The Journey of the Steerable Punch

This innovation did not come easily, though. The Steerable Punch is the result of more than a decade of cooperative research between Dutch hospitals and universities, which joined forces to give surgeons an instrument that truly matches their needs.

By Surgeons, for Surgeons

It all started with a realization by Dr.ir. Gabriëlle Tuijthof about the available instrumentation in OR’s. Tuijthof, a researcher from Amsterdam UMC and Delft University of Technology, noticed in 2000 how surgeons struggled with the stiff and pre-bent instrumentation during minimally invasive surgeries. She started researching into solutions for the reachability problem but, after some years and several research students, only a few improvements were made. Subsequently, she decided to bring Prof.dr. Gino Kerkhoffs MD into the research team.

Prof.dr. Kerkhoffs was a prominent arthroscopic surgeon at Amsterdam UMC, who shared Dr.ir. Tuijthof’s drive for innovative surgical tools. In his years of experience, he noticed that the amount of pre-bent instruments required per surgery was too high, just to reach areas in the knee that are difficult to access. The constant exchange of instruments was a problem for surgeons, who started to develop wrist pain from holding the instruments in uncomfortable positions, in an effort to reach the surgical site without exchanging tools. As a consequence, patients were also suffering from portal pain in the areas where extra force was applied using the inadequate instruments.

Prof.dr. Kerkhoffs joined Dr.ir. Tuijthof’s quest for developing better tools for arthroscopy, following three basic guidelines: that the new instrument must replace the multiple pre-bent instruments currently used, that it must be easy to use for surgeons, and that it must be cleanable and reusable. And so the research began.

Supporting Prof.dr. Kerkhoffs’s vision, an elite test team of eleven Dutch surgeons participated in the joint research between hospitals and Delft University of Technology.

Dr.ir. Tim Horeman was at that time a young researcher at Delft University of Technology, and he joined this ambitious project under the supervision of Dr.ir. Tuijthof. Together with his supervisor, Horeman designed a steerable system based on a purely mechanical, simple and cable-free approach. The invention was quickly taken in by the research team, and the first prototype of a steerable arthroscopic punch was made since it is the instrument mostly used for meniscectomies.

The initial versions of the Steerable Punch featured a plastic ergonomic handle believed to be more comfortable for surgeons. The instrument passed the force tests and the cadaver tests successfully, confirming that the new mechanism is strong enough to withstand the forces involved in a typical meniscectomy. However, most of the surgeons involved in the project complained about the handle’s design. They were already used to the simple scissors-like handle of traditional pre-bent instruments, and they did not feel comfortable with the new design.

Considering the surgeons’ wishes, the final version of the Steerable Punch was produced with a standard handle completely in steel.

Four Patents and Counting

The research culminated in two patents filed in 2013 and several scientific articles. However, it was not the end of the journey for the Steerable Punch. Both surgeons and engineers were eager to use the instrument in real environments and to bring it to the market. It was time to share this innovation with the world. Prof.dr. Kerkhoffs was very satisfied with the instrument developed and could not wait to start performing surgeries with it.

Under the guidance of Surge-on Medical B.V., a med-tech company founded in 2015 by Dr.ir. Tim Horeman and Benno Groosman MScBA to launch the Steerable Punch in the market, further studies took place. The steerable mechanism was improved and protected with two extra patents in 2017, and the cleanability of the Steerable Punch was confirmed.

At the end of 2018, the Steerable Punch obtained the ethical committee’s approval to start with the first in-patient surgeries to be performed at the Amsterdam UMC hospital, under the leadership of Prof.dr. Gino Kerkhoffs and Dr.ir. Gabriëlle Tuijthof. The Dutch Ministry of Health (by its Health and Youth Care Inspectorate) has now also given the green light to perform surgeries with our innovative surgical instrument. This will be an important milestone that many have been waiting for since surgeons around the world have already shown their interest in using the Steerable Punch in their procedures.

Just the Tip of the Iceberg

After the enthusiastic welcome that the Steerable Punch had received through these years, Dr.ir. Tim Horeman started to receive many requests for new instruments from surgeons in various surgical fields. Since the patented steerable mechanism can be adapted to any instrument with a cylindrical shaft, Horeman started to research into steerable laparoscopic instruments.

Soon, the Steerable Punch will also be adapted with other tips such as those of arthroscopic graspers, scissors and oval punches to expand the presence of steerable instruments in orthopedy.

“What makes me happy the most is to develop something that will make surgeons smile when they hold our instruments for the first time,” says Tim. “That is the goal that you want to achieve when you’re a researcher as I am, and I want to keep innovating in steerable instruments since it’s what surgeons request.”