TRIZ-based method for developing a conceptual laparoscopic surgeon’s chair

Abstract

TRIZ, also known as the theory of innovative problem-solving, has garnered attention from several proponents who advocate its merits as a systematic technique or toolkit that offers a rational framework for fostering creativity in pursuing innovation and creative problem-solving. The broad range of tools and procedures used in the TRIZ-based innovating enable the effective development of next-generation items while successfully enhancing existing ones. Using these tools and approaches may also facilitate the development of the necessary functionality and mitigate the costs associated with manufacturing processes, hence allowing the introduction of novel and enhanced products to be introduced into the market. This study aims to employ the TRIZ approach to develop an optimal laparoscopic chair design. The design of the laparoscopic chair was with a particular emphasis on ease and usability. The laparoscopic chair’s design demonstrated adherence to ergonomic principles despite the absence of actual ergonomic testing. This design has the chair’s adjustable components, which allow for height and level modifications, as well as customizable positioning to accommodate the preferences of the seated individual. The outcome of this design is comparable to laparoscopic chairs offered by medical corporations and preparing for the prototyping phase.

Keywords:

• TRIZ
• laparoscopy
• surgeon chair
• optimization
• innovative design
• innovation

REVIEWING EDITOR:

• D T Pham, University of Birmingham, United Kingdom

SUBJECTS:

• CAD CAE CAM - Computing & Information Technology
• Computation
• Computer Engineering
• Mechanics
• Biomedical Engineering
• Engineering Economics
• Medicine

1. Introduction

The term ‘innovation’ is being employed excessively. Innovation can arise not solely as a byproduct of novel scientific information derived from research and development. The outcome frequently arises from using preexisting knowledge in a novel manner. As per the Oslo Manual (OECD, Eurostat, 2018), a publication established by the Organization for Economic Cooperation and Development (OECD), the concept of innovation encompasses the adoption of a novel or substantially enhanced product, process, marketing approach, or organizational method within the realms of business practices, workplace organization, or external relations.

There are two distinct approaches to innovation: intuitive and systematic (Ikovenko et al., 2021). The initial approach is linked to the conventional comprehension of the creative process. Once ideas have been generated, a comprehensive evaluation of all available possibilities is conducted. The deemed unfeasible variants are discarded; ultimately, the market validates the developed solution. The likelihood of achieving success is minimal. The inherent unpredictability of this process is intrinsically associated with a substantial financial investment directed toward new endeavors. The second method, known as the Theory of Inventive Problem-Solving (TRIZ), posits that inventiveness may be approached systematically through a set of algorithms that guide toward achieving an ideal solution. The thesis posited by Genrikh Saulovich Altshuller (1926–1998) (G. S. (Genrikh S. Alʹtshuller, 1984)), the concept’s founder, asserts that all engineering systems, which refer to human-made entities designed to fulfill specific functions, undergo development in line with objectively existing principles. The aforementioned guidelines have the potential to be identified and applied deliberately to address innovative tasks (Al′tshuller, 1999; Al′tshuller & Genrikh, 1984).

The term TRIZ originates from the Russian expression ‘teorija rezhenija izobretatelskih zadach’, which means the ‘theory of inventive problem-solving’ (Kohnen, 2004). Altshuller et al. conducted an extensive analysis of almost 400,000 technological patents. They discovered regularities and essential patterns in these patents’ problem-solving procedures, idea generation, and innovation (Ilevbare et al., 2013). TRIZ first intended to address issues on technology (Ilevbare et al., 2013). Nevertheless, it has been used in several domains.

The implementation of a systematic approach to innovation encompasses more than just the act of forecasting. The TRIZ methodology has continuously developed since the 1950s (Yatsunenko, n.d.) and has evolved into a comprehensive collection of tools designed to analyze and address challenges encountered throughout the innovation process. Similar to every system, this idea is susceptible to further refinement and advancement. Initially, the endeavor was only focused on developing an algorithm capable of resolving any given technological quandary. By the conclusion of the twentieth century, TRIZ emerged as a very effective commercial tool, offering reliable solutions and facilitating the successful introduction of products or processes (Ikovenko et al., 2021).

The TRIZ methodology is inherently a technical system that undergoes ongoing advancements and refinements. The field of study is characterized by its comprehensive scope, encompassing a wide range of algorithmic tools that extend beyond technical considerations. The entire field is commonly referred to as modern TRIZ. The inception of classic TRIZ can be attributed to the tools that Genrikh Altshuller initially developed. These tools include the Algorithm of Inventive Problem-Solving (ARIZ), Trends of Engineering System Evolution (TESE), Technical and Physical Contradictions, Inventive Principles, and the System of Standard Inventive Solutions (SIS) (Ikovenko et al., 2021).

Several advantages can be derived from the utilization of TRIZ (Ikovenko et al., 2021). The application of concepts that yield substantial enhancements to existing products through the identification and resolution of fundamental technical issues and contradictions, ultimately leading to innovative and transformative solutions; The development of innovative product concepts that surpass competitors through the utilization of technology trends analysis, function-based competitive benchmarking, and robust solution identification methods; Proposed resolutions for the implementation of novel or significantly enhanced cost-effective manufacturing methodologies that facilitate the creation of innovative products; Strategies for obtaining comprehensive patent protection and effectively navigating rivals’ patent barriers within the bounds of the law.

Numerous experts consider TRIZ one of the most advanced and suitable techniques for accelerating the initial stages of engineering design (Chechurin & Borgianni, 2016). Numerous studies highlight the potential of TRIZ in improving creativity and problem-solving abilities. TRIZ tools facilitate the expedited generation of inventive solutions, even when facing complex issues. TRIZ seems to possess a wide range of tools and methodologies to foster innovation effectively. It has the potential to be integrated with a variety of tools (Sojka & Lepšík, 2020). The quality function deployment (QFD) approach was employed to maximize the technical characteristics, while the TRIZ method was applied to design the function of the items (Caligiana et al., 2017a, 2017b; Frizziero et al., 2018; Naveiro & Oliveira, 2018; Zhang et al., 2019). The study conducted by Rosli et al. (Rosli et al., 2013) aimed to enhance the TRIZ technique by incorporating the analytical hierarchy process (AHP) into the design of car door panels. The use of the Analytic Hierarchy Process (AHP) in the problem-solving methodology of TRIZ led to the mitigation of cost inefficiencies and the enhancement of design effectiveness across the stages of product design and development. The authors recommended establishing two more links between Eco-Compass instruments and the contradiction matrix (Boavida et al., 2020). In previous studies, researchers integrated the TRIZ methodology with morphological charts and analytic network process approaches (Asyraf et al., 2019; Asyraf, Ishak, et al., 2020; Asyraf, Rafidah, et al., 2020; Azammi et al., 2018; Mansor et al., 2014; 2015; Sharaf et al., 2020).

Engineering systems within the context of artificial systems is the primary focus of the modern iteration of TRIZ (Ikovenko et al., 2021), which serves as the essential framework for the systematic innovation approach. This solution was developed with the specific aim of efficiently addressing complex problem-solving. These activities include both the generation of novel concepts and the rectification of flaws in current systems or inefficiencies. The use of TRIZ tools leads to the development of a collection of suggested design solutions (concepts) that enable the attainment of desired outcomes while simultaneously adhering to technical, business, and time-to-market constraints. The value of TRIZ across varying fields is widely acknowledged, and its application is proven to produce outstanding results.

As shown in Figure 1 (Ikovenko, 2017; Ikovenko et al., 2021), incorporating the three phases is an essential component of every project that applies TRIZ. The problem identification process produces a list of major issues that, if resolved, will considerably improve the system and make it easier to achieve the project’s technical goals. The outcome of the problem-solving step is a substantial collection of suggested design solutions or concepts. During the stage of issue solving, various solutions are produced and afterward assessed for their practical viability in the idea substantiation stage. This evaluation is conducted by considering the technical and business needs. This procedure expeditiously selects the most optimal solutions, maximizing the efficient use of valuable resources and time.

Figure 1. The three stages of pragmatic innovation, based on (Ikovenko, 2017; Ikovenko et al., 2021).

The laparoscopic surgeon’s chair is a potential product that may be produced using the principles of TRIZ. Surgeons experienced cumulative uncomfortable postures and repeated movements, and research showed a correlation between laparoscopy and musculoskeletal discomfort (Dalager et al., 2019; Franasiak et al., 2012; Giberti et al., 2014; Ruitenburg et al., 2013). Several occupational variables significantly influenced surgeons’ musculoskeletal discomfort development, including workstation design, work method, posture, and instruments. The use of conventional laparoscopy resulted in surgeons being exposed to diminished dexterity and constrained range of motion (Sari et al., 2010; Szeto et al., 2009).

The existing compelling data indicates that workgroups engaged in high-level static contractions, extended static loadings, or severe working postures face an elevated susceptibility to musculoskeletal problems affecting the shoulder, neck, and lower back (Riaei et al., 2021). Research has shown a notable increase in musculoskeletal problems among surgeons specializing in minimally invasive surgery and endoscopists compared to their counterparts in other medical and surgical specialties (Ramakrishnan & Montero, 2013). It is quite probable that surgeons are exposed to one or several risk factors, such as recurrent and incorrect posture. The exposure level is heightened due to the duration of engaging with microscopes (Darragh et al., 2008). The existing literature (Oyama et al., 2021, 2022; Schurr et al., 1999) suggested that the seat-stand ergonomic chairs created for surgeons might not adequately support the ergonomic posture necessary for microscopic procedures. However, these chairs can potentially prevent back issues during open surgeries (Aghilinejad et al., 2016).

Scientists have uncovered many patents related to laparoscopic chairs. Twisselmann (Twisselmann, 1991) has designed a surgical chair that allows the surgeon to easily adjust their position. The chair features a seat that can be adjusted vertically and horizontally, along with a detachable backrest and articulated arms with armrests. These arms can be positioned at different angles using two hinges, and can even be moved to the side of the backrest when the surgeon needs to sit facing it. Yuan (Yuan, 2023) invented a physician chair that addresses the issue of surgeon fatigue during protracted operations. This chair is under the technological domain of physician chairs. The armrest bracket mechanism invented by Yang et al. (Yang et al., 2019) pertains to the domain of medical system consoles and is specifically designed for application in laparoscopic surgical systems. Turner and Economaki (Turner & Economaki, 2010) created a surgical support system that helps the surgeon sit while straddling the patient.

Scholarly studies on the participation of academics in the development of particular laparoscopic chairs based on the TRIZ approach are scarce as of yet. This study aims to develop a conceptual chair that effectively mitigates physical strain experienced by laparoscopic surgeons. A chair is specifically made to support the anatomical structure of the human body and has adjustable characteristics that might theoretically allow laparoscopic surgeons to adopt more neutral positions. Enhanced comfort would subsequently facilitate physicians in executing surgical procedures more efficiently, thereby enhancing the overall quality of the treatment. A chair design concept suitable for laparoscopic surgeons to facilitate their work may be developed via the TRIZ technique and the TRIZ problem-solving tool in conjunction with the assistance of computer-aided design (CAD) (Salaha et al., 2023).

2. Materials and methods

TRIZ is superior to other problem-solving and creativity methodologies (Feniser et al., 2017; Ghane et al., 2022; Li et al., 2022; Munje et al., 2023; Yao et al., 2020). TRIZ facilitates the identification of issues and provides explicit answers while instilling assurance that a comprehensive exploration of potential novel solutions to the problem has been undertaken. Figure 2 illustrates the systematic problem-solving approach used in the TRIZ methodology. The tools depicted in Figure 2 are TRIZ tools that are employed in the process of product development. The TRIZ tools exhibit a high degree of simplicity and user-friendliness. In this study, the development of a laparoscopic surgical chair could be achieved using the aforementioned techniques, as the complexity of the problem did not necessitate additional resources. Those TRIZ tools were frequently employed by various scholars, including Li et al. (Li et al., 2022), Hassan et al. (Yeop Wasir et al., 2020), Frizziero et al. (Frizziero et al., 2018), Boavida et al. (Boavida et al., 2020), Azammi et al. (Azammi et al., 2018), Asyraf et al. (Asyraf et al., 2019; Asyraf, Ishak, et al., 2020; Asyraf, Rafidah et al., 2020), He et al. (Li et al., 2015), Mansor et al. (Mansor et al., 2014, 2015), combined with other applications.

Figure 2. Structured problem-solving using TRIZ.

Function analysis (FA) is an analytical methodology used to identify and examine the functions performed by various components within a system or supersystem. This approach aims to ascertain the distinctive properties of these functions and evaluate the associated costs of the components involved. The FA does not provide novel insights on the examined system or propose resolutions. Nevertheless, enhancing the system is of utmost importance. The process involves organizing and translating system-related information into a functional language. This understanding enables the use of problem-solving tools (Al′tshuller, 1999; Ikovenko, 2017; Ikovenko et al., 2021).

Cause-effect chain analysis (CECA), also known as root cause analysis, is an analytical methodology used to identify an engineering system’s primary drawbacks or limitations. The CECA serves the dual purpose of reducing the potential issues arising from function analysis and delving into the underlying causes of the problem beyond the limitations of the set of function drawbacks.

Trimming is an analytical technique used in engineering to enhance a system’s performance by selectively eliminating specific components and reallocating their beneficial functions among the rest of the components of the system or its supersystem. This process aims to maintain the quality and performance of the system. There are three distinct methods for trimming rules. The initial approach, referred to as ‘rule A’, involves the complete elimination of the object of the Function, which can be considered the most radical form of trimming. In this scenario, if component B is deleted, it follows that component A, which relies on component B for its functionality, no longer serves a purpose and can consequently be eliminated. The second rule, denoted as Rule B, states that if the object of a function is capable of performing the function itself, then the presence of another component, denoted as component A, which serves the purpose of enabling component B to execute its function, becomes redundant. Consequently, component A can be eliminated from the system. The last rule, denoted as Rule C, states that if another component inside the engineering system or supersystem performs the same useful function as the current component, the latter can be eliminated (Al′tshuller, 1999; Ikovenko, 2017; Ikovenko et al., 2021).

The concept of engineering contradiction (EC), sometimes known as a technical contradiction (TC), refers to a scenario in which an endeavor to enhance one aspect of an engineering system results in the degradation of another aspect. The engineer’s everyday job often involves encountering issues that might be expressed as engineering contradictions. TRIZ presents an alternative methodology that facilitates the attainment of solutions whereby the enhancement of one engineering system parameter does not result in the degradation of other parameters and may even improve their respective performance. The instrument that establishes a connection between issue models and extended solutions models is often called a contradiction matrix (CM). Meanwhile, a physical contradiction (PC) refers to a scenario in which a single physical parameter of an item is subjected to two justifiable opposing requests, resulting in the need to produce the desired outcome (Al′tshuller, 1999; Ikovenko, 2017; Ikovenko et al., 2021).

Altshuller (Al′tshuller, 1999; Al′tshuller & Genrikh, 1984) observed that whether issues were represented as either EC or PC, the patents’ proposed remedies had conceptual similarities. The author derived a set of generalized procedures and afterward referred to them as inventive principles (IP). The mechanism for addressing PC issues is an algorithm designed to resolve physical contradictions. Various methodologies are used to address issues on PC:

1. Separating the contradictory demands.

   1. Separation in space

   2. Separation in time

   3. Separation in relation (conditions)

   4. Separation in direction

   5. Separation at the system level

2. Satisfying the contradictory demands.

3. Bypassing the contradictory demands.

The presence of chairs in the operating room might provide challenges for laparoscopic surgeons since they could potentially impede the surgical procedure. Surgeons preferred sitting alternatives that do not interfere with their professional responsibilities and have features like compactness, lightweight construction, comfort, user-friendliness, and multifunction. Presently, most laparoscopic surgeons performed surgical operations using regular chairs or, in some cases, office chairs. Figure 3 illustrates many instances of office chairs and surgical seats.

Figure 3. Examples of office chairs and surgeon seats: (a) Office chair; (b) Surgeon chair from rinimedtech.com; (c) Surgeon chair from merciansurgical.com.

3. Results and discussion

3.1. Function analysis (FA)

The use of a laparoscopic surgical chair is imperative for laparoscopic surgeons during the execution of laparoscopic surgical procedures. The main function of this chair is to serve as a seating apparatus for medical professionals while also providing necessary support to the body during surgical procedures. The chair necessitates a high level of strength and rigidity in order to adequately sustain the weight of the doctor’s body. In addition, it can conveniently adjust to accommodate the patient’s bodily orientation.

The functional analysis has three distinct steps: component analysis, interaction analysis, and function modeling. The level of FA, known as component analysis, involves identifying components within an engineering system and its supersystem. An engineering system is a purpose-built system designed by individuals to carry out a specific task or function. A supersystem is a system encompassing an examined engineering system as one of its components. The supersystem may be defined as the encompassing environment surrounding the engineering system. This component analysis serves as the first stage of the functional analysis process. Table 1 presents a comprehensive study of the components of a laparoscopic surgeon’s chair.

Table 1. The component model of the engineering system and its supersystem.

Description of engineering system	Components of the system	Components of the supersystem
Engineering system for laparoscopic chair	Backrest	Human
	Chest rest	Floor
	Armrests
	Seat
	Footsteps
	Chair legs
	Casters

The subsequent phase in the process of functional analysis is interaction analysis. Interaction analysis is a crucial phase within the framework of FA, whereby the objective is to identify and examine the interactions between the many components included within the component model. Table 2 presents the interaction matrix pertaining to the laparoscopic surgeon’s chair. The interaction matrix may be characterized as a kind of filter. The symbol ‘+’ indicates the presence of an interaction, whereas the symbol ‘−’ denotes the absence of such interaction.

Table 2. Interaction matrix of laparoscopic surgeon’s chair.

	Backrest	Chest rest	Armrests	Seat	Footsteps	Chair legs	Casters	Human	Floor
Backrest	X	−	−	+	−	−	−	+	−
Chest rest	−	X	−	+	−	−	−	+	−
Armrests	−	−	X	+	−	−	−	+	−
Seat	+	+	+	X	−	+	−	+	−
Footsteps	−	−	−	−	X	+	−	+	−
Chair legs	−	−	−	+	+	X	+	−	−
Casters	−	−	−	−	−	+	X	−	+
Human	+	+	+	+	+	−	−	X	+
Floor	−	−	−	−	−	−	+	+	X

The last phase of functional analysis involves the construction of a function model for the engineering system under analysis. During the phase of function modeling, the verification process involves examining interacting components to ensure that they fulfill their respective functions on each other. The functional model of the laparoscopic surgeon’s chair is shown in Figure 4. The presence of footsteps in a laparoscopic surgical chair was considered a non-essential feature, as the chair remains fully functional and poses no significant issues even in the absence of footsteps. Similarly, the chest rest served as an auxiliary component that proved beneficial in supporting the body’s frontal part. In actuality, the utilization of chest rest was warranted solely under specific circumstances. The functional model of an engineering system identifies and describes the functions carried out by the various components within the system and the components of the larger supersystem.

Figure 4. Function model of laparoscopic surgeon’s chair.

3.2. Cause-effect chain analysis (CECA)

The CECA may be seen as a mechanism that perpetuates a series of interconnected disadvantages. Several drawbacks were identified prior to the start of the project, while others were decided during the FA. Additional disadvantages have emerged and become apparent during the cost-effectiveness and cost analysis. The CECA framework identifies optimal initiation and termination points within a given chain. The point of departure for the analysis is referred to as the initial disadvantage. One primary drawback associated with the laparoscopic surgeon’s chair was its lack of comfort, limited functionality, and inflexibility in use.

After identifying the first disadvantages, it was important to delve into the underlying reasons. The entities at the chains’ terminal positions are called critical disadvantages, and their removal leads to a cascading impact. The primary drawbacks may be derived from the findings of the FA about components that exhibit little or negligible use within the system. Based on the findings of the preceding FA, it could be determined that the chest rest and footsteps components exhibit relatively lower levels of usefulness. Footsteps were components explicitly designed to provide support for the feet. Interestingly, it was possible to use a chair leg for this purpose. Similarly, the chest rest had the potential to be eliminated, and its purpose was integrated with the armrest. The drawbacks are mutually exclusive; hence, eliminating one does not impact the remaining ones.

3.3. Trimming the devices

The preceding analytical tool implementation yielded functional drawbacks. Now is the opportune moment to choose the appropriate action to address these issues. One potential approach to advancing the innovation project is identifying its drawbacks, articulating the challenges they provide, and devising strategies to address them. Typically, engineers tend to troubleshoot or enhance a system when it fails to function according to expectations. This approach is very advantageous, particularly for those who want minimal alterations to the existing system.

Within the framework of TRIZ, the focus lies not on rectifying issues but rather on the total removal of components while simultaneously ensuring the preservation of the system’s valuable functions by their redistribution among the remaining components. This novel methodology is referred to as trimming. The process of trimming leads to the emergence of a new system architecture. A reduced number of components must now execute the comprehensive array of beneficial activities revealed during FA.

The applied trimming technique was categorized as type trimming rule C, which referred to the involvement of another component within the engineering system or supersystem that served the purpose of the function carrier.

According to the findings of the CECA study, a laparoscopic chair exhibited many components that posed certain disadvantages. These components might be streamlined, and their functionality integrated with other existing components. Figure 5 illustrates the several components that are eligible for trimming. The chestrests have the potential to be detached and integrated with armrests that include a seat-centric rotational structure. This design modification enables the armrests to serve numerous purposes, functioning as supplementary backrest, chest rests, and armrests. Furthermore, it is possible to eliminate the presence of footsteps and have their purpose fulfilled by the legs of the chair.

Figure 5. Trimming model.

3.4. Engineering contradiction (EC) and physical contradiction (PC)

Altshuller’s goal in developing TRIZ was to establish it as a scientific subject comparable to mathematics, chemistry, and other well-established sciences. The observer carefully observed the organizational structure of these mature regions and identified a common characteristic among them. Each individual have distinct methodologies for analyzing the problem’s model that necessitated resolution, generating a solution model through these methodologies.

TRIZ presents an alternative methodology that facilitates the identification of solutions whereby the enhancement of one parameter within an engineering system does not result in the degradation of other parameters and may even provide improvements in their respective performance. TRIZ encompasses a set of 39 engineering criteria that delineate the Engineering Contradiction inside a given system. Darrell Mann (Mann & Dewulf, 2003) enhanced the technical paradox by leveraging the principles of classical TRIZ, resulting in a significant increase in its general engineering parameters from 39 to 48. Remarkably, eight newly included engineering parameters directly correlate with societal benefits.

An effective EC should be constructed with the IF-THEN-BUT framework. The engineering parameters may be discovered by analyzing the THEN and BUT expressions. This work included the division of the laparoscopic chair into many components. However, the determination of EC was limited to a few specific components, as shown below.

• Backrest = IF the contours of the backrest can be arbitrary, THEN the backrest will be comfortable, BUT the structure of the backrest will be more complex.

The metric that exhibits enhancement is comfort, whereas the one that demonstrates decline is increased complexity. In the context of the parameter of comfort, parameter #12, which refers to shape, may be considered appropriate. Conversely, parameter #36, which pertains to device complexity, may be suitable when considering the criterion associated with complexity.

• Armrests = IF the armrests can be moved, THEN the armrests have the multifunction of being an additional backrest and chestrest, BUT the design of the armrests becomes more complex.

The enhancement of the parameter is multifunction, whereas the degradation of the parameter is characterized by increased complexity. In the context of the multifunction parameter, parameter #35, adaptability/versatility, may be considered an appropriate choice. Similarly, while considering the parameter more complicated, parameter #36 device complexity may be a suitable option. The CM is derived from the EC statement in Table 3.

Table 3. Contradiction matrix.

	#36 (Device complexity)
#12 (Shape)	16, 29, 1, 28
#35 (Adaptability/versatility)	15, 29, 37, 28

EC could not finish many additional components of the laparoscopic chair due to a single conflicting parameter. Hence, the resolution of this issue was achieved by using physical contradiction. The precision of PC is greater in comparison to EC. In the context of problem-solving, the PC approach involves modeling a problem using a single parameter associated with a specific component. This approach enhances clarity in identifying the component to which the suggestions derived from TRIZ should be applied. The PC is intricately connected to the EC and may be derived from it. Several components of a laparoscopic chair were integrated with the PC.

• Backrest; the uppermost part of the backrest must be high to accommodate tall people and be short to accommodate short people.

• Seat; the seat must be high for jobs that require height, and the seat must be short for jobs that do not require height, and it must be adjustable to accommodate people of different talls.

• Footsteps; there must be footsteps to support the feet when needed, and footsteps must not exist when it is not needed; then its function is replaced by chair legs.

• Casters; the casters must be slipped to make it easier for the chair to move, and the casters must be non-slipped so that the chair does not move by itself.

3.5. Inventive principles (IP)

The inventive principles refer to offered models of solution. They have a significant role in reducing the scope of the search for a solution to the issue. The implemented solution can choose any combination of the available solutions, ranging from one to all. Many options may be seen based on the data in Table 3 relative to the idea of CM.

Backrest; have IP #16 (partial or excessive actions), #29 (pneumatic and hydraulics/fluidity), #1 (segmentation), or #28 (mechanics substitution/another sense). It is possible to combine the three offered IPs in this laparoscopic chair. The backrest was made of a balloon (IP #29), which was divided into three parts (IP #1) and could be moved back and forward (IP #16).

Armrests; have IP #15 (dynamization), #29 (pneumatic and hydraulics/fluidity), #37 (thermal expansion/relative changes), or #28 (mechanics substitution/another sense). Armrests could only implement one solution, namely IP #15 dynamization. The armrests moved around the seat from back to front and could be adjusted high and low, forward and backward. When the armrests were positioned in front, the armrests would function as a chest rest to support the body during laparoscopic surgery. Figure 6 illustrates the armrests concept for a laparoscopic chair.

Figure 6. The armrests plus chest rest concept.

The concept of the CM pertains to considering two factors inside an engineering system. Consequently, it does not address the primary issues described as PC, specifically applied to a single parameter. Each technique for resolving PC requires a distinct set of IPs to be suggested. The IPs used for resolving EC are the same; however, they are organized differently for PC than CM. The following concepts discussed potential PC-based solutions for the components of a laparoscopic chair.

The backrest used separation in space. The solution chosen was IP #2 (separation) and IP #7 (‘nested doll’). The top part of the backrest (headrest) was separated from the part below (separation) and could be lowered and raised (‘nested doll’). The final design of the backrest is shown in Figure 7.

Figure 7. The backrest’s final concept.

The seat used separation in time. The solution chosen was IP #15 (dynamization). The seat could be adjusted high or low according to the work setting and the person.

The footsteps used satisfying the contradictory demands. The solution chosen was IP #13 (the other way around). Footsteps could be raised and hidden with a spring mechanism by pressing it. Figure 8 depicts the notion of footsteps design.

Figure 8. The footsteps concept.

The casters used bypassing the contradictory demands. There were no recommended IPs for this approach. Each IP could be applied. The IP suitable for solving this caster problem was IP #10 (preliminary action), by adding a caster lock.

3.6. Conceptual model

The proposal for a specialized chair equipped with pedal switches to enhance the ergonomics of laparoscopy was put out in 1999 (Schurr et al., 1999). Between 2005 and 2010, surgical support was used during laparoscopic radical prostatectomy (LRP) procedures to mitigate the strain experienced by the knee joints (Bansal et al., 2021; Rassweiler et al., 2010). This chair was only intended for use during surgical procedures using ipsilateral trocars. The suturing was feasible in a physically challenging standing posture known as the ‘torero’ stance (Bagrodia & Raman, 2009; Wauben et al., 2006; Wolf et al., 2000). A novel ergonomic body support system was recently introduced, comprising many components, including a platform with a foot pedal, semi-standing support, a remote control, and chest support (Albayrak et al., 2007).

The enhancement of laparoscopy ergonomics might be achieved by developing novel platforms, such as the c, which facilitated the seated posture of the surgeon by including armrests and integrated foot pedals. The ETHOS system allowed surgeons to do operations while sitting comfortably, supported by ergonomic chest, arm, and back support. This design significantly reduced muscular activity and pain, possibly increasing surgeon satisfaction.

The use of the TRIZ method yielded a conceptual design for a laparoscopic chair, as shown by the analytical findings. Figure 9 illustrates the comprehensive configuration of the laparoscopic chair. The design of this laparoscopic chair is tailored to meet the preferences and requirements of a laparoscopic surgeon. This chair served a dual purpose, as it might be used for relaxation and laparoscopic surgical procedures. The presence of adjustable backrest, armrests, chest rests, seat, and footsteps components in this chair signified its compliance with ergonomic standards.

Figure 9. The laparoscopic chair concept: (a) relaxation mode; (b) laparoscopic surgical mode.

The previous chapter discussed several designs that have been granted patents. Certain designs are undeniably commendable and effectively fulfill the requirements of laparoscopic surgeons. However, there are further components that require development. Table 4 compares different patented laparoscopic chair concepts with current designs.

Table 4. Comparison of several patented designs.

Authors	Components
	Backrest	Chest rest	Armrests	Seat	Footsteps	Chair legs
Twisselmann (Twisselmann, 1991)	The backrest that can be adjusted vertically. This backrest is attached to the seat in a way that allows it to be readjusted. This means that the backrest can also be used as a frontrest to support the surgeon’s chest.	Combined with backrest.	The armrests can be individually adapted in a manner not previously observed when performed under sterile conditions; the surgeon can modify them in this way.	The height of the seat can be adjusted vertically with a motor drive which is operated via a foot pedal.	None	T-shape without rolling wheel
Yang et al. (Yang et al., 2019)	A laparoscopic surgical system console’s armrest bracket mechanism includes a connecting plate, two single-axis drives, two armrest brackets, two support bases, two rotating parts, two bracket mounting plates, two mounting seats, two armrests, and two electric push rods.
Turner and Economaki (Turner & Economaki, 2010)	The backrest is fixed and lacks the ability to be adjusted, similar to a foldable chair.	The chest support can be adjusted both forwards and backward, as well as upwards and downwards.	The arm support can be rotated both upwards and downwards along a horizontal pivot axis and a vertical axis, allowing it to move from a lowered position near the surgeon to a raised position further away from the surgeon.	The seat, equipped with a slender cushion, can be adjusted in a vertical position.	The foot supports can be mounted onto the support members and adjusted along their length manually using pins.	The A-shaped leg tubular frame on the right and left is connected by supports. The leg is not equipped with a rolling wheel, but can be installed alternatively.
Current design	The backrest was made of a balloon, which was divided into three parts and could be moved back and forward	Combined with armrest.	The armrests moved around the seat from back to front and could be adjusted high and low, forward and backward. When the armrests were positioned in front, the armrests would function as a chest rest to support the body during laparoscopic surgery	The seat could be adjusted high or low according to the work setting and the person.	Footsteps could be raised and hidden with a spring mechanism by pressing it	The structure comprises four horizontally positioned legs arranged in the shape of the letter ‘H’, each of which is fitted with rolling wheels and wheel locks.

Based on the aforementioned research (Li et al., 2022; Yao et al., 2020), it is feasible to infer that the application of TRIZ has the potential to provide high and all-encompassing benefits. Three distinct kinds of TRIZ tools have shown to be very successful in enhancing economic and social advantages. Additionally, knowledge-based tools and psychological operators have substantially improved intellectual benefits. The most effective techniques for problem-solving in technical contexts are the identification of technical contradictions and the application of 40 innovation principles, as well as the analysis of physical contradictions and the use of separation principles. Furthermore, functional analysis and cause-effect chain analysis are valuable approaches in this regard.

4. Conclusions

The TRIZ approach was used to produce the conceptual design of the laparoscopic chair. The laparoscopic chair is equipped with individual and adjustable components, including backrests, armrests, seats, and footsteps. This chair has dual purposes, functioning both as a way of relaxation and as a work chair designed explicitly for laparoscopic surgeons. One notable benefit of this chair compared to its counterparts is its unique features and characteristics. The current chair design is intended to undergo the patenting process and thereafter be prepared for large-scale manufacturing. Finally, engineers must demonstrate flexibility in selecting TRIZ tools based on the specific challenge. Various techniques provide distinct advantages concerning certain sorts of complete benefits. Hence, the decision-making process should be driven by practical considerations and desired outcomes while considering the specific attributes of the challenges at hand while selecting appropriate instruments.

Author contributions

Gatot Santoso: Methodology, validation, formal analysis, writing—review and editing, and Funding acquisition. Muhammad Imam Ammarullah: Validation, investigation, and writing—review and editing. S. Sugiharto: Project administration and funding acquisition. Taufiq Hidayat: Conceptualization, data curation, writing—original draft preparation, and visualization. Slamet Khoeron: Software and resources. Athanasius Priharyoto Bayuseno: Writing—review and editing and supervision. J. Jamari: writing—review and editing and supervision.

Acknowledgments

The authors gratefully thank the author’s respective institution for their strong support in this study. All authors consent to the publication of this manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

All data used to support the findings of this study are included in the article.

Additional information

Funding

The research was funded by the Grant research program Faculty of Engineering, Universitas Pasundan.