Cable-driven instruments used in robotic surgery are difficult to sterilize and prone to wear. The reuse of these instruments is, therefore, limited. Since robotic surgery continues to grow, millions of robotic instruments will be discarded, impacting the environment and increasing operational costs. As an alternative, the Shaft-Actuated Tip-Articulating (SATA) instrument was developed: a reusable, modular and sterilisable laparoscopic instrument. The Advanced Laparoscopic Robotic System (ADLAP RS) is a robotic surgical platform being developed as an affordable and sustainable system that is compatible with the SATA instrument and features modular components for inspection and sterilization. The aim of this study is to develop a new robotic driver that features smart sensing to avoid electronics and sensors in the sterile environment (which complicates sterilization). The Smart SATA Driver (SSD) was developed as an interface for the ADLAP RS, which connects to the robotic arm and actuates the SATA instrument. This paper presents the design, development, and validation process of the SSD. The SSD is a reusable, cableless, modular, lightweight and sensorless system that actuates SATA instruments. Utilizing StallGuard technology, a low-cost, sensorless solution for instrument calibration and force limitation was developed based on back EMF measurements in stepper motors. Hereby, sensors and electronics are omitted from the sterile environment. Future work will focus on refining the coupling process and enhancing the force feedback system using StallGuard.

This research evaluates granulator performance at GreenCycl B.V., focusing on particle breakage factors like size and material properties. It uses the discrete element method (DEM) and Tavares' breakage model for simulations. The granulator's geometry is modeled in SolidWorks and imported into EDEM.

Key research question: "How to improve granulating performance at GreenCycl B.V.?" Four geometries (Long Axis - 2 Cutting Blades, Long Axis - 3 Cutting Blades, Short Axis - 2 Cutting Blades, Short Axis - 3 Cutting Blades) are tested, with the Short Axis - 3 Cutting Blades being the most productive.

Further analysis of rotation speed and filling technique shows high rotation speed and simultaneous filling yield the best results, despite higher power consumption. The study provides insights for optimizing granulator performance to maximize productivity and efficiency at GreenCycl B.V.

With increasing healthcare demand, environmental concerns and waste management in healthcare, particularly in the operating room (OR), are significant issues. Disposable surgical energy devices, like vessel sealers, gain popularity in veterinary healthcare, but reusing them is officially forbidden by law and presents challenges. Objective: This research aims to clinically validate reprocessing the Ethicon HARMONIC® HD 1000i for safe reuse in veterinary healthcare. The study assesses the feasibility of using readily available disinfection methods and evaluates the device’s functionality and safety. The research’s scope is limited to a case study (functional analysis) on the Ethicon HARMONIC® HD 1000i. Methods: A comprehensive device analysis was performed using Hot Spot Mapping and Disassembly Map methods, followed by mechanical stability testing during sterilization conditions. A design update was proposed for easier disassembly. The functionality of 2x new, 2x reprocessed and 2x redesigned Ethicon HARMONIC® HD 1000i’s after reprocessing (disinfection, disassembly, reassembly, sterilization) was evaluated in a bench-top study. Tissue transsections on 120 cm pork fillets (6-11mm thickness) per device and pinch force measured with newly developed sensor (40 movements/device) were performed. Furthermore, 2 burst pressure measurements per device on frozen and embalmed artery sections were performed in collaboration with Amsterdam Skills Centre for Health Science. Results: In the disassembly analysis, 42 operations were needed, involving 40 parts and 10 steps with 6 tools. The disassembly time was 429 seconds (07:09 minutes) total. In tissue transsection, the new and reprocessed devices performed similarly, with mean task times ranging from 62.3 to 66.8 seconds. The redesigned devices had slower task times (averaging 196.1 seconds and 104.7 seconds) resulting in lower marching speeds (0.5-1.0 mm/s compared to 1.5-1.6 mm/s for new and reprocessed devices). In pinch force measurements the new devices performed best with average pinch forces of 19.1 N and 20.2 N. The reprocessed devices had slightly lower performance (16.8 N and 16.7 N), while the redesigned devices performed the worst with pinch forces of 5.6 N and 8.8 N, representing a significant drop in performance compared to the new devices. The burst pressure measurement tests showed that none of the devices were able to effectively seal the arteries, resulting in no pressure buildup. Discussion: Overall, reprocessed devices performed similarly to new devices in tissue transsection, showing the effectiveness of reprocessing. Achieved marching speeds by reprocessed and redesigned were considerable given tissue thickness differences, highlighting reprocessing’s potential to extend device lifespan. New devices had 15% higher pinch force than reprocessed, while redesigned had 63% lower force due to a weakened casing. Strengthening redesign and adding new jaw ends could improve modularity and power transmission. Burst pressure tests revealed all Ethicon Harmonic devices (new, reprocessed, redesigned) couldn’t effectively seal
arteries, likely due to frozen artery characteristics and tissue alterations from embalming. Conclusion: This study emphasized the potential of modular medical devices with improved disassembly time, demonstrating that a modular design approach combined with reprocessing strategies holds promise to ensure a more sustainable healthcare system. This research is a collaboration between the Technical University of Delft, Johnson & Johnson Netherlands and GreenCycl.
Keywords: ETHICON, harmonic, ENSEAL, Ligasure, ster- ilisation, reprocessing, medical instruments, healthcare, veterinary, redesign, modular, burst pressure, tissue transection, pinch force

Abstract—Introduction: Surgical instruments are stored, transported, cleaned, disinfected, and sterilized in instrument sets. These instrument sets have a predetermined fixed size, which means they cannot be stored or transported efficiently when empty or used efficiently for different types of instruments. This report presents the design of an instrument set that is adaptable in shape for efficient storage and transport. Method: Based on a questionnaire completed by various departments that come into contact with instrument sets, such as the CSSD, logistics and repair and fixation, the context, the requirements and wishes of van Straten Medical. B.V. and CSA Services B.V., 15 requirements and criteria have been established. Five concepts were developed based on a morphological chart, after which a Harris profile showed that stacki is the best concept. Result: Stacki was further developed and designed using the 3D CAD software SolidWorks. 3 prototypes were created using water/laser cutting and 3D printing. To evaluate the prototypes and identify critical points, 3 tests were carried out regarding completion, ease of use, and strength. These tests have shown that the prototype is promising, but that the corner needs to be redesigned to make the prototype even better. Discussion: Of the requirements, 7 requirements have been met, and 6 requirements were not tested. For further research, these remaining requirements can be tested by applying the points of improvement. Conclusion: A prototype with perforations made from the final materials could be made and this new prototype could be tested for cleaning, disinfection, and sterilization. Finally, the idea with two half sides instead of one long side can also be further developed and tested. Overall, the instrument set is promising for further development, with this design as a starting point.

Introduction: The environmental impact of singleuse medical plastics is a growing concern. One such plastic component, autoclave laminated plastic (ALP), commonly used in medical sterilization pouches, is typically discarded after use, but it holds potential for recycling. This research paper investigates the feasibility and effectiveness of mechanical recycling as a solution for ALP waste.
Methods: The study commences by analyzing the composition of collected ALP materials using X-ray diffraction analysis. Subsequently, recycling techniques,
including melting, and shredding, are explored and assessed.
Results: After multiple melting setups, the high-pressure melting setup, augmented by a continuous pressure spring mechanism, successfully yielded recycled ALP blocks that could be further processed into dogbone-shaped specimens. The results of the tensile tests revealed a Young’s modulus of 269 ± 85 MPa for the recycled ALP.
Discussion: These findings hold promise in the transformation of ALP waste into valuable recycled products, mitigating the environmental impact of single-use medical plastics. However, the study underscores the need for further optimization of the recycling process to enhance mechanical properties and overall material quality, ultimately advancing sustainability efforts in the medical sector.

Introduction
Each year hospitals in the Netherlands generate approximately 1.3 million kilogram of waste from the polypropylene (PP) wrapping paper (WP) used to wrap surgical instruments. The objective of this thesis is to acquire high quality PP, for the use of injection moulding, from blue wrapping paper waste as well as analysing and proposing solutions for optimizing the current melting process.
Method
In the first part of this thesis the WP was melted at different temperatures into bars, granulated and mixed with virgin PP. Dog bones were injection moulded to analyse the influence of the initial melting temperature, mixing ratio with virgin, pollution (sticker and tape) and ten washing cycles of disinfection at the sterilization department.
The reduction of the cycle time by means of pressure was analysed on a conceptual level. The separation of the pollution from the WP during the melting cycle with filtration was tested with three different filter designs. Finally, partitioning of the end product with a tray divider was tested.
Results
The results on the initial melting temperature show marginal differences in material properties. In general the reprocessed material behaves in a more brittle manner, with the ultimate tensile strength, Young's modulus and Shore D hardness increasing and the strain at break decreasing with amount of WP recyclate used compared to virgin material. Pollution seemed to decrease the strain at even further while also decreasing the ultimate tensile strength. The results for the washing and disinfection showed minimal material changes.
The results on the tested filtration prototypes showed that filtration can be used to separate pollution during the melting cycle. Furthermore, IR temperature measurements and flow measurements, with clean and polluted WP waste, show the importance of heat flow characteristics for an efficient filter design. The combination of a filter with proper heat flow characteristics and a conceptual pressure system showed a weight reduction of 40%. The tray divider partitioned the end product, making the end product directly implementable in a granulator.
Discussion
The changes in material properties when using 50% virgin material and 50% recyclate (50%R) indicated minimal changes when compared with 100% virgin. Moreover, this does not imply a lesser product, rather a different product. Different applications require different material properties, as such the mixing ratio can be adapted according to the applications needs.
When designing a full-scale filter it is recommended to use spikes to keep the bulk of the pollution from reaching the permeable surface of the filter. The use of a coating on a filter could reduce the time needed to clean the filter.
Conclusion
This thesis project showed that it possible to make high-quality products with the granulate obtained from blue wrapping paper waste. Also, adding; a pressure system, a filtration system and a tray divider can reduce the process time for obtaining 99% pure granulate from WP waste.

For healthcare, an industry that is currently responsible for up to 10% of the global carbon footprint, the transition to carbon neutrality and circularity will be an enormous challenge. As 20-30% of the total hospital waste originates from operating rooms, optimising recovery from these waste streams has the potential to make a significant improvement on the environmental footprint of the healthcare sector. However, the recovery of components from current surgical devices is difficult and laborious and thus redesigns are necessary. A gap in the literature is identified regarding design methods specifically targeting circular redesign of surgical devices. Therefore, this thesis aimed to develop a method that helps designers in redesigning surgical devices for circularity.
As a result, the Circular Redesign Focus Point (CRFP) tool is developed. The tool guides designers in making substantiated decisions on which components to improve the recoverability of, by redesigning the surgical device. Through the assessment of the device on a component level, a set of outputs is generated which are split in the categories disassembly effort and potential gain. Utilising this division the new Circular Redesign Necessity metric is developed, which is used to score the focus points for redesign.
The validation results indicate that the thesis aim is achieved by the development of the tool. With this, the novel tool addresses the identified gap in the literature. The tool forms the first design tool for circular surgical device design and provides a starting point for future studies in this field.