--- title: Cook Medical Evolution Case Study - Dolmen Design description: Esophageal stent delivery used to be a two handed operation for surgeons. The original challenge from Cook Medical was to find a way to develop a single handed approach to esophageal stent delivery. --- [![sticky-header-logo](https://www.dolmen.ie/hubfs/sticky-header-logo.svg "sticky-header-logo")](https://www-dolmen-ie.sandbox.hs-sites.com/) [![Contact](https://no-cache.hubspot.com/cta/default/2822537/63771b00-f3c8-4196-a096-96592fcd5c32.png)](https://cta-redirect.hubspot.com/cta/redirect/2822537/63771b00-f3c8-4196-a096-96592fcd5c32) ** ** ** [![sticky-header-logo](https://www.dolmen.ie/hubfs/sticky-header-logo.svg "sticky-header-logo")](https://www-dolmen-ie.sandbox.hs-sites.com/) [![Contact](https://no-cache.hubspot.com/cta/default/2822537/63771b00-f3c8-4196-a096-96592fcd5c32.png)](https://cta-redirect.hubspot.com/cta/redirect/2822537/63771b00-f3c8-4196-a096-96592fcd5c32) ** ** ** Search Making ideas work. ** ** [![Contact](https://no-cache.hubspot.com/cta/default/2822537/63771b00-f3c8-4196-a096-96592fcd5c32.png)](https://cta-redirect.hubspot.com/cta/redirect/2822537/63771b00-f3c8-4196-a096-96592fcd5c32) ![work-cook-2](https://www.dolmen.ie/hs-fs/hubfs/DEV-Folder/Cook/work-cook-2.png?width=1920&name=work-cook-2.png "work-cook-2") ###### MEDICAL / COOK MEDICAL # Designing from the inside out Sometimes you just need to take a step back  Esophageal stent delivery used to be a two handed operation for surgeons. The original challenge from Cook Medical was to find a way to develop a single handed approach to esophageal stent delivery. ### Insights delivering innovation We carried out ethnographic research in the US, UK and Europe, interviewing and observing surgeons in their place of work and gathering as much data as possible. One key insight became a critical pivot point for the project; One surgeon mentioned “sometimes it might be nice to be able to reposition the stent”. ![cook gun rs crop](https://www.dolmen.ie/hs-fs/hubfs/DEV-Folder/Cook/cook%20gun%20rs%20crop.jpg?width=5999&name=cook%20gun%20rs%20crop.jpg "cook gun rs crop") ### Stakeholder needs are paramount Upon further investigation we discovered that though the esophageal stent delivery procedure was generally a 45min day procedure and very straightforward, if a stent was badly positioned things would take a significant turn for the worst. It would lead to minimum 3 days in hospital, open chest surgery, health risks for the patient and *reputational* risks for the surgeon. This was definitely an opportunity worth exploring. ![Evolution-situ-01](https://www.dolmen.ie/hs-fs/hubfs/DEV-Folder/Cook/Evolution-situ-01.jpg?width=704&name=Evolution-situ-01.jpg "Evolution-situ-01") ### Technical innovation across industries During our technical research stage we found a reversible gearing system that was coming off patent in a different industry. We were able to take this technology and re-apply (and re-patent) for Cook Medical. The insight from the surgeon allowed us to create a single handed operation with an actuation trigger, a reverse clutch and 14 gear wheels. ![evolution-proto-03](https://www.dolmen.ie/hs-fs/hubfs/DEV-Folder/Cook/evolution-proto-03.jpg?width=704&name=evolution-proto-03.jpg "evolution-proto-03") ![Hands holding the early cook evolution prototype](https://www.dolmen.ie/hs-fs/hubfs/DEV-Folder/Cook/Cook-Prototype-2.jpeg?width=3387&name=Cook-Prototype-2.jpeg "Hands holding the early cook evolution prototype") ### Impact from insights The Evolution is still the only controlled release stent system in the world and has become a platform product for Cook Medical, resulting in significant revenues for the global company. ![CAD render of the internal gears of the cook evolution gun](https://www.dolmen.ie/hs-fs/hubfs/DEV-Folder/Cook/1-2-704x400.jpg?width=704&name=1-2-704x400.jpg "CAD render of the internal gears of the cook evolution gun") ## Related case studies [![home-guinness-2](https://www.dolmen.ie/hs-fs/hubfs/DEV-Folder/home-guinness-2.png?width=1456&name=home-guinness-2.png "home-guinness-2")](https://dolmen-2822537-hs-sites-com.sandbox.hs-sites.com/project/guinness) ###### [CONSUMER / DIAGEO](https://dolmen-2822537-hs-sites-com.sandbox.hs-sites.com/project/guinness) ## [A harp that is made of more](https://dolmen-2822537-hs-sites-com.sandbox.hs-sites.com/project/guinness) [Explore](https://dolmen-2822537-hs-sites-com.sandbox.hs-sites.com/project/guinness) ![Moocall Split_1-IG](https://www.dolmen.ie/hs-fs/hubfs/DEV-Folder/Moocall%20Split_1-IG.png?width=1049&name=Moocall%20Split_1-IG.png "Moocall Split_1-IG") ###### [PROFESSIONAL / MOOCALL](https://dolmen-2822537-hs-sites-com.sandbox.hs-sites.com/project/sms-calving-alert-sensor) ## [Helping cows commoonicate](https://dolmen-2822537-hs-sites-com.sandbox.hs-sites.com/project/sms-calving-alert-sensor) [Explore](https://dolmen-2822537-hs-sites-com.sandbox.hs-sites.com/project/sms-calving-alert-sensor) ![home-medical-1](https://www.dolmen.ie/hs-fs/hubfs/DEV-Folder/Philips/home-medical-1.jpg?width=610&name=home-medical-1.jpg "home-medical-1") ###### MEDICAL / PHILIPS RESPIRONICS ## [Breathing life into healthcare](https://www.dolmen.ie/project/v60-ventilator) [Explore](https://www.dolmen.ie/project/v60-ventilator) ![Corridor in the Dolmen studio office](https://www.dolmen.ie/hubfs/DEV-Folder/CameraTest-29-01-19-4.jpg) ### Work with Dolmen Our creative + technical team is ready to discuss your idea with you. 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