following sets of standards:

U.S. Science Education Standards (http://www.nap.edu/catalog.php?record_id=4962)
U.S. Next Generation Science Standards (http://www.nextgenscience.org/)
International Technology Education Association’s Standards for Technological Literacy (http://www.iteea.org/TAA/PDFs/xstnd.pdf)
U.S. National Council of Teachers of Mathematics’ Principles and Standards for School Mathematics (http://www.nctm.org/standards/content.aspx?id=16909)
U.S. Common Core State Standards for Mathematics (http://www.corestandards.org/Math)
Computer Science Teachers Association K-12 Computer Science Standards (http://csta.acm.org/Curriculum/sub/K12Standards.html)

National Science Education Standards Grades K-4 (ages 4 – 9)

CONTENT STANDARD A: Science as Inquiry

As a result of the activities, all students should develop

Abilities necessary to do scientific inquiry

CONTENT STANDARD C: Life Science

As a result of the activities, all students should develop an understanding of

Characteristics of organisms

CONTENT STANDARD E: Science and Technology

As a result of the activities, all students should develop an understanding of

Abilities of technological design
Understanding about science and technology

CONTENT STANDARD G: History and Nature of Science

As a result of the activities, all students should develop understanding of

Science as a human endeavor

National Science Education Standards Grades 5-8 (ages 10 – 14)

CONTENT STANDARD A: Science as Inquiry

As a result of the activities, all students should develop

Abilities necessary to do scientific inquiry

CONTENT STANDARD C: Life Science

As a result of the activities, all students should develop an understanding of

Structure and functions in living systems

CONTENT STANDARD E: Science and Technology

As a result of the activities, all students should develop an understanding of

Abilities of technological design
Understanding about science and technology

CONTENT STANDARD G: History and Nature of Science

As a result of the activities, all students should develop understanding of

History of science

National Science Education Standards Grades 9-12 (ages 14-18)

CONTENT STANDARD A: Science as Inquiry

As a result of the activities, all students should develop

Abilities necessary to do scientific inquiry

CONTENT STANDARD C: Life Science

As a result of the activities, all students should develop understanding of

Matter, energy and organization in living systems

National Science Education Standards Grades 9-12 (ages 14-18)

CONTENT STANDARD E: Science and Technology

As a result of the activities, all students should develop an understanding of

Abilities of technological design
Understanding about science and technology

CONTENT STANDARD G: History and Nature of Science

As a result of the activities, all students should develop understanding of

Historical perspectives

Next Generation Science Standards Grades 3-5 (Ages 8-11)

Engineering Design

Students who demonstrate understanding can:

3-5-ETS1-1.Define a simple design problem reflecting a need or a want that includes specified criteria for success and constraints on materials/time/cost.
3-5-ETS1-2.Generate and compare multiple possible solutions to a problem based on how well each is likely to meet criteria/constraints of the problem.
3-5-ETS1-3.Plan and carry out fair tests in which variables are controlled and failure points are considered to identify aspects of a model or prototype that can be improved.

Next Generation Science Standards Grades 6-8 (Ages 11-14)

Engineering Design

Students who demonstrate understanding can:

MS-ETS1-2 Evaluate competing design solutions using a systematic process to determine how well they meet the criteria and constraints of the problem.

Next Generation Science Standards Grades 9-12 (Ages 14-18)

Engineering Design

Students who demonstrate understanding can:

HS-ETS1-2.Design a solution to a complex real-world problem by breaking it down into smaller, more manageable problems that can be solved through engineering.

Standards for Technological Literacy – All Ages

Design

Standard 8: Students will develop an understanding of the attributes of design.
Standard 9: Students will develop an understanding of engineering design.
Standard 10: Students will develop an understanding of the role of troubleshooting, research and development, invention and innovation, and experimentation in problem solving.
Standard 14: Students will be able to develop an understanding of and be able to select and use medical technologies.

Student Worksheet

You are a team of engineers who have been given the challenge to design a surgical instrument. This instrument will need to be able to perform very precise surgical procedures without disturbing any of the surrounding tissue or organs. To test your surgical instrument you will need to remove 3 small objects from a shoe box without knocking over any of the dominos in the box. All of the components of your surgical instrument must be physically connected. Materials such as pencils cannot be broken in half. All objects removed must remain intact for additional study by the medical team.

Planning Stage

Meet as a team and discuss the problem you need to solve. Then develop and agree on a design for your surgical instrument. You’ll need to determine what materials you want to use.

Draw your design in the box below, and be sure to indicate the description and number of parts you plan to use. Present your design to the class.

Design:

Materials Needed:

You may choose to revise your teams’ plan after you receive feedback from class.

Construction Phase

Build your surgical instrument. During construction you may decide you need additional materials or that your design needs to change. This is ok – just make a new sketch and revise your materials list.

Testing Phase

Each team will test their surgical instrument. Be sure to watch the tests of the other teams and observe how their different designs worked.

Evaluation Phase

Evaluate your teams’ results, complete the evaluation worksheet, and present your findings to the class.

Use this worksheet to evaluate your team’s results in the “Smooth Operator” lesson: