John J van den Dobbelsteen

Delft University of Technology | TU · Department of Biomechanical Engineering

Literature proposes numerous initiatives for optimization of the Operating Room (OR). Despite multiple suggested strategies for the optimization of workflow on the OR, its patients and (medical) staff, no uniform description of ‘optimization’ has been adopted. This makes it difficult to evaluate the proposed optimization strategies. In particular,...

Purpose: A proportion of patients are not directly eligible for prostate brachytherapy (BT) due to pubic arch interference (PAI). Constraints in positioning sources behind the pubic arch due to linear, horizontal needle paths, may hamper effective irradiation of the target volume. This work evaluated the effect of prostate volume (Vp) and patient...

Background: Newly developed techniques for minimally invasive abdominal wall reconstruction (AWR) for complex ventral hernia are continuously evolving. In order to achieve hernia defect closure, the aponeurotic edges of the hernia defect need to be approximated. Currently, surgeons have no way to objectively measure and quantify the traction requir...

Steerable instruments allow for precise access to deeply-seated targets while sparing sensitive tissues and avoiding anatomical structures. In this study we present a novel omnidirectional steerable instrument for prostate high-dose-rate (HDR) brachytherapy (BT). The instrument utilizes a needle with internal compliant mechanism, which enables dist...

Background Entrainment test methods are described in most European standards and guidelines to determine the protected area for Ultra-Clean Ventilation (UCV) systems. New UCV systems, such as temperature-controlled airflow (TcAF) and controlled-dilution ventilation (cDV) claim the whole Operating Room (OR) to be ultra-clean. Current test standards...

Background Operating room planning is a complex task as pre-operative estimations of procedure duration have a limited accuracy. This is due to large variations in the course of procedures. Therefore, information about the progress of procedures is essential to adapt the daily operating room schedule accordingly. This information should ideally be...

Purpose: To present a novel methodical approach to compare visibility of percutaneous needles in ultrasound images. Methods: A motor-driven rotation platform was used to gradually change the needle angle while capturing image data. Data analysis was automated using block-matching-based registration, with a tracking and refinement step. Every 25 fr...

This study reports on the effects of insertion velocity, needle tip geometry and needle diameter on tissue deformation and maximum insertion force. Moreover, the effect of multiple insertions with the same needle on the maximum insertion force is reported. The tissue deformation and maximum insertion force strongly depend on the insertion velocity...

Existing challenges in surgical education (See one, do one, teach one) as well as the Covid-19 pandemic make it necessary to develop new ways for surgical training. This is also crucial for the dissemination of new technological developments. As today’s live transmissions of surgeries to remote locations always come with high information loss, e.g....

Microbrachytherapy with radioactive holmium-166 (¹⁶⁶Ho) microspheres (MS) has the potential to be an effective treatment method for brain malignancies. Direct intratumoural delivery of ¹⁶⁶Ho-MS and dose coverage of the whole tumour are crucial requirements. However, currently no dedicated instruments for controlled intratumoural delivery exist. Thi...

Link - https://zenodo.org/record/4923036#.YNS17KgzaHs Cooperative Brachytherapy (CoBra) project intends to perform localized cancer treatment and biopsy of soft-tissues. The robot executes needle insertion within the MRI-scanner, performing adaptive prostate brachytherapy under real-time (RT) imaging. An active steerable-needle under closed-loop c...

Awarded as Best Poster at HSMR2021. CoBra (Cooperative Brachytherapy) project 2018-2022.

Purpose To investigate the performance of two microwave ablation (MWA) systems regarding ablation volume, ablation shape and variability. Materials and Methods In this ex vivo study, the Emprint and Amica MWA systems were used to ablate porcine livers at 4 different settings of time and power (3 and 5 minutes at 60 and 80 Watt). In total, 48 ablat...

Accurate needle placement in deep-seated liver tumours can be difficult. In this work, we disclose two new manually controlled steerable needles for 17G radio-frequency ablation probe placement. The needles contain stylets with embedded compliant joints for active tip articulations, and concentric tubes for (curved-path) guidance. Needle steering w...

Introduction: The current COVID-19 pandemic has caused large shortages in personal protective equipment, leading to hospitals buying their supplies from alternative suppliers or even reusing single-use items. Equipment from these alternative sources first needs to be tested to ensure that they properly protect the clinicians that depend on them. T...

The SARS-CoV-2 pandemic resulted in shortages of production and test capacity of FFP2-respirators. Such facemasks are required to be worn by healthcare professionals when performing aerosol-generating procedures on COVID-19 patients. In response to the high demand and short supply, we designed three models of facemasks that are suitable for local p...

Objective There are widespread shortages of personal protective equipment as a result of the COVID-19 pandemic. Reprocessing filtering facepiece particle (FFP)-type respirators may provide an alternative solution in keeping healthcare professionals safe. Design Prospective, bench-to-bedside. Setting A primary care-based study using FFP-2 respirat...

Aim: this literature review was conducted to evaluate liver biopsy adequacy, including total core length (TCL), number of portal tracts (PT), fragmentation and complication rates, as a function of needle type and gauge. Method: a systematic electronic search was performed in the Web of Science and Google Scholar databases, according to the PRISMA s...

Objective: There are widespread shortages of personal protective equipment as a result of the coronavirus disease 2019 (COVID-19) pandemic. Reprocessing filtering facepiece respirators may provide an alternative solution in keeping health care professionals safe. Design: prospective, bench-to-bedside Setting: A primary care-based study using filter...

A steam sterilization method is evaluated, measured on an acceptable outcome giving repeating satisfactory results of sterilized the mouth masks. The permeability of mouth masks are examined using a Solair 3100 particle counter from Lighthouse Benelux (www.lighthousetest.com). https://repository.tudelft.nl/islandora/object/uuid:078a3733-84d6-4d4a-...

The filtration efficiencies of protective masks are evaluated with use of several different types of airborne particle counters from Lighthouse Benelux (www.lighthousetest.com). These particle counters are intended for clean room validation and enable the measurement of filter integrity for particle sizes between 0.3 and 25 μm. https://repository....

Purpose The purpose is to design and validate an anthropomorphic polyvinyl alcohol (PVA) liver phantom with respiratory motion to simulate needle-based interventions. Such a system can, for example, be used as a validation tool for novel needles. Methods Image segmentations of CT scans of four patients during inspiration and expiration were used t...

Background Surgical Process Modelling (SPM) offers the possibility to automatically gain insight in the surgical workflow, with the potential to improve OR logistics and surgical care. Most studies have focussed on phase recognition modelling of the laparoscopic cholecystectomy, because of its standard and frequent execution. To demonstrate the bro...

During percutaneous coronary interventions (PCI), a guidewire is used as an initial way of accessing a specific vasculature. There are varieties of guidewires on the market and choosing an appropriate one for each case is critical for a safe and successful intervention. The main objective of this study is to predict the behavior of the guidewire an...

During ultrasound-guided percutaneous interventions, needle localization can be a challenge. To increase needle visibility, enhancements of both the imaging methods and the needle surface properties have been investigated. However, a methodical approach to compare potential solutions is currently unavailable. The work described here involves automa...

Background and objectives Learning epidural anesthesia traditionally involves bedside teaching. Visualization aids or a simulator can help in acquiring motor skills, increasing patient safety and steepening the learning curve. We evaluated the face and construct validity of the TU-Delft Epidural Simulator and the effect of needle visualization. Me...

Introduction: Electrosurgery is used in 80% of surgical procedures. The technique allows surgeons to skilfully dissect tissues and achieve haemostasis. Since improper use of electrosurgery can lead to serious adverse events, training is required to potentially reduce the number and severity of these events. In this study we evaluate education and t...

Purpose: Accurate and precise needle placement is of utmost importance in interventional radiology. However, targeting can be challenging due to, eg, tissue motion and deformation. Steerable needles are a possible solution to overcome these challenges. The present work studied the clinical need for steerable needles. We aimed to answer three subque...

Background: During the implementation of new interventions (i.e., surgical devices and technologies) in the operating room, surgical safety might be compromised. Current safety measures are insufficient in detecting safety hazards during this process. The aim of the study was to observe whether surgical teams are capable of measuring surgical safe...

Realistic physical liver phantoms are needed in interventional radiology for validation of novel instruments and for training of medical residents, because the use of biological tissues is not always a feasible option. Most research on liver phantoms focuses on the imaging mimicking qualities. However, an ideal liver phantom should also mimic liver...

Needles are advanced tools commonly used in minimally invasive medical procedures. The accurate manoeuvrability of flexible needles through soft tissues is strongly determined by variations in tissue stiffness, which affects the needle-tissue interaction and thus causes needle deflection. This work presents a variable stiffness mechanism for percut...

Guidewires and catheters are used during minimally invasive interventional procedures to traverse in vascular system and access the desired position. Computer models are increasingly being used to predict the behavior of these instruments. This information can be used to choose the right instrument for each case and increase the success rate of the...

Background and objectives: Neuraxial blockade using a midline approach can be challenging. Part of this challenge lies in finding the optimal approach of the needle to its target. The present study aimed at finding (1) the optimal point of insertion of the needle between the tips of 2 adjacent spinous processes and (2) the optimal angle relative t...

More and more medical technology is finding its way to the operating room, which is a great benefit for efficiency and patient safety. However, it may also cause disturbances in the workflow. Living labs and Test Beds such as a Research Operating Room can provide a real-life setting in which safe implementation/ research in the field of work proces...

Medical phantoms can be used to study needle-tissue interaction and to train medical residents. The purpose of this research is to study the suitability of polyvinyl alcohol (PVA) as a liver tissue mimicking material in terms of needle-tissue interaction. Insertions into ex-vivo human livers were used for reference. Six PVA samples were created by...

The benefits of electrosurgery have been acknowledged since the early 1920s, and nowadays more than 80% of surgical procedures involve devices that apply energy to tissues. Despite its widespread use, it is currently unknown how the operator’s choices with regard to instrument selection and application technique are related to complications. As suc...

Steering of needles involves the planning and timely modifying of instrument-tissue force interactions to allow for controlled deflections during the insertion in tissue. In this work, the effect of tip shape on these forces was studied using 10 mm diameter needle tips. Six different tips were selected, including beveled and conical versions, with...

A needle-tissue interaction experiment has been carried out, by inserting the inner needle of a trocar needle into two ex-vivo human livers. The dataset contains the forces that act on the needle during insertion and retraction into the livers. In addition, a MATLAB code file is included that provides base-level analysis of the data and generates f...

Background Minimally invasive surgery (MIS) is frequently compromised by surgical flow disturbances due to technology- and equipment-related failures. Compared with MIS in a conventional cart-based OR, performing MIS in a dedicated integrated operating room (OR) is supposed to be beneficial to patient safety. The aim of this study was to compare a...

A range of complex percutaneous procedures, such as biopsy or regional anesthesia, rely heavily on accurate needle insertion. Small variations in the mechanical properties of the pierced tissue can however cause deviations from the projected needle path and can thus result in inaccurate placement of the needle. Navigation of a rigid needle towards...

Patient safety increasingly depends on health professionals' ability to deal with the technological, organisational and social complexity of their working environment.1 The operating room (OR) is such a complex dynamic environment, not just because of the increasing use of technology, such as information technology (IT), monitoring and surgical dev...

As the connection at the proximal tip plays an important role for sensing guidewires, we compared various sensing guidewires with regard to their proximal connectors. The strengths and weaknesses of each are discussed and recommendations for future development are provided. A literature search limited to the English language for the time period fro...

Operating Room (OR) scheduling is crucial to allow efficient use of ORs. Currently, the predicted durations of surgical procedures are unreliable and the OR schedulers have to follow the progress of the procedures in order to update the daily planning accordingly. The OR schedulers often acquire the needed information through verbal communication w...

Purpose: To study the ability of a human operator to manually correct for errors in the needle insertion path without partial withdrawal of the needle by means of an active, tip-articulated steerable needle. Materials and methods: The needle is composed of a 1.32-mm outer-diameter cannula, with a flexure joint near the tip, and a retractable sty...

Mark Vogt,1 Dennis J van Gerwen,2 John J van den Dobbelsteen,2 Martin Hagenaars,3 1Department of Anesthesiology, Erasmus MC Sophia Children Hospital, Rotterdam, the Netherlands; 2Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands; 3Department of Anesthesiology, Canisius Wilhelmina Ziekenhuis, Nijmegen, t...

Background: Unavailability of instruments is recognised to cause delays and stress in the operating room, which can lead to additional risks for the patients. The aim was to provide an overview of the hazards in the entire delivery process of surgical instruments and to provide insight into how Information Technology (IT) could support this proces...

Each year, in the Netherlands alone, more than 50.000 percutaneous procedures are performed for treatment or for removal of tissue from possibly diseased organs, of which 30% return non-diagnostic due to erroneous needle targeting, often as a result of non-homogeneity of the penetrated tissue. In this study, we aim to facilitate needle targeting by...

This study aims to develop and evaluate a manually controlled steerable needle that is compatible with and visible on MRI to facilitate full intra-procedural control and accurate navigation in percutaneous interventions. The steerable needle has a working channel that provides a lumen to a cutting stylet or a therapeutic instrument. A steering mech...

The unavailability of the required surgical instruments at the start of a procedure is undesirable. It causes delays and stress in the operating room (OR), which can lead to additional risks for the patients. Issues with availability of surgical instruments may become visible just before the start of the procedure but are induced earlier in the del...

New surgical techniques and technology have simplified laparoscopic hysterectomy and have enhanced the safety of this procedure. However, the surgical colpotomy step has not been addressed. This study evaluates the surgical colpotomy step in laparoscopic hysterectomy with respect to difficulty and duration. Furthermore, it proposes an alternative r...

Full text, open access: http://www.openaccessjournals.com/articles/catheters-and-guide-wires-for-interventional-mri-are-we-there-yet.pdf?aid=9440 Abstract: Clinical feasibility of interventional MRI has been shown for a number of procedures. However, MRI-guided endovascular interventions have not yet reached clinical routine due to the lack of sui...

Objective: To assess and compare the rate of procedure-related complications after intrauterine treatment of spina bifida by endoscopic surgery and by open fetal surgery. Methods: Systematic literature searches in PubMed and SCOPUS databases were performed on 20 September 2015 to identify randomized controlled trials and observational studies on...