1 Nick Ladwig, Kevin Hanson,Nick Ladwig, Kevin Hanson, Kara Barnhart, Daniel JonovicKara Barnhart, Daniel Jonovic Client: Dr. Jon GouldClient: Dr. Jon Gould Advisor: Professor Mitch TylerAdvisor: Professor Mitch Tyler

2 Nissen Fundoplication Treatment for chronic heartburn by GERD Daily problem for 15 million Americans Upper stomach wrapped around esophagus Liver retracted to expose surgical site http://adam.about.com/surgery/Gastroesophageal-reflux-series.htm Fundoplication

3 Current Trend Single incision laparoscopic – Need single port liver retractor Other Applications – Adrenal gland, Heller’s, Lap Band, Bariatric – 200,000 surgeries/yr http://adam.about.com/surgery/Gastroesophageal-reflux-series.htm Umbilicus (SILS Port) Umbilicus (SILS Port)

4 Motivation Decrease # of incisions – Cosmetic – Less risk of infection – Patient satisfaction http://www.skininfection.com/images/ImgLib/Large_380/WoundInfection/Surgery_Sutures.jpg http://my.clevelandclinic.org/PublishingImages/Urology/umbilical_incision.jpg

5 Nathanson Retractor http://adam.about.com Gastroesophageal Junction Dedicated port required Dedicated port required Liver

6 Problem Statement Use in single incision surgery Retract left liver lobe to abdominal wall Expose gastroesophogeal junction Safely deployed and removed Fit through laparoscopic port http://www.covidien.com/campaigns/pagebuilder.aspx?topicID=175991&page=SILSPort:Main

8 Last Semester Design Deployment Retraction

9 Deployment Procedure http://www.meb.uni-bonn.de/cancer.gov 1. Attach suture to left crus 2. Thread suture through retractor 3. Insert retractor 4. Deploy retractor 5. Move retractor under liver 6. Pass suture out abdominal wall 7. Apply tension to retract liver 1 1 6 6

10 Hinge Design 1: Screw Arm has male threads Base has female threads Deployment – Arms ½ screwed, straight Retraction – Surgeon screws arms until tight – Requires additional tool – When tightened arms at 45° and 135° Female Threads Female Threads Male Threads Male Threads

11 Hinge Design 2: Detents Arm axle fits into base – rotation axis Surgeon manually moves arms into position Spring-coupled peg fits into 1 of 2 base detents – Detents lock arms for deployment or retraction – Spring relaxed with peg in detents Axle Detents Peg

12 Hinge Design 3: Spring Loaded Hollow cylinder axle – Torsional spring inside connecting arm to base Deployment – Straight arms – Torsional spring in tension Retraction – Tension release rotates arms – Spring relaxed Hollow Axle Torsional Spring

13 Design Matrix WeightScrewDetentsSpring Loaded Ease of Fabrication15%117 Ease of Deployment / Removal25%131621 Reliability20%151618 Cost10%967 Risk for Trauma30%29 28 Total777485

14 Future Work Determine spring constant Construct prototype Test device Submit invention disclosure

15 Questions?