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Vital Signs

Surgical stencil: A simple but inventive idea

By Jennifer Durgin

Dr. Lori Alvord is used to getting attention for being the first woman Navajo surgeon. But she wants to leave a legacy that goes beyond that. "I don't want to be niched into one corner," she says. So she's decided to become an inventor—in addition to her roles as associate dean of student and multicultural affairs at DMS and a general surgeon at DHMC and the DMS-affiliated VA in White River Junction, Vt.

She recently received a patent for her first invention, a sort of stencil for laparoscopic surgery. In laparoscopy, a small incision of less than half an inch is made, usually in the abdomen, and a tunnel is cut through the body to the site in need of surgery. That tunnel, which is lined with a tube, serves as a pathway for the tiny instruments that the surgeon will operate with from outside the body. While the instruments and tubes are specific sizes, says Alvord, surgeons "just look and guesstimate" how long to make incisions in the skin. "What we should be doing is making them just the right size," she says.

Seal: If an incision is too small, the surgeon may try to force the instruments through, injuring adjacent tissues. If an incision is too big, that can cause problems, too. "The way we look at everything inside," Alvord explains, "is we pump carbon dioxide into the abdomen to distend it . . . [so] we have a little place to work." If there's not a good seal between the skin and the tube, air can leak out, making the surgeon's workspace inside the body smaller than is optimal.

Alvord's stencil design has openings that correspond to specific instruments and sizes. It also has longer slots that can be used for non-laparoscopic incisions, which most surgeons also do freehand. The idea behind the stencil is "so amazingly simple," she admits with a laugh. "But remember . . . the Post-it note!"

To develop the stencil, and the other surgical inventions for which she'll seek patents, Alvord has been working with Hanover, N.H.-based NeoVention. She located the company through the Dartmouth Entrepreneurial Network, which helps Dartmouth faculty, staff, and students bring ideas to the marketplace. Neo- Vention is led by two graduates of Dartmouth's Thayer School of Engineering, Katherine Hickey and Amish Parashar. Now that they have a patent for the stencil, they'll create a prototype and shop it around to manufacturers.

Outside: "Discoveries often occur when someone from one discipline walks into a world of someone else's discipline," says Alvord. "That's why it's kind of neat" to be working with an interdisciplinary team. She believes that "being a person from the outside" has helped her see opportunities for surgical innovations. "Both as a woman and as a minority," she says, "looking at things through the lens of a different culture may be part of the reason why I sometimes see things that need to be fixed."

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Dartmouth Medical SchoolDartmouth-Hitchcock Medical CenterWhite River Junction VAMCNorris Cotton Cancer CenterDartmouth College