Comparing scissors and scalpels to a novel surgical instrument: a biomechanical sectioning study

If you're an athlete, or even if you just know the basics about ligaments, you know that when they tear, recovery takes a looong time—months, sometimes more. Ligament injuries are common for athletes, often requiring surgery and therapy, and they come back months later as a different athlete.

But this article isn’t about sports injuries. It’s about a surgery where the solution is... to cut a ligament in half—on purpose. Surprisingly, this isn’t rare. It’s a common and effective surgery in the U.S. for treating carpal tunnel syndrome.

Let me explain: there’s a tendon in your hand that passes through the wrist to help you move it. Beneath that tendon is a nerve that runs through the carpal tunnel. When that tunnel gets tight, the median nerve gets compressed, causing tingling or pain in the hand.

There are therapies for this, but when they don’t work, doctors go in and cut the ligament. Pretty wild, right? And the most curious part comes next—a creative connection between two fields of biomedical engineering, biomaterials and biomechanics, that’s helping solve the recovery process from that split ligament.The process of connecting ideas to address real-world problems is what makes this field so exciting.

 

Surgical instrumentation used to perform carpal tunnel decompression surgery and other similar surgeries has not changed for a long time. This leads to injuries to the surrounding tissue of patients as a result of direct damage from the surgical tools. So, biomedical engineers and orthopedic surgeons have partnered to solve this problem. They used advanced biomechanical testing, a field that applies biological concepts, such as surrounding tissue, ligaments, and nerves, and studies the mechanical forces that are acting on them or by them.

 

The reason why damage occurs to the median nerve (the nerve that surgeons want to release pressure from) is caused by the surgical instruments. These instruments are common for all surgeries and are effective for their utility, but for decompression surgery, they are less effective: there is a 0.49% incidence of tissue damage caused by the surgeon. The novel instrumentation was created with the utility of scissors and the sharpness of the scalpel. This improves safety and efficiency (copy from the article). Although there are not only benefits, this instrument has limited flexibility and range of movement compared to the scalpel or scissors alone. This makes it less maneuverable.

 

This design is important for the field of orthopedic surgery because it offers a device that requires less force, has less risk, and is more precise. This improves the confidence of patients that their decompression surgery will have a much lower risk.

 

This instrument serves as an illustration of conventionality for surgeons. It is interesting how engineers and scientist have created a tool that is easy to use and does not require the surgeon to learn about  a new method or a new apparatus. It is the same as it was, just with the combination of the tools they used. Also, they accomplished their task by only creating ONE apparatus that could do TWO key tasks: separate the tissue and cut the tendon, going here for simplicity.

 

Now, here comes the most interesting part, where creativity plays the main role.

 

For carpal/cubital tunnel release surgery, they have to cut an important ligament that is compressing the nerve, either the median nerve or the ulnar nerve ( median located at the wrist and ulnar located at the elbow) . Well, how is the patient going to recover that big cut, because it is cut in between and is no longer connected to the bones on both sides? Here comes the creative connection: the ligament is tissue, and what the patient needs is to recover that tissue. So, what can be used for this? Granular hydrogel scaffolds, a biomaterial developed by Stanford Medicine, which promotes tissue recovery in a more precise and effective manner. Perfect for this surgery. It is such a novel creation, and I wrote about it  here. That is how I learned about it. This new hydrogel scaffold is more accurate, quick ,and effective than the one commonly used, therefore it better promotes tissue recovery. 

 

This is why learning about various fields, such as biomaterials, bioinstrumentation, and biomechanics, allows you to make connections and find solutions.

 

Conclusion

 

In this case, it is fundamental to learn about various fields. As you have seen, knowing about biomaterials allows you to solve post-surgical problems. This opens space for solutions and creative connections, while moving ahead in knowledge. The tool explained appears simple—a combination of tools—yet it is now more effective than what was being used prior.

 

If you would like to look further into this instrument, read about it here. They present the tests that they conducted, with all the data comparisons and more about its benefits and areas of improvement.

 

This article was published by BioMed Central from the Department of Biomedical Engineering.

 

I do not claim the post-surgical GHS, this concept had already been developed at the time, you can find about it here. However, that does not lower the significance of the idea. It emerged without prior knowledge of its utility , simply because I learned about it through a Stanford report.

 The process of connecting unrelated ideas to address real-world problems is what makes this field so exciting.