The healthcare sector, while dedicated to promoting human well-being, is also a major contributor to declining environmental conditions, paradoxically adversely affecting health through resource-intensive and waste-generating practices. Laparoscopic surgeries using single-use insufflation devices, or disposables, exemplify the tension between healthcare delivery and sustainability. This graduation project addresses these challenges by exploring and proposing circular strategies to mitigate the environmental impacts of disposables inside a insufflation system through strategic design.

The research follows the Double Diamond Design Framework, beginning with an in-depth context analysis of the environmental impacts of an average laparoscopic patient journey and an extensive literature review on circular economy principles. Empirical studies, incorporating semi-structured interviews with relevant stakeholders, provide insight from the hospital perspective. Intermediate findings are combined into a design scope, guiding subsequent work. Environmental hotspots are identified by combining a self-executed fast-track life cycle analysis with insights from existing studies. Finally, conceptual circular interventions are developed to address identified hotspots and improve the environmental sustainability of the insufflation system.

This results in a strategic sustainability plan designed to help the client, a medical start-up, integrate sustainability and create a truly “future-proof” insufflation system. This plan includes company level strategies offering recommendations for actionable steps, commitments, and documentation, potentially leading to a competitive advantage in hospital procurement processes and product level circular strategies. These include redesigning devices to reduce material use, introducing reusable or hybrid devices, and exploring recycling opportunities. Applying strategic design thinking, the proposed strategies balance sustainability ambitions and both the complexity and practical constraints of healthcare systems and medical start-ups, offering a roadmap for implementing more circular and sustainable medical practices.

In conclusion, this project demonstrates the potential for applying circular strategies to complex healthcare settings. By integrating circular economy principles, it exemplifies how sustainable healthcare practices can reduce CO₂ emissions and waste from single-use devices. Ultimately, this thesis underscores the growing need for healthcare to adopt circularity, enabling it to continue improving human well-being while respecting the planet.

Cervical cancer poses a huge challenge to global health (Sung et al., 2021). To provide access to cervical-cancer care to women in Low Resource Settings (LRS), the startup GIC Space is developing the C-Spec and GICMED application. With these innovations the company aims to offer remote Cervical Cancer Screening (CCS) and diagnosis, and a more comfortable experience than with a regular speculum. With the implementation of Artificial Intelligence (AI) algorithms, diagnoses will partly be automated and this requires a new workflow for the app.

Literature revealed that the deployment of information systems (such as smartphones) is needed to offer professional support to medical personnel in LRS in performing and managing CCS. The objective of this master thesis was to redesign the existing GICMED application to enhance the interaction between patient and healthcare provider, and assist in keeping track of patient data more efficiently. GIC Space set the challenge to design for both highly trained medical professionals, like general practitioners and gynaecologists, and less trained healthcare providers such as nurses and midwives. By responding to medical practitioners' lack of expertise and experience to accurately diagnose cervical cancer, the GICMED application could increase screening reliability in LRS. In addition, allowing healthcare providers to have more time for patients, will enable them to better empathise with their client and will lead to better care.

The usability of the current application was inspected with a cognitive walkthrough. Insights about desirable features were gathered by means of a benchmark with competitors. Four User Journey Maps were created to explore design opportunities. To determine whether the concept would be viable, the Lean Startup Model was deployed to rapidly develop a Minimum Viable Product (MVP). The MVP was assessed through user testing in order to determine its desirability.

Since the redesign combines paper work and implements EMRs, patient data can be stored and accessed digitally, allowing personnel to work in a efficient manner and devote more time on providing care. EMRs enable exchange of patient data between healthcare facilities, which is particularly beneficial for reducing loss of follow-up. In order to establish an accurate diagnosis and management plan, AI should solely serve as a second opinion and still rely on the user's own judgement. To avoid AI’s diagnosis from simply being adopted, users should be requested to share their findings and diagnosis first, before AI hands over its conclusion.

During user tests, the redesigned application received an average score of 82.8 out of 100. Participants unanimously agreed that the app helps healthcare providers to keep track of patient data more efficiently and two out of three subjects agreed the app allows both user groups to devote more attention to patients and to express empathy.

This master thesis highlights that potential users are open to trust the result given by AI. Users will first provide their own judgment and then utilise AI’s findings to come to a final conclusion. This thesis thereby affirms the potential for the integration of AI to partly automate diagnosis for cervical cancer.

Current wind turbine blades are made from a material that is difficult to recycle, while a lot of them are being decommissioned. A large influx of high-performance and high embodied energy wind turbine waste material (WTBM) is forming. Next to structural applications, very few novel applications that make proper use of the excellent material properties of decommissioned WTBM are known.

To identify novel applications for WTBM sourced from decommissioned wind turbines a focus on the acoustic properties of WTBM was taken. Various strategies including a variation on material driven design, i.e. circular application through selection strategies (CATSS), were used to identify applications. For that, relevant acoustic WTBM properties were determined to properly identify a knowledge gap. To evaluate the applications identified through CATSS, experiments were set up in the anechoic chamber of the Applied Sciences faculty of the Delft Technical University. The data generated from these experiments, together with the knowledge gained during earlier parts of the project were used for concept ideation of an acoustic application. Sitka Spruce, a natural tone wood used for making tone boards in acoustic instruments, has been found to be the most acoustically similar to WTBM. Based on that, various applications including a distributed mode loudspeaker (DML) line array, acoustic instruments and a resonating acoustic amplifier (RAA) have been identified and evaluated. An application based on replacing tone wood in a resonating acoustic amplifier (RAA) was chosen to embody through a functional prototype. The performance of this RAA prototype showed that WTBM has potential to replace tone woods in acoustic applications; however, more research is needed to identify all the advantages and limitations of such a replacement.

Myopia, or nearsightedness, represents a significant and escalating global issue, with projections indicating that by 2050, 50% of the world’s population will be affected (Holden et al., 2016). Because myopia is a progressive condition, early onset significantly increases the risk of severe visual impairment and, in extreme cases, permanent vision loss. Immediate and effective interventions are essential to mitigate this risk. While treatments to slow myopia progression currently exist, they are often suboptimal. To address these limitations, a novel treatment [confidential information withheld] is being developed at Amsterdam UMC to more effectively arrest myopia progression.

Given the novelty of this procedure, only makeshift instruments have been produced and used to date. This thesis focuses on the design of a scalable, safe, and effective instrument to perform this novel treatment.

A prototype was developed to facilitate further development of the treatment by supporting ex-vivo testing. Considerations, including manufacturability, anatomical compatibility, sterilization, and compliance with medical device regulations, have been integrated into the design process. The final concept provides a feasible instrument design that minimizes the need for modifications during transition to series production, ensuring scalability as the treatment advances toward clinical application.

Recently, the world population has crossed 8 million people and it is estimated that out of every three persons two cannot afford surgery (Meara et al., 2015a). Surgery is the primary treatment for one-third of the diseases (Quene et al., 2022), but since 6 percent of all procedures are performed in the poorest countries, where more than one third of the world’s population lives (Meara et al., 2015). This creates a need for accessible surgery.
Laparoscopic surgery is a commonly used surgery technique to replace open surgery on the abdominal region. Research shows that this method gas multiple benefits over conventional laparoscopy , including: lower infection rates, shorter hospital stay, faster return to normal activity, improved cosmetics, reduced postoperative pain and medication use (2013; Chao et al., 2016; Epstein et al., 2013; Kalser, 1993; Murphy et al., 1992; Solomon Bekele & Hagos Biluts, 2012; Straub et al., 2011; Udwadia, 2001; Zadey et al., 2023). However, in low resource countries, without advanced technology like robot arms, laparoscopes are hold by healthcare assistants. A field study showed that these healthcare assistants need to hold and manoeuvre the laparoscope in the abdominal without support. Resulting in fatigue that hinders the movement of the laparoscopic instruments and vision on the operation area. Therefore, the goal of this study is to
‘Design a product to improve the ergonomics for healthcare personnel that holds a laparoscope during surgery in low resource settings’.
To provide a thorough solution for this design goal incorporating the local context, a framework is chosen. The first four steps follow a Roadmap for safe (Oosting, 2019), covering: 0) identify need 1) understanding of the local context, 2) determine design requirements, 3) concept development and validation. Two following steps are added based on (Webb et al., 2022) 4) refine through design to manufacture 5) clinical validation. In this study, the last step is modified by a phantom test.
Step 0 concludes the reason for this study, the ergonomics of the healthcare assistants needs to be improved. Followed by gaining contextual insight though field studies in India. This results in preliminary design requirements that will updated during the study. This field study showed that it is desirable to have a holder that supports the laparoscope during surgery. The ideal location is below the RAIS abdominal ring (top of the incision) and above the laparoscopic instruments (placed at the bottom of the incision) and connected to the RAIS device. A second field study for Phase 3 at a WHO conference and rural hospitals in India is used to iterate and validate the concepts. In this step, an ideal design is made that form fits easily on the abdominal ring of the RAIS device and that provides a stable support for the laparoscope. In the fourth step, this design is refined for manufacturing. A medical grade material selection is performed which resulted into AISI 316L stainless steel that is able to be manipulated by cold forming and welding if needed. With this material and production method in mind, the holder is designed according to ISO 7153-1 to make sure the holder remains hygienic. An Indian manufacturer can produce the holder for around 200 Indian Rupees, meaning just above two euro, which is within the requirement of 5 Euros per piece.
A phantom test with an Indian surgeon is conducted to test the performance of the holder. The vertical force on the holder during surgery is measured and used for a final FEM analysis. The FEM analysis shows a stress well below the fatigue stress for 1e7 cycles. The phantom test concluded that the holder is suitable to support the laparoscope reducing the stress on the laparoscopic assistant. Secondly, the holder is suitable for implementation in low resource settings.
To conclude, the designed holder improves the ergonomics for the healthcare assistants during operation, its price to produce is well below 5 Euros and is therefore suitable for low resource settings. Initially it was desired to make a holder that could fix the laparoscope by a surgeon during single surgery, this demand was deemed unnecessary because the field study showed that enough personnel was available. However, introducing this option could also improve the ergonomics, but at the cost of complexity.

“A ruptured AAA [Abdominal Aortic Aneurysm] is the 15th leading cause of death in the country, and the 10th leading cause of death in men older than 55” in the United States, states Singh (n.d.), in the Society for Vascular Surgeons. Such Abdominal Aortic Aneurysms (AAA, see Figure 2.2) are increasingly treated by endovascular surgery, during which stent grafts are placed in the ballooned vessel through access sites such as the femoral (thigh) arteries, a procedure called Endo Vascular Aneurysm Repair (EVAR). 10% of patients has an aneurysm near significant arteries (Mayo Clinic, 2019), called a complex AAA, requiring stent grafts fitted with fenestrations (FEVAR, see Figure 2.1) or side branches (BEVAR).   After puncture of the femoral artery, an introducer sheath is placed in the vessel, functioning as a re-usable access point to the arterial system. The sheath prevents blood from flowing out of the artery and enables entrance of tools such as guide wires, catheters and smaller sheaths into the arteries. However, treatment of complex AAA requires introduction of multiple tools (up to 5) through the sheath simultaneously, compared to just one or two during EVAR. With every additional tool being introduced, the valve’s capability of adequate closure is reduced even more. This results in leakage that can lead to significant blood loss for the patient.   The Pentaport is a new, safe gateway for complex endovascular aortic repair (Figure 2.3). It functions as an add-on for commonly used sheath models. A leakproof ‘plug & screw’ connection facilitates safe and easy fastening to large-bore introducer sheaths. The Pentaport minimises blood leakage. Preventing severe blood losses of 2L or even more during one surgery, spares a heavy attack on the patient’s condition and eliminates the need for costly consequences, such as cell-saving or blood transfusion. In addition, it prevents the need for lengthy recatheterisation efforts (up to 60 minutes) and possible harm to the patient’s arteries. The design was evaluated and proof of concept was achieved, through functionality tests in simulated environments and usability tests with medical specialists.  

Taming Esortra is a persuasive game for people diagnosed with osteoarthritis. The two most important symptoms of osteoarthritis are pain and joint stiffness; making it hard and painful for patients to exercise. However, exercise is important and can actually stop the osteoarthritis from getting worse. Taming Esortra uses narrative game-elements and self-monitoring to help patients gain control over their disease. It does this by helping them gain insight in the burden of osteoarthritis and see how they can decrease that burden through exercise.