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Lippenberger F, Ziegelmayer S, Berlet M, Feussner H, Makowski M, Neumann PA, Graf M, Kaissis G, Wilhelm D, Braren R, Reischl S. Development of an image-based Random Forest classifier for prediction of surgery duration of laparoscopic sigmoid resections. Int J Colorectal Dis 2024; 39:21. [PMID: 38273097 PMCID: PMC10811180 DOI: 10.1007/s00384-024-04593-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2024] [Indexed: 01/27/2024]
Abstract
PURPOSE Sigmoid diverticulitis is a disease with a high socioeconomic burden, accounting for a high number of left-sided colonic resections worldwide. Modern surgical scheduling relies on accurate prediction of operation times to enhance patient care and optimize healthcare resources. This study aims to develop a predictive model for surgery duration in laparoscopic sigmoid resections, based on preoperative CT biometric and demographic patient data. METHODS This retrospective single-center cohort study included 85 patients who underwent laparoscopic sigmoid resection for diverticular disease. Potentially relevant procedure-specific anatomical parameters recommended by a surgical expert were measured in preoperative CT imaging. After random split into training and test set (75% / 25%) multiclass logistic regression was performed and a Random Forest classifier was trained on CT imaging parameters, patient age, and sex in the training cohort to predict categorized surgery duration. The models were evaluated in the test cohort using established performance metrics including receiver operating characteristics area under the curve (AUROC). RESULTS The Random Forest model achieved a good average AUROC of 0.78. It allowed a very good prediction of long (AUROC = 0.89; specificity 0.71; sensitivity 1.0) and short (AUROC = 0.81; specificity 0.77; sensitivity 0.56) procedures. It clearly outperformed the multiclass logistic regression model (AUROC: average = 0.33; short = 0.31; long = 0.22). CONCLUSION A Random Forest classifier trained on demographic and CT imaging biometric patient data could predict procedure duration outliers of laparoscopic sigmoid resections. Pending validation in a multicenter study, this approach could potentially improve procedure scheduling in visceral surgery and be scaled to other procedures.
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Affiliation(s)
- Florian Lippenberger
- Institute of Diagnostic and Interventional Radiology, School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sebastian Ziegelmayer
- Institute of Diagnostic and Interventional Radiology, School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Maximilian Berlet
- Department of Surgery, School of Medicine, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
- Research Group MITI, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Hubertus Feussner
- Department of Surgery, School of Medicine, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
- Research Group MITI, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Marcus Makowski
- Institute of Diagnostic and Interventional Radiology, School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Philipp-Alexander Neumann
- Department of Surgery, School of Medicine, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Markus Graf
- Institute of Diagnostic and Interventional Radiology, School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Georgios Kaissis
- Institute of Diagnostic and Interventional Radiology, School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Institute for Artificial Intelligence in Medicine and Healthcare, School of Medicine and Faculty of Informatics, Technical University of Munich, Munich, Germany
| | - Dirk Wilhelm
- Department of Surgery, School of Medicine, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
- Research Group MITI, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Rickmer Braren
- Institute of Diagnostic and Interventional Radiology, School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- German Cancer Consortium (DKTK, Partner Site Munich) and German Cancer Research Center, DKFZ, Heidelberg, Germany
| | - Stefan Reischl
- Institute of Diagnostic and Interventional Radiology, School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
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Berlet M, Fuchtmann J, Krumpholz R, Naceri A, Macari D, Jähne-Schon C, Haddadin S, Friess H, Feussner H, Wilhelm D. Toward telemedical diagnostics-clinical evaluation of a robotic examination system for emergency patients. Digit Health 2024; 10:20552076231225084. [PMID: 38205033 PMCID: PMC10777806 DOI: 10.1177/20552076231225084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
Introduction The SARS-CoV-2 pandemic has affected global public healthcare for several years. Numerous medical professionals have been infected since the outbreak in 2019, resulting in a shortage of healthcare providers. Since traditional personal protective wear was insufficient to eliminate the virus transmission reliably, new strategies to avoid cross-infection were imperative while enabling high-quality medical care. In the project ProteCT, we investigated the potential of robotic-assisted examination in providing medical examination via a telemedical approach. Material and Methods We constructed a fully functional examination cabin equipped with cameras, microphones, screens and robotic arms to evaluate usability and perception. Therefore, we conducted a preliminary study with 10 healthy volunteers and 10 physicians to gain first insights and optimize the setup. In a second step, we performed telemedical examinations of actual patients from the local emergency department to compare the robotic approach with the classical method of measuring vital signs, auscultation, palpation and percussion. Results The preliminary study identified basic requirements, such as the need for force-feedback and telemedical training for physicians. In the main study, acceptance was high and most patients indicated they would use a telemedical system again. Our setup enabled the physician to make the same diagnoses as by classic examination in the emergency department in most cases. Discussion The potential acceptance of a telemedical system such as ProteCT is high. Robotic telemedical approaches could complement future healthcare beyond the Corona pandemic to reach rural areas or even war zones. Moreover, the daily clinical use of robotic telemedicine could improve patients' safety, the quality of perioperative management and the workflow in any medical facility. Conclusion The development of telemedical and telerobotic systems is a multidisciplinary and complex challenge. However, acceptance of the proposed system was high among patients and physicians, indicating the potential use of similar systems for future healthcare.
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Affiliation(s)
- Maximilian Berlet
- Department of Surgery, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
- MITI Research Group, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jonas Fuchtmann
- MITI Research Group, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Roman Krumpholz
- MITI Research Group, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Abdeldjallil Naceri
- Munich Institute of Robotics and Machine Intelligence, Technical University of Munich, Munich, Germany
| | - Daniela Macari
- Franka Emika GmbH, Munich, Germany
- Max Planck Institute for Intelligent Systems, Max Planck ETH Center for Learning Systems, Stuttgart, Germany
| | | | - Sami Haddadin
- Munich Institute of Robotics and Machine Intelligence, Technical University of Munich, Munich, Germany
| | - Helmut Friess
- Department of Surgery, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hubertus Feussner
- Department of Surgery, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
- MITI Research Group, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Dirk Wilhelm
- Department of Surgery, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
- MITI Research Group, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
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Dimpel R, Jell A, Reim D, Berlet M, Kranzfelder M, Vogel T, Friess H, Feussner H, Wilhelm D. The impact of prior endoscopic or surgical therapy on open Zenker's diverticulum surgery: analysis on a large single center cohort : Comparison of primary and revisional open surgery for Zenker's diverticulum. Surg Endosc 2023; 37:2112-2118. [PMID: 36316583 PMCID: PMC10017560 DOI: 10.1007/s00464-022-09690-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 09/25/2022] [Indexed: 03/17/2023]
Abstract
BACKGROUND Endoscopic treatment of Zenker's diverticulum is an attractive minimally invasive alternative compared to the classic open approach. However, increased recurrence rate were reported. In case of relapse, endoscopic therapy might be repeated, or alternatively open surgery is performed. This study aimed to identify potential differences in the outcomes between primary or secondary surgical treatment in Zenker's diverticulum. METHODS From January 2003 to April 2019, 227 subsequent patients underwent surgical diverticulectomy and cervical myotomy at the surgical department of TUM. 41 of 227 patients had received previous therapy, either open or endoscopic. Perioperative parameters in priorly untreated patients were retrospectively compared to those after previous therapy (mostly endoscopic) with special regard to perioperative data and postoperative complications. Univariate and multivariate regression analyses were performed to identify predictors for postoperative complications. RESULTS We could show that the number of complications (p = 0.047) in pretreated patients is significant higher as well as the severity after Clavien-Dindo (p = 0.025). Stapler line leakage, wound infections, and operative revision rate was higher also pretreated group. Pretreatment and surgery time showed a significant association with postoperative complications in univariate analysis. In multivariate analysis, pretreatment remained a significant independent predictor of complications. CONCLUSION The present data indicate that endoscopic therapy might represent a risk factor for postoperative complications in case of relapse surgery. Therefore primary open surgery should be debated in patients with an increased high risk of relapse.
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Affiliation(s)
- Rebekka Dimpel
- Department of Surgery, Faculty of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
- MITI Research Group (Minimally Invasive Interdisciplinary Therapeutical Interventions), Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
| | - Alissa Jell
- Department of Surgery, Faculty of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- MITI Research Group (Minimally Invasive Interdisciplinary Therapeutical Interventions), Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Daniel Reim
- Department of Surgery, Faculty of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Maximilian Berlet
- Department of Surgery, Faculty of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- MITI Research Group (Minimally Invasive Interdisciplinary Therapeutical Interventions), Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Michael Kranzfelder
- Department of Surgery, Faculty of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- MITI Research Group (Minimally Invasive Interdisciplinary Therapeutical Interventions), Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Thomas Vogel
- Department of Surgery, Faculty of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- MITI Research Group (Minimally Invasive Interdisciplinary Therapeutical Interventions), Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Helmut Friess
- Department of Surgery, Faculty of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Hubertus Feussner
- Department of Surgery, Faculty of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- MITI Research Group (Minimally Invasive Interdisciplinary Therapeutical Interventions), Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Dirk Wilhelm
- Department of Surgery, Faculty of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- MITI Research Group (Minimally Invasive Interdisciplinary Therapeutical Interventions), Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Nitsche U, Seitz M, Friess H, Feussner H, Hüser N, Jell A. Long-term outcome of patients with epiphrenic diverticula: A retrospective single-center analysis over 20 years. Surgery 2022; 172:1689-1696. [PMID: 36202656 DOI: 10.1016/j.surg.2022.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 06/30/2022] [Accepted: 08/24/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Epiphrenic diverticula are extremely rare. Evidence-based treatment recommendations are scarce. The primary study outcome was to examine whether surgical treatment in patients with epiphrenic diverticula leads to improved quality of life by outweighing the perioperative risks compared with conservative treatment. METHODS All patients with an epiphrenic diverticula at our institution between 2001 and 2021 were retrospectively reviewed and followed-up using a specific questionnaire, including the Eating Assessment Tool, and Gastrointestinal Quality of Life Index quality-of-life scores. RESULTS Of 51 patients with epiphrenic diverticula, 28 had surgery and 23 had conservative treatment. The most common symptom at presentation was dysphagia. Although 16 patients underwent open surgery, 12 had minimally invasive procedures. A prophylactic stent was applied intraoperatively in 6 patients. The morbidity rate in surgically treated patients was 50% (14/28), with a leakage in 43% (12/28; 33% for prophylactic stenting). Mortality was nil. At a median follow-up of 139 months, patients with surgery had better outcomes than those without (ie, less dysphagia [6/12 vs 11/12; P = .025]), a less likely pathologic Eating Assessment Tool score (4/12 vs 9/12; P = .041), and a nonsignificant better Gastrointestinal Quality of Life Index score (122 vs 112; P = .929). The rate of recurrence/progression of symptoms was significantly higher for conservatively treated patients (11/18 vs 6/27 for any surgery; P = .008), as well as for patients with minimally invasive procedure (5/12 vs 1/15 for open surgery; P = .030). CONCLUSION Despite the high perioperative morbidity, surgical treatment of epiphrenic diverticula leads to an improved long-term quality of life and lower recurrence rates than conservative treatment.
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Affiliation(s)
- Ulrich Nitsche
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
| | - Marie Seitz
- School of Medicine, Technical University of Munich, Munich, Germany
| | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hubertus Feussner
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Norbert Hüser
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Alissa Jell
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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5
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Hartwig R, Berlet M, Czempiel T, Fuchtmann J, Rückert T, Feussner H, Wilhelm D. [Image-based supportive measures for future application in surgery]. Chirurgie (Heidelb) 2022; 93:956-965. [PMID: 35737019 DOI: 10.1007/s00104-022-01668-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/02/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The development of assistive technologies will become of increasing importance in the coming years and not only in surgery. The comprehensive perception of the actual situation is the basis of every autonomous action. Different sensor systems can be used for this purpose, of which video-based systems have a special potential. METHOD Based on the available literature and on own research projects, central aspects of image-based support systems for surgery are presented. In this context, not only the potential but also the limitations of the methods are explained. RESULTS An established application is the phase detection of surgical interventions, for which surgical videos are analyzed using neural networks. Through a time-based and transformative analysis the results of the prediction could only recently be significantly improved. Robotic camera guidance systems will also use image data to autonomously navigate laparoscopes in the near future. The reliability of the systems needs to be adapted to the high requirements in surgery by means of additional information. A comparable multimodal approach has already been implemented for navigation and localization during laparoscopic procedures. For this purpose, video data are analyzed using various methods and these data are fused with other sensor modalities. DISCUSSION Image-based supportive methods are already available for various tasks and will become an important aspect for the surgery of the future; however, in order to be able to be reliably implemented for autonomous functions, they must be embedded in multimodal approaches in the future in order to provide the necessary security.
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Affiliation(s)
- R Hartwig
- Forschungsgruppe MITI, Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - M Berlet
- Forschungsgruppe MITI, Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
- Fakultät für Medizin, Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - T Czempiel
- Computer Aided Medical Procedures, Technische Universitat München, München, Deutschland
| | - J Fuchtmann
- Forschungsgruppe MITI, Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - T Rückert
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Regensburg, Deutschland
| | - H Feussner
- Forschungsgruppe MITI, Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - D Wilhelm
- Forschungsgruppe MITI, Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland.
- Fakultät für Medizin, Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland.
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Jell A, Fuchtmann J, Xiao M, Bernhard L, Berlet M, Feussner H, Wilhelm D. Robotic Endoscope Control - State of the Art of Voice Control and Other Options for Laparoscopic Camera Robot Guidance. Surg Technol Int 2022; 40:17-24. [PMID: 35546494 DOI: 10.52198/22.sti.40.so1545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In video-based surgery (VBS), the surgeon is no longer the master of his or her view. Visualization of the surgical field is mediated by a video camera guided by an assistant. The separation of visualization and surgical activities leads to significant drawbacks. Early in the history of VBS, active camera holders controlled directly by the surgeon were introduced to replace the human camera assistant. However, despite remarkable technological advances over the past 25 years, robotic camera guidance systems (RCGS) still play only a marginal role. This is less due to inadequate mechanical designs or kinematics, and mainly due to inadequate human-machine interaction. In most cases, a simple task-shift is required that increases the surgeon's mental workload instead of reducing it. The current state of the art in robotic camera guidance, as represented by the SOLOASSIST II RCGS (AKTORmed, Neutraubling, Germany), includes a sophisticated combination of direct manual control, joystick navigation and high-quality voice control that provides the most intuitive surgeon-machine interaction currently available. An in-depth analysis of further clinical needs and promising developments in operating room integration suggests that the addition of context sensitivity could actually enhance the assistive effect of RCGS, making them potentially superior to the average human camera guidance.
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Affiliation(s)
- Alissa Jell
- Surgical Department, Klinikum rechts der Isar, Technical University of Munich
- MITI Research Group, Klinikum rechts der Isar, Technical University of Munich
| | - Jonas Fuchtmann
- MITI Research Group, Klinikum rechts der Isar, Technical University of Munich
| | - Michel Xiao
- MITI Research Group, Klinikum rechts der Isar, Technical University of Munich
| | - Lukas Bernhard
- MITI Research Group, Klinikum rechts der Isar, Technical University of Munich
| | - Max Berlet
- Surgical Department, Klinikum rechts der Isar, Technical University of Munich
- MITI Research Group, Klinikum rechts der Isar, Technical University of Munich
| | - Hubertus Feussner
- Surgical Department, Klinikum rechts der Isar, Technical University of Munich
- MITI Research Group, Klinikum rechts der Isar, Technical University of Munich
| | - Dirk Wilhelm
- Surgical Department, Klinikum rechts der Isar, Technical University of Munich
- MITI Research Group, Klinikum rechts der Isar, Technical University of Munich
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7
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Maier-Hein L, Eisenmann M, Sarikaya D, März K, Collins T, Malpani A, Fallert J, Feussner H, Giannarou S, Mascagni P, Nakawala H, Park A, Pugh C, Stoyanov D, Vedula SS, Cleary K, Fichtinger G, Forestier G, Gibaud B, Grantcharov T, Hashizume M, Heckmann-Nötzel D, Kenngott HG, Kikinis R, Mündermann L, Navab N, Onogur S, Roß T, Sznitman R, Taylor RH, Tizabi MD, Wagner M, Hager GD, Neumuth T, Padoy N, Collins J, Gockel I, Goedeke J, Hashimoto DA, Joyeux L, Lam K, Leff DR, Madani A, Marcus HJ, Meireles O, Seitel A, Teber D, Ückert F, Müller-Stich BP, Jannin P, Speidel S. Surgical data science - from concepts toward clinical translation. Med Image Anal 2022; 76:102306. [PMID: 34879287 PMCID: PMC9135051 DOI: 10.1016/j.media.2021.102306] [Citation(s) in RCA: 69] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 02/06/2023]
Abstract
Recent developments in data science in general and machine learning in particular have transformed the way experts envision the future of surgery. Surgical Data Science (SDS) is a new research field that aims to improve the quality of interventional healthcare through the capture, organization, analysis and modeling of data. While an increasing number of data-driven approaches and clinical applications have been studied in the fields of radiological and clinical data science, translational success stories are still lacking in surgery. In this publication, we shed light on the underlying reasons and provide a roadmap for future advances in the field. Based on an international workshop involving leading researchers in the field of SDS, we review current practice, key achievements and initiatives as well as available standards and tools for a number of topics relevant to the field, namely (1) infrastructure for data acquisition, storage and access in the presence of regulatory constraints, (2) data annotation and sharing and (3) data analytics. We further complement this technical perspective with (4) a review of currently available SDS products and the translational progress from academia and (5) a roadmap for faster clinical translation and exploitation of the full potential of SDS, based on an international multi-round Delphi process.
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Affiliation(s)
- Lena Maier-Hein
- Division of Computer Assisted Medical Interventions (CAMI), German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Mathematics and Computer Science, Heidelberg University, Heidelberg, Germany; Medical Faculty, Heidelberg University, Heidelberg, Germany.
| | - Matthias Eisenmann
- Division of Computer Assisted Medical Interventions (CAMI), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Duygu Sarikaya
- Department of Computer Engineering, Faculty of Engineering, Gazi University, Ankara, Turkey; LTSI, Inserm UMR 1099, University of Rennes 1, Rennes, France
| | - Keno März
- Division of Computer Assisted Medical Interventions (CAMI), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Anand Malpani
- The Malone Center for Engineering in Healthcare, The Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Hubertus Feussner
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stamatia Giannarou
- The Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom
| | - Pietro Mascagni
- ICube, University of Strasbourg, CNRS, France; IHU Strasbourg, Strasbourg, France
| | | | - Adrian Park
- Department of Surgery, Anne Arundel Health System, Annapolis, Maryland, USA; Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Carla Pugh
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - Swaroop S Vedula
- The Malone Center for Engineering in Healthcare, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Kevin Cleary
- The Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, D.C., USA
| | | | - Germain Forestier
- L'Institut de Recherche en Informatique, Mathématiques, Automatique et Signal (IRIMAS), University of Haute-Alsace, Mulhouse, France; Faculty of Information Technology, Monash University, Clayton, Victoria, Australia
| | - Bernard Gibaud
- LTSI, Inserm UMR 1099, University of Rennes 1, Rennes, France
| | - Teodor Grantcharov
- University of Toronto, Toronto, Ontario, Canada; The Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Makoto Hashizume
- Kyushu University, Fukuoka, Japan; Kitakyushu Koga Hospital, Fukuoka, Japan
| | - Doreen Heckmann-Nötzel
- Division of Computer Assisted Medical Interventions (CAMI), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hannes G Kenngott
- Department for General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Ron Kikinis
- Department of Radiology, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Nassir Navab
- Computer Aided Medical Procedures, Technical University of Munich, Munich, Germany; Department of Computer Science, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Sinan Onogur
- Division of Computer Assisted Medical Interventions (CAMI), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tobias Roß
- Division of Computer Assisted Medical Interventions (CAMI), German Cancer Research Center (DKFZ), Heidelberg, Germany; Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Raphael Sznitman
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Russell H Taylor
- Department of Computer Science, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Minu D Tizabi
- Division of Computer Assisted Medical Interventions (CAMI), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Martin Wagner
- Department for General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Gregory D Hager
- The Malone Center for Engineering in Healthcare, The Johns Hopkins University, Baltimore, Maryland, USA; Department of Computer Science, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Thomas Neumuth
- Innovation Center Computer Assisted Surgery (ICCAS), University of Leipzig, Leipzig, Germany
| | - Nicolas Padoy
- ICube, University of Strasbourg, CNRS, France; IHU Strasbourg, Strasbourg, France
| | - Justin Collins
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, Leipzig University Hospital, Leipzig, Germany
| | - Jan Goedeke
- Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Daniel A Hashimoto
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA; Surgical AI and Innovation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Luc Joyeux
- My FetUZ Fetal Research Center, Department of Development and Regeneration, Biomedical Sciences, KU Leuven, Leuven, Belgium; Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Obstetrics and Gynecology, Division Woman and Child, Fetal Medicine Unit, University Hospitals Leuven, Leuven, Belgium; Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Kyle Lam
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Daniel R Leff
- Department of BioSurgery and Surgical Technology, Imperial College London, London, United Kingdom; Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom; Breast Unit, Imperial Healthcare NHS Trust, London, United Kingdom
| | - Amin Madani
- Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Hani J Marcus
- National Hospital for Neurology and Neurosurgery, and UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Ozanan Meireles
- Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | - Alexander Seitel
- Division of Computer Assisted Medical Interventions (CAMI), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dogu Teber
- Department of Urology, City Hospital Karlsruhe, Karlsruhe, Germany
| | - Frank Ückert
- Institute for Applied Medical Informatics, Hamburg University Hospital, Hamburg, Germany
| | - Beat P Müller-Stich
- Department for General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Pierre Jannin
- LTSI, Inserm UMR 1099, University of Rennes 1, Rennes, France
| | - Stefanie Speidel
- Division of Translational Surgical Oncology, National Center for Tumor Diseases (NCT/UCC) Dresden, Dresden, Germany; Centre for Tactile Internet with Human-in-the-Loop (CeTI), TU Dresden, Dresden, Germany
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8
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Krumpholz R, Fuchtmann J, Berlet M, Hangleiter A, Ostler D, Feussner H, Wilhelm D. Telemedical percussion: objectifying a fundamental clinical examination technique for telemedicine. Int J Comput Assist Radiol Surg 2021; 17:795-804. [PMID: 34820748 PMCID: PMC8612625 DOI: 10.1007/s11548-021-02520-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 10/07/2021] [Indexed: 11/14/2022]
Abstract
Purpose While demand for telemedicine is increasing, patients are currently restricted to tele-consultation for the most part. Fundamental diagnostics like the percussion still require the in person expertize of a physician. To meet today’s challenges, a transformation of the manual percussion into a standardized, digital version, ready for telemedical execution is required. Methods In conjunction with a comprehensive telemedical diagnostic system, in which patients can get examined by a remote-physician, a series of three robotic end-effectors for mechanical percussion were developed. Comprising a motor, a magnetic and a pneumatic-based version, the devices strike a pleximeter to perform the percussion. Emitted sounds were captured using a microphone-equipped stethoscope. The 84 recordings were further integrated into a survey in order to classify lung and non-lung samples. Results The study with 21 participants comprised physicians, medical students and non-medical-related raters in equal parts. With 71.4% correctly classified samples, the ventral motorized device prevailed. While the result is significantly better compared to a manual or pneumatic percussion in this very setup, it only has a small edge over the magnetic devices. In addition, for all ventral versions non-lung regions were rather correctly identified than lung regions. Conclusion The overall setup proves the feasibility of a telemedical percussion. Despite the fact, that produced sounds differ compared to today’s manual technique, the study shows that a standardized mechanical percussion has the potential to improve the gold standard’s accuracy. While further extensive medical evaluation is yet to come, the system paves the way for future uncompromised remote examinations.
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Affiliation(s)
- Roman Krumpholz
- Research Group MITI - Minimally Invasive Interdisciplinary Therapeutical Intervention, Technical University Munich, Munich, Germany.
| | - Jonas Fuchtmann
- Research Group MITI - Minimally Invasive Interdisciplinary Therapeutical Intervention, Technical University Munich, Munich, Germany
| | - Maximilian Berlet
- Research Group MITI - Minimally Invasive Interdisciplinary Therapeutical Intervention, Technical University Munich, Munich, Germany.,Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Annika Hangleiter
- Research Group MITI - Minimally Invasive Interdisciplinary Therapeutical Intervention, Technical University Munich, Munich, Germany
| | - Daniel Ostler
- Research Group MITI - Minimally Invasive Interdisciplinary Therapeutical Intervention, Technical University Munich, Munich, Germany
| | - Hubertus Feussner
- Research Group MITI - Minimally Invasive Interdisciplinary Therapeutical Intervention, Technical University Munich, Munich, Germany.,Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Dirk Wilhelm
- Research Group MITI - Minimally Invasive Interdisciplinary Therapeutical Intervention, Technical University Munich, Munich, Germany.,Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
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9
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Fuchtmann J, Krumpholz R, Ostler D, Naceri A, Macari D, Haddadin S, Wilhelm D, Feussner H, Berlet M. New Method for Surgical Diagnostics - a Robotic Telemedical Approach. Surg Technol Int 2021; 39:28-33. [PMID: 34816418 DOI: 10.52198/21.sti.39.so1498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Apart from the tremendous increase in the demand for telemedicine during the COVID-19 pandemic, the use of telemedical technology offers many advantages, such as better coverage of rural areas and improved access to specialists. While current telediagnostic possibilities are often limited to a verbal consultation, the field of surgery has already made use of robotics for one of the most challenging areas of medicine: invasive procedures. Since comprehensive diagnostics are a prerequisite for each surgery, we built upon the knowledge gained in telesurgery and developed a telediagnostic system that allows for an extensive perioperative and emergency examination. It is based on a robotic platform consisting of a remote lead robotic arm at the physician's site and a follower robot at the patient's site. Mirroring all movements directly and using force-feedback, both parties can precisely interact, enabling tasks such as auscultation, percussion, and palpation without the need for extensive training. Our overall setup also includes the possibility to measure and monitor all relevant vital parameters and can be used to perform ear and nasopharyngeal inspections as well as an automatic swab to screen for COVID or other contagious diseases prior to hospital admission. In this paper, we focus on the potential of this technology for the surgical community by demonstrating the ease of adding an ultrasound probe to our modular setup to perform a high-quality emergency ultrasound examination. While the system is not yet ready for everyday use in a hospital and drawbacks such as a high cost persist, our setup paves the way for the future use of telediagnostics in surgery.
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Affiliation(s)
- Jonas Fuchtmann
- Minimally Invasive Interdisciplinary Therapeutical Intervention, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Roman Krumpholz
- Minimally Invasive Interdisciplinary Therapeutical Intervention, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Daniel Ostler
- Minimally Invasive Interdisciplinary Therapeutical Intervention, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Abdeldjallil Naceri
- Chair of Robotics and System Intelligence, Munich Institute of Robotics and Machine Intelligence, Technical University Munich, Munich, Germany
| | | | - Sami Haddadin
- Chair of Robotics and System Intelligence, Munich Institute of Robotics and Machine Intelligence, Technical University Munich, Munich, Germany
| | - Dirk Wilhelm
- Minimally Invasive Interdisciplinary Therapeutical Intervention, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
- Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Hubertus Feussner
- Minimally Invasive Interdisciplinary Therapeutical Intervention, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
- Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Maximilian Berlet
- Minimally Invasive Interdisciplinary Therapeutical Intervention, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
- Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
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10
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Ostler D, Steger J, Bernhard L, Yu K, Hartwig R, Feussner H, Wilhelm D. “Hybrid” scientific conference: lessons learned from the digital annual meeting of the CARS international conference during the Covid-19 pandemic. Innov Surg Sci 2021; 6:115-123. [PMID: 35224179 PMCID: PMC8826162 DOI: 10.1515/iss-2021-0012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 10/18/2021] [Indexed: 12/11/2022] Open
Abstract
Abstract
Objectives
Due to the coronavirus disease 2019 (Covid-19) pandemic, all scientific conferences in the year 2020 had to be adapted in their form of presence to accommodate for safety regulations, postponed, or canceled entirely. As organizers of the annual Computer Assisted Radiology & Surgery International Conference & Exhibition (CARS)-Conference 2020, we decided to hold a “hybrid” conference, i.e., a virtual conference with partial presence to mitigate the drawbacks of a purely virtual conference. It is the purpose of this paper to describe the results and experience gained by our first hybrid conference.
Methods
Besides technical necessities like an online conferencing tool, we introduced additional personal namely the technical chairs and communication officers ensuring a smooth flow of presentations. To measure the success of the hybrid conference, we assessed various parameters during the conference (e.g., counting of adverse events, delays, and no-shows) and sent a questionnaire to participants for evaluation after the conference.
Results
We offered four types of presentation formats, whereas the majority of speakers presented their pre-produced videos including live discussions. Significant delays in sessions occurred during the morning sessions, which could be reduced during lunch breaks. The analysis of the influence of the distribution of the audience’s location/time zone toward the attendance rate showed a high relevance for the American zone and only little influence for the Asian-Pacific region. Based on the questionnaire, 60% of responders considered the hybrid approach as superior and 12% as inferior to purely virtual conferences.
Conclusions
Most scientific associations in 2020 had to struggle with a dramatic change: Regular, traditional meetings with personal communication and exchange, networking, and creation of new visions became obsolete almost instantly. As an alternative, virtual conferences became increasingly popular, and are offering additional advantages (e.g., reduction of cost for travel, lodging, and time on transit). To overcome the drawbacks of purely virtual conferences, we introduced a hybrid concept for the CARS-Congress. While certainly, those with the privilege to take part personally on-site did benefit most from the hybrid format. Facing upcoming waves of the Covid-19 Pandemic, with ongoing changes to the regulations on meetings and transit, hybrid conferences are a viable option for scientific conferences for the future.
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Affiliation(s)
- Daniel Ostler
- Minimally Invasive Interdisciplinary Therapeutical Intervention, Klinikum rechts der Isar, Technical University Munich , Munich , Germany
| | - Jana Steger
- Minimally Invasive Interdisciplinary Therapeutical Intervention, Klinikum rechts der Isar, Technical University Munich , Munich , Germany
| | - Lukas Bernhard
- Minimally Invasive Interdisciplinary Therapeutical Intervention, Klinikum rechts der Isar, Technical University Munich , Munich , Germany
| | - Kevin Yu
- Minimally Invasive Interdisciplinary Therapeutical Intervention, Klinikum rechts der Isar, Technical University Munich , Munich , Germany
| | - Regine Hartwig
- Minimally Invasive Interdisciplinary Therapeutical Intervention, Klinikum rechts der Isar, Technical University Munich , Munich , Germany
| | - Hubertus Feussner
- Minimally Invasive Interdisciplinary Therapeutical Intervention, Klinikum rechts der Isar, Technical University Munich , Munich , Germany
- Department of Surgery , Klinikum rechts der Isar, Technical University Munich , Munich , Germany
| | - Dirk Wilhelm
- Minimally Invasive Interdisciplinary Therapeutical Intervention, Klinikum rechts der Isar, Technical University Munich , Munich , Germany
- Department of Surgery , Klinikum rechts der Isar, Technical University Munich , Munich , Germany
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Berlet M, Fuchtmann J, Krumpholz R, Ostler D, Feussner H, Wilhelm D. Acting in a Robotic Environment Requires New Skills for Physicians. Current Directions in Biomedical Engineering 2021. [DOI: 10.1515/cdbme-2021-1020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
In context of the Corona pandemic, telemedicine acquired a new significance. Whereas previously the aim was to override given barriers, now, in the case of a pandemic, the main idea is to create an intentional distance between patients and healthcare professionals in order to avoid cross-infection. To meet the needs of a fully diagnostic examination, a robotic based system was designed. However, collaborative robotic systems bear new risks, that have to be dealt with. To prepare future physicians for telediagnostics, we developed a training curriculum for the telemedical examinations. It is based upon multiple stages including a skill trainer, healthy volunteers, supervised examinations of real patients and an exam. In a first proof of concept, we demonstrated the existence of a learning curve and significant better performance after the passed curriculum compared to an untrained collective.
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Affiliation(s)
- Maximilian Berlet
- MITI research group, Surgical department, Klinikum rechts der Isar, Ismaninger Str. 22, 81675 München , Germany
| | - Jonas Fuchtmann
- MITI research group, Surgical department, Klinikum rechts der Isar, München , Germany
| | - Roman Krumpholz
- MITI research group, Surgical department, Klinikum rechts der Isar, München , Germany
| | - Daniel Ostler
- MITI research group, Surgical department, Klinikum rechts der Isar, München , Germany
| | - Hubertus Feussner
- MITI research group, Surgical department, Klinikum rechts der Isar, München , Germany
| | - Dirk Wilhelm
- MITI research group, Surgical department, Klinikum rechts der Isar, München , Germany
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12
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Walter B, Krieger YS, Wilhelm D, Feussner H, Lueth TC, Meining A. Evaluation of improved bi-manual endoscopic resection using a customizable 3D-printed manipulator system designed for use with standard endoscopes: a feasibility study using a porcine ex-vivo model. Endosc Int Open 2021; 9:E881-E887. [PMID: 34079871 PMCID: PMC8159599 DOI: 10.1055/a-1395-7089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 02/03/2021] [Indexed: 12/27/2022] Open
Abstract
Background and study aims A major drawback of endoscopic en-bloc resection technique is its inability to perform bimanual tasks. Although endoscopic platforms that enable bimanual tasks are commercially available, they are neither approved for various locations nor adaptable to specific patients and indications. Methods Based on evolution of an adaptive 3D-printable platform concept, system variants with different characteristic properties were evaluated for ESD scenarios, ex-vivo in two locations in the stomach and colorectum. Results In total 28 ESDs were performed (7 antrum, 7 corpus in inversion, 7 cecum, 7 rectum) in a porcine ex-vivo setup. ESD was feasible in 21 cases. Investigated manipulator variants are differently well suited for performing ESD within the varying interventions scenarios. Dual-arm manipulators allowed autonomous ESD, while single-arm flexible manipulators could be used more universally due to their compact design, especially for lesions difficult to access. Pediatric scopes were too frail to guide the overtube-manipulators in extremely angled positions. Working in the rectum was impaired using long-sized manipulator arms. Conclusions The presented endoscopic platform based on 3D-printable and customizable manipulator structures might be a promising approach for future improvement of ESD procedure. With regard to localization, especially flexible manipulators attached to standard endoscopes appear to be most promising for further application of specific and individualised manipulator systems.
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Affiliation(s)
- Benjamin Walter
- Department of Internal Medicine I, University Hospital of Ulm, Ulm, Germany
| | - Yannick S. Krieger
- Department of Mechanical Engineering, Institute of Micro Technology and Medical Device Technology (MIMED), Technical University of Munich, Munich Germany
| | - Dirk Wilhelm
- MITI Research Group, Department of General and Visceral Surgery, Technical University of Munich, Munich, Germany
| | - Hubertus Feussner
- MITI Research Group, Department of General and Visceral Surgery, Technical University of Munich, Munich, Germany
| | - Tim C. Lueth
- Department of Mechanical Engineering, Institute of Micro Technology and Medical Device Technology (MIMED), Technical University of Munich, Munich Germany
| | - Alexander Meining
- Medical Clinic and Policlinic II, University Hospital Würzburg, Würzburg, Germany
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Wilhelm D, Müller-Stich B, Ostler D, Schmitz-Rixen T, Feussner H. Positionspapier „Digitalisierung in der Chirurgie“ – Konsequenzen? Zentralbl Chir 2020; 145:495-498. [DOI: 10.1055/a-1030-3888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Dirk Wilhelm
- Technische Universität München, Fakultät für Medizin, Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, München, Deutschland
- Arbeitsgruppe MITI, Technische Universität München, Klinikum rechts der Isar, München, Deutschland
| | | | - Daniel Ostler
- Arbeitsgruppe MITI, Technische Universität München, Klinikum rechts der Isar, München, Deutschland
| | - Thomas Schmitz-Rixen
- Klinik für Gefäß- und Endovaskularchirurgie, Universitätsklinikum Frankfurt, Deutschland
| | - Hubertus Feussner
- Arbeitsgruppe MITI, Technische Universität München, Klinikum rechts der Isar, München, Deutschland
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14
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Ostler D, Wilhelm D, Bernhard L, Fuchtmann J, Kranzfelder M, Vogel T, Feussner H. Machine Learning in the OR: A Collaborative Environment for Surgical Interventions in Visceral Medicine. Surg Technol Int 2020; 37:16-21. [PMID: 32681728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Modern surgical methods are becoming increasingly sophisticated and the number of technical devices that are used during these interventions is increasing. However, the surgical operating room (OR) remains a mere conglomerate of unconnected medical devices. The increase in the complexity of device functionality, in addition to the demands of surgery, pushes human mental capacity to its limit. Hence, an "intelligent" collaborative support system would be more than welcome. We envision a "human-like" intelligent system, which could support the surgical team as a situation-aware consultant. This so-called "active collaborative support system" (ACSS) is based on four main pillars: real-time data inflow, a comprehensive knowledge-base, access to the Internet of Things (surgical devices), and an understanding of human language through natural language processing. Recent advances in the area of AI are bringing this ambitious goal within reach, but there is still a considerable amount of work to be done, including the establishment of a new way of thinking in the collaboration between surgeons and computer scientists/engineers, and possibly one day with intelligent machines-provided that AI systems can be sufficiently trusted.
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Affiliation(s)
- Daniel Ostler
- Research Group MITI, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Dirk Wilhelm
- Research Group MITI, Klinikum rechts der Isar, Technical University Munich, Munich, Germany, Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Lukas Bernhard
- Research Group MITI, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Jonas Fuchtmann
- Research Group MITI, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Michael Kranzfelder
- Research Group MITI, Klinikum rechts der Isar, Technical University Munich, Munich, Germany, Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Thomas Vogel
- Research Group MITI, Klinikum rechts der Isar, Technical University Munich, Munich, Germany, Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Hubertus Feussner
- Research Group MITI, Klinikum rechts der Isar, Technical University Munich, Munich, Germany, Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
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15
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Berlet M, Hartwig R, Feussner H, Neumann PA, Wilhelm D. New insights in diagnostic laparoscopy. Current Directions in Biomedical Engineering 2020. [DOI: 10.1515/cdbme-2020-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
The basic concept of Diagnostic Laparoscopy (DL) is old but not old-fashioned. – Before the rise of tomography and ultrasound there was just the direct look into the abdomen and onto the affected organ available. As open surgery comes along with trauma, blood loss and infection, every effort have been made to improve the access strategies. Finally, due to innovation in optics, video technology and computer science, the look into the abdomen through a “keyhole” is a standard procedure today. – In this review we give an overview of history, implications and cost-effectiveness of DL, attempting an extrapolation of its future role.
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Affiliation(s)
- Maximilian Berlet
- Department of Surgery, Technical University of Munich , Munich , Germany
| | - Regine Hartwig
- Department of Surgery, Technical University of Munich , Munich , Germany
| | - Hubertus Feussner
- Department of Surgery, Technical University of Munich , Munich , Germany
| | | | - Dirk Wilhelm
- Department of Surgery, Technical University of Munich , Munich , Germany
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16
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Lemke HU, Feussner H, Berliner L. Guiding principles for video presentations of IJCARS articles and long abstracts. Int J Comput Assist Radiol Surg 2020; 15:897-899. [DOI: 10.1007/s11548-020-02213-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Ostler D, Seibold M, Fuchtmann J, Samm N, Feussner H, Wilhelm D, Navab N. Acoustic signal analysis of instrument-tissue interaction for minimally invasive interventions. Int J Comput Assist Radiol Surg 2020; 15:771-779. [PMID: 32323212 PMCID: PMC7261275 DOI: 10.1007/s11548-020-02146-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/27/2020] [Indexed: 12/03/2022]
Abstract
Purpose Minimally invasive surgery (MIS) has become the standard for many surgical procedures as it minimizes trauma, reduces infection rates and shortens hospitalization. However, the manipulation of objects in the surgical workspace can be difficult due to the unintuitive handling of instruments and limited range of motion. Apart from the advantages of robot-assisted systems such as augmented view or improved dexterity, both robotic and MIS techniques introduce drawbacks such as limited haptic perception and their major reliance on visual perception. Methods In order to address the above-mentioned limitations, a perception study was conducted to investigate whether the transmission of intra-abdominal acoustic signals can potentially improve the perception during MIS. To investigate whether these acoustic signals can be used as a basis for further automated analysis, a large audio data set capturing the application of electrosurgery on different types of porcine tissue was acquired. A sliding window technique was applied to compute log-mel-spectrograms, which were fed to a pre-trained convolutional neural network for feature extraction. A fully connected layer was trained on the intermediate feature representation to classify instrument–tissue interaction. Results The perception study revealed that acoustic feedback has potential to improve the perception during MIS and to serve as a basis for further automated analysis. The proposed classification pipeline yielded excellent performance for four types of instrument–tissue interaction (muscle, fascia, liver and fatty tissue) and achieved top-1 accuracies of up to 89.9%. Moreover, our model is able to distinguish electrosurgical operation modes with an overall classification accuracy of 86.40%. Conclusion Our proof-of-principle indicates great application potential for guidance systems in MIS, such as controlled tissue resection. Supported by a pilot perception study with surgeons, we believe that utilizing audio signals as an additional information channel has great potential to improve the surgical performance and to partly compensate the loss of haptic feedback.
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Affiliation(s)
- Daniel Ostler
- Minimally Invasive Interdisciplinary Therapeutical Intervention, Technical University Munich, Munich, Germany.
- Chair for Computer Aided Medical Procedures and Augmented Reality, Technical University Munich, Munich, Germany.
| | - Matthias Seibold
- Minimally Invasive Interdisciplinary Therapeutical Intervention, Technical University Munich, Munich, Germany.
- Chair for Computer Aided Medical Procedures and Augmented Reality, Technical University Munich, Munich, Germany.
- Research in Orthopedic Computer Science Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | - Jonas Fuchtmann
- Minimally Invasive Interdisciplinary Therapeutical Intervention, Technical University Munich, Munich, Germany
| | - Nicole Samm
- Minimally Invasive Interdisciplinary Therapeutical Intervention, Technical University Munich, Munich, Germany
- Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Hubertus Feussner
- Minimally Invasive Interdisciplinary Therapeutical Intervention, Technical University Munich, Munich, Germany
- Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Dirk Wilhelm
- Minimally Invasive Interdisciplinary Therapeutical Intervention, Technical University Munich, Munich, Germany
- Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Nassir Navab
- Chair for Computer Aided Medical Procedures and Augmented Reality, Technical University Munich, Munich, Germany
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18
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Czempiel T, Paschali M, Keicher M, Simson W, Feussner H, Kim ST, Navab N. TeCNO: Surgical Phase Recognition with Multi-stage Temporal Convolutional Networks. Medical Image Computing and Computer Assisted Intervention – MICCAI 2020 2020. [DOI: 10.1007/978-3-030-59716-0_33] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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19
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Jell A, Vogel T, Ostler D, Marahrens N, Wilhelm D, Samm N, Eichinger J, Weigel W, Feussner H, Friess H, Kranzfelder M. 5th-Generation Mobile Communication: Data Highway for Surgery 4.0. Surg Technol Int 2019; 35:36-42. [PMID: 31694061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION 5th generation cellular mobile communications (5G) is one of the main requirements for the digital future. The new standard will offer high bandwidths (10GB/s), low latency (<1ms), and a high quality of service. It is not yet known whether 5G performance is sufficient for demanding eHealth applications (e.g., telemedicine). MATERIAL AND METHODS We evaluated 5G performance in two different medical applications (person/asset track & tracing and video data transmission for telesurgery) to appraise the impact of this new technology. In addition, a Delphi study was conducted evaluating the expectations and acceptance of 5G in the medical field in general. RESULTS Delphi study revealed that 5G has great potential for the future information transfer in the healthcare domain, and an increase of research activities for 5G applications in hospitals is needed. Clinical evaluation proved technical feasibility and accuracy of the 5G track & trace prototype solution. For the telepresence use case, the video stream data rate varied between 900KB-1MB/s (7.2-8 Mb/s). The data rate of the robotic control command varied between 2.4-7.2KB/s (19.2-57.6Kb/s). Delay time (latency) ranged between 2-60ms depending on the transmitted data packet length. Seventy-five percent of data packets were processed after 30ms. CONCLUSION 5G data transmission volume, rate, and latency met the requirements for real-time track & trace and telemedicine applications. Especially for the latter, 5G data transmission offers a high potential and further research should be carried out.
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Affiliation(s)
- Alissa Jell
- Department of Surgery, Research Group Minimally Invasive Interdisciplinary Therapeutical Intervention (MITI), Klinikum rechts der Isar, Technical University Munich (TUM), Munich, Germany, Department of Surgery, Klinikum rechts der Isar, Technical University Munich (TUM), Munich, Germany
| | - Thomas Vogel
- Department of Surgery, Research Group Minimally Invasive Interdisciplinary Therapeutical Intervention (MITI), Klinikum rechts der Isar, Technical University Munich (TUM), Munich, Germany, Department of Surgery, Klinikum rechts der Isar, Technical University Munich (TUM), Munich, Germany
| | - Daniel Ostler
- Department of Surgery, Research Group Minimally Invasive Interdisciplinary Therapeutical Intervention (MITI), Klinikum rechts der Isar, Technical University Munich (TUM) , Munich, Germany
| | - Nils Marahrens
- Department of Surgery, Research Group Minimally Invasive Interdisciplinary Therapeutical Intervention (MITI), Klinikum rechts der Isar, Technical University Munich (TUM) , Munich, Germany
| | - Dirk Wilhelm
- Department of Surgery, Research Group Minimally Invasive Interdisciplinary Therapeutical Intervention (MITI), Klinikum rechts der Isar, Technical University Munich (TUM), Munich, Germany, Department of Surgery, Klinikum rechts der Isar, Technical University Munich (TUM), Munich, Germany
| | - Nicole Samm
- Department of Surgery, Research Group Minimally Invasive Interdisciplinary Therapeutical Intervention (MITI), Klinikum rechts der Isar, Technical University Munich (TUM), Munich, Germany, Department of Surgery, Klinikum rechts der Isar, Technical University Munich (TUM), Munich, Germany
| | - Josef Eichinger
- Huawei Technologies Düsseldorf GmbH, European Research Center, Munich, Germany
| | - Walter Weigel
- Huawei Technologies Düsseldorf GmbH, European Research Center, Munich, Germany
| | - Hubertus Feussner
- Department of Surgery, Research Group Minimally Invasive Interdisciplinary Therapeutical Intervention (MITI), Klinikum rechts der Isar, Technical University Munich (TUM), Munich, Germany, Department of Surgery, Klinikum rechts der Isar, Technical University Munich (TUM), Munich, Germany
| | - Helmut Friess
- Germany, Department of Surgery, Klinikum rechts der Isar, Technical University Munich (TUM), Munich, Germany
| | - Michael Kranzfelder
- Department of Surgery, Research Group Minimally Invasive Interdisciplinary Therapeutical Intervention (MITI), Klinikum rechts der Isar, Technical University Munich (TUM), Munich, Germany, Department of Surgery, Klinikum rechts der Isar, Technical University Munich (TUM), Munich, Germany
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20
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Feussner H, Krieger Y, Wilhelm D, Brunner S, Ostler D, Meining A, Lueth T. Mechatronic Support System for NOTES and Monoport Surgery - A New Approach. Surg Technol Int 2019; 34:23-29. [PMID: 31034576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
To circumvent the drawbacks of currently available platforms for natural orifice transluminal endoscopic surgery (NOTES) and monoport surgery (MPS), we developed a patient-specific, disposable, surgical soft robotic system. The system (Single-Port Overtube; SPOT) is designed as an overtube for standard surgical equipment. The platform body and the manipulators can be quickly adapted to transmural (monoport), NOTES and endoluminal (endoscopic) applications, and 3D-printed overnight as an individualized system. In addition, practical considerations, such as the predicted "ideal" dimensions of the platform, were evaluated. As a result, we found that preoperatively available biometric data currently provide little support for tailored instrument design. Further work is required to provide engineers / developers with more useful preoperative information.
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Affiliation(s)
- Hubertus Feussner
- Department of General and Visceral Surgery, Technical University of Munich, Munich, Germany
| | - Yannick Krieger
- Department of General and Visceral Surgery, Technical University of Munich, Munich, Germany
| | - Dirk Wilhelm
- Department of General and Visceral Surgery, Technical University of Munich, Munich, Germany
| | - Stephan Brunner
- Department of General and Visceral Surgery, Technical University of Munich, Munich, Germany
| | - Daniel Ostler
- Department of General and Visceral Surgery, Technical University of Munich, Munich, Germany
| | - Alexander Meining
- Clinic for Internal Medicine I, Center for Internal Medicine, Ulm University Hospital, Ulm, Germany
| | - Tim Lueth
- Department of Mechanical Engineering, Technical University of Munich, Munich, Germany
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21
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He S, Jell A, Hüser N, Kohn N, Feussner H. 24-hour monitoring of transient lower esophageal sphincter relaxation events by long-term high-resolution impedance manometry in normal volunteers: The "mirror phenomenon". Neurogastroenterol Motil 2019; 31:e13530. [PMID: 30676686 DOI: 10.1111/nmo.13530] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/30/2018] [Accepted: 11/27/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND The aim of this study was to investigate the frequency and circadian changes in transient lower esophageal sphincter relaxations (TLESRs) in normal volunteers using 24-hour high-resolution impedance manometry (HRIM). METHODS Fifteen volunteers underwent HRIM. TLESRs were recorded during the mealtime, 2-hour postprandial, daytime, and supine periods. The catheter was firmly secured to the nose, and subjects went home, ate normal meals, and continued routine daily activities. KEY RESULTS Successful recordings were obtained in 11 volunteers. Overall, 1083 TLESRs were documented; the average occurrence was 4.2/h, and the duration was 21.0 ± 5.2 seconds. The majority of the TLESRs occurred during the 2-hour postprandial (42.7%) and daytime (31.5%) periods, while 10.2% and 15.6% occurred during the mealtime and supine periods, respectively. Eight hundred and eighty-six (81.8%) TLESRs were associated with reflux. Overall, 25.5% of TLESRs were preceded by partial secondary peristalsis (PSP), while 74.5% were preceded by nothing. Terminating events included primary peristalsis (PP; 40.3%), PSP (42.8%), full secondary peristalsis (FSP; 8.2%), or nothing (8.7%). Both preceding and terminating events periodically changed throughout the four periods. One hundred and twelve (10.3%) TLESRs with both preceding and terminating events of PSP, presenting as a "mirror phenomenon," were documented. The majority of these TLESRs occurred during the supine (70.5%). CONCLUSIONS & INFERENCES Transient lower esophageal sphincter relaxations are common physiological motor events in normal volunteers; these events have certain circadian rhythms, as do the events that precede and terminate TLESR events. A special "mirror phenomenon" is observed when both the preceding and terminating events are PSP.
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Affiliation(s)
- Suyu He
- The Fourth Department of the Digestive Disease Center, Suining Central Hospital, Sichuan, China
| | - Alissa Jell
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Working Group for Minimally Invasive Interdisciplinary Therapeutical Intervention, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Norbert Hüser
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Nils Kohn
- Working Group for Minimally Invasive Interdisciplinary Therapeutical Intervention, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hubertus Feussner
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Working Group for Minimally Invasive Interdisciplinary Therapeutical Intervention, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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22
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Feussner H, Wilhelm D, Navab N, Knoll A, Lüth T. Surgineering: a new type of collaboration among surgeons and engineers. Int J Comput Assist Radiol Surg 2018; 14:187-190. [PMID: 30539502 DOI: 10.1007/s11548-018-1893-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 11/28/2018] [Indexed: 11/24/2022]
Affiliation(s)
- H Feussner
- Department of General and Visceral Surgery, Klinikum rechts der Isar Munich, Technical University of Munich, Munich, Germany.
| | - D Wilhelm
- Department of General and Visceral Surgery, Klinikum rechts der Isar Munich, Technical University of Munich, Munich, Germany
| | - N Navab
- Chair for Computer Aided Medical Procedures and Augmented Reality, Institute of Informatic I16, Technische Universität München, Boltzmannstr. 3, 85748, Garching bei München, Germany
| | - A Knoll
- Chair of Robotics and Embedded Systems, Institute of Informatic VI, Technische Universität München, Boltzmannstraße 3, 85748, Garching bei München, Germany
| | - T Lüth
- Chair of Micro Technology and Medical Device Technology, TUM Department of Mechanical Engineering, Technische Universität München, Boltzmannstraße 3, 85748, Garching bei München, Germany
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23
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Knoll A, Mewes HW, Schwaiger M, Bode A, Broy M, Daniel H, Feussner H, Gradinger R, Hauner H, Höfler H, Holzmann B, Horsch A, Kemper A, Krcmar H, Kochs EF, Lange R, Leidl R, Mansmann U, Mayr EW, Meitinger T, Molls M, Navab N, Nüsslin F, Peschel C, Reiser M, Ring J, Rummeny EJ, Schlichter J, Schmid R, Wichmann HE, Ziegler S, Kuhn KA. Informatics and Medicine. Methods Inf Med 2018. [DOI: 10.3414/me9117] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Summary
Objectives: To clarify challenges and research topics for informatics in health and to describe new approaches for interdisciplinary collaboration and education. Methods: Research challenges and possible solutions were elaborated by scientists of two universities using an interdisciplinary approach, in a series of meetings over several months. Results and Conclusion: In order to translate scientific results from bench to bedside and further into an evidence-based and efficient health system, intensive collaboration is needed between experts from medicine, biology, informatics, engineering, public health, as well as social and economic sciences. Research challenges can be attributed to four areas: bioinformatics and systems biology, biomedical engineering and informatics, health informatics and individual healthcare, and public health informatics. In order to bridge existing gaps between different disciplines and cultures, we suggest focusing on interdisciplinary education, taking an integrative approach and starting interdisciplinary practice at early stages of education.* See more detailed authors´ affiliations at the end of the article.
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24
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Maier-Hein L, Vedula SS, Speidel S, Navab N, Kikinis R, Park A, Eisenmann M, Feussner H, Forestier G, Giannarou S, Hashizume M, Katic D, Kenngott H, Kranzfelder M, Malpani A, März K, Neumuth T, Padoy N, Pugh C, Schoch N, Stoyanov D, Taylor R, Wagner M, Hager GD, Jannin P. Surgical data science for next-generation interventions. Nat Biomed Eng 2017; 1:691-696. [PMID: 31015666 DOI: 10.1038/s41551-017-0132-7] [Citation(s) in RCA: 185] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Lena Maier-Hein
- Division Computer Assisted Medical Interventions (CAMI), German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany.
| | - Swaroop S Vedula
- The Malone Center for Engineering in Healthcare, The Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Stefanie Speidel
- Division Translational Surgical Oncology, National Center for Tumor Diseases (NCT), 01307, Dresden, Germany
| | - Nassir Navab
- Computer Aided Medical Procedures, Technical University of Munich, 80333, Munich, Germany.,Department of Computer Science, The Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Ron Kikinis
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02215, USA.,Department of Computer Science, University of Bremen, 28359, Bremen, Germany.,Fraunhofer MEVIS, 28359, Bremen, Germany
| | - Adrian Park
- Department of Surgery, Anne Arundel Health System, Annapolis, MD, 21401, USA.,Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Matthias Eisenmann
- Division Computer Assisted Medical Interventions (CAMI), German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany
| | - Hubertus Feussner
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany
| | - Germain Forestier
- Department of Computer Science, University of Haute-Alsace, 68093, Mulhouse, France
| | - Stamatia Giannarou
- The Hamlyn Centre for Robotic Surgery, Imperial College London, London, SW7 2AZ, UK
| | - Makoto Hashizume
- Department of Advanced Medical Initiatives, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Darko Katic
- Institute for Anthropomatics and Robotics, Karlsruhe Institute of Technolgoy (KIT), 76131, Karlsruhe, Germany
| | - Hannes Kenngott
- Department for General, Visceral and Transplant Surgery, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Michael Kranzfelder
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany
| | - Anand Malpani
- The Malone Center for Engineering in Healthcare, The Johns Hopkins University, Baltimore, MD, 21218, USA.,Department of Computer Science, The Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Keno März
- Division Computer Assisted Medical Interventions (CAMI), German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany
| | - Thomas Neumuth
- Innovation Center Computer Assisted Surgery (ICCAS), University of Leipzig, 04103, Leipzig, Germany
| | - Nicolas Padoy
- ICube, University of Strasbourg, CNRS, IHU, 67081, Strasbourg, France
| | - Carla Pugh
- Department of Surgery, University of Wisconsin, Madison, WI, 53792, USA
| | - Nicolai Schoch
- Engineering Mathematics and Computing Lab (EMCL), IWR, Heidelberg University, 69120, Heidelberg, Germany
| | - Danail Stoyanov
- Centre for Medical Image Computing (CMIC) and Department of Computer Science, University College London, London, WC1E 6BT, UK
| | - Russell Taylor
- Department of Computer Science, The Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Martin Wagner
- Department for General, Visceral and Transplant Surgery, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Gregory D Hager
- The Malone Center for Engineering in Healthcare, The Johns Hopkins University, Baltimore, MD, 21218, USA. .,Department of Computer Science, The Johns Hopkins University, Baltimore, MD, 21218, USA.
| | - Pierre Jannin
- Université de Rennes 1, 35065, Rennes, France. .,INSERM, 35043, Rennes, France.
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He S, Feussner H, Nennstiel S, Bajbouj M, Hüser N, Wilhelm D. Endoluminal Sphincter Augmentation with the MUSE System and GERDX System in the Treatment of Gastroesophageal Reflux Disease: A New Impact? Surg Technol Int 2017; 30:131-140. [PMID: 28537351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
To bridge the gap between the long-term intake of proton pump inhibitors (PPIs) and the potential risks of laparoscopic fundoplication, a number of endoscopic procedures for the treatment of gastro-esophageal reflux disease (GERD) have been developed over the past 30 years. Because of the minimally invasive approach, short operative time, and efficacy in selected patients, endoluminal sphincter augmentation appears to be highly attractive. However, most early devices have proven to be unsafe or failed to provide long-term symptom relief. Accordingly, products for endoluminal sphincter augmentation have undergone several modifications to achieve an increased lower esophageal sphincter (LES) baseline pressure to re-establish the LES as an efficacious anti-reflux barrier. This paper reviews and discusses the two latest products for endoluminal sphincter augmentation, the MUSE device (Medigus, Ltd., Omer, Israel) and the GERDX system (G-SURG GmbH, Seeon-Seebruck, Germany). While the currently available literature has proven their effectiveness in principle, long-term results are lacking. Further studies and developments are necessary to determine whether these two new devices will truly impact GERD therapy.
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Affiliation(s)
- Suyu He
- The Fourth Department of the Digestive Disease Center, Suining Central Hospital, Sichuan, China
| | - Hubertus Feussner
- Chirurgische Klinik, Klinikum rechts der Isar, Technische Universität München, Germany, Munich, Germany
| | - Simon Nennstiel
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Monther Bajbouj
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Norbert Hüser
- Chirurgische Klinik, Klinikum rechts der Isar, Technische Universität München, Germany, Munich, Germany
| | - Dirk Wilhelm
- Chirurgische Klinik, Klinikum rechts der Isar, Technische Universität München, Germany, Munich, Germany
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26
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Neu B, Nennstiel S, von Delius S, Abdelhafez M, Bajbouj M, Schmid RM, Berger H, Feussner H, Meining A. Endoscopic rendez-vous reconstruction of complete biliary obstruction. Dig Liver Dis 2017; 49:769-772. [PMID: 28314602 DOI: 10.1016/j.dld.2017.01.170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 01/15/2017] [Accepted: 01/19/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND STUDY AIMS Complete biliary strictures normally require surgical intervention. We describe an alternative, minimally invasive endoscopic/percutaneous rendez-vous technique for the reconstruction of complete benign biliary strictures. PATIENTS AND METHODS Complete biliary strictures were reconstructed in four patients using a rendez-vous percutaneous-endoscopic or percutaneous-percutaneous route guided by fluoroscopic and visual (transillumination) control. RESULTS All four patients were treated successfully and safely with the rendez-vous technique. Complications were caused by the preliminary creation, dilatation and maturation of the percutaneous tract. CONCLUSION This technique may offer a good alternative to surgical bilio-enteric anastomosis in experienced hands. The long term course of the patients treated remains to be seen.
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Affiliation(s)
- B Neu
- Academic Teaching Hospital Landshut-Achdorf, Medizinische Klinik II, Landshut, Technische Universität München, Germany.
| | - S Nennstiel
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - S von Delius
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - M Abdelhafez
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - M Bajbouj
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - R M Schmid
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - H Berger
- Institut für diagnostische und interventionelle Radiologie, Klinikums rechts der Isar, Technische Universität München, München, Germany
| | - H Feussner
- Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - A Meining
- Klinik für Innere Medizin I, Universitätsklinikum Ulm, Ulm, Germany
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27
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Schneider A, Wilhelm D, Bohn U, Wichert A, Feussner H. An evaluation of a surgical telepresence system for an intrahospital local area network. J Telemed Telecare 2016; 11:408-13. [PMID: 16356315 DOI: 10.1177/1357633x0501100806] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
summary We evaluated a digital telepresence system in an operating theatre (OR) environment which enabled a consultant to join the surgical team from a remote site by audiovisual communication. The system is based on video transmission using a streaming technique, with a server and a client connected via a local area network (LAN). Two cameras can be remotely controlled: one camera is built into the OR lamp and a second, laparoscopic camera is mounted on a robotic arm. Another feature of the system is teledemonstration, which permits the remote consultant to demonstrate points of particular interest. We evaluated the system clinically in 237 cases. In 28 cases (12%), telepresence could not be established for various reasons, mainly human failure. In 42 cases (18%), the full potential of telepresence was used. Technical evaluation showed that a data rate of 2 Mbit/s provides sufficient audio and video quality, as well as reliable teledemonstration. The data transmission delay was acceptable for clinical purposes (video 0.92 s, audio 0.6s from OR to client, audio 0.7s from client to OR). The study showed that telepresence is a promising means of providing highly specialized expertise within the OR.
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Affiliation(s)
- A Schneider
- Workgroup MIT, Klinikum r.d. Isar, Technical University Munich, Germany
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28
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Becker V, Ostler D, Feussner H, Nennstiel S, Haller B, Schmid RM, Bajbouj M, Schneider A. Esophageal bougination: a novel ex vivo endoscopic training model correlated with clinical data. Surg Endosc 2016; 31:2566-2572. [PMID: 27670649 DOI: 10.1007/s00464-016-5262-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 09/19/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Esophageal bougination is a worldwide standard endoscopic procedure. Clinical methods and recommendations are based on clinical experiences only. Mechanical properties have never been described. Aim of the study was to establish a realistic ex vivo training model. Therefore, detailed assessment of relevant mechanical features of esophageal bougination should be evaluated ex vivo and in patient setting and correlated against. PATIENTS AND METHODS A three-step concept was used to evaluate mechanical properties at stenosis level. First, insertion forces were evaluated in an ex vivo linear single stenosis model during steady mechanical insertion. Second, adding friction and properties of the pharynx and upper esophagus, the model was integrated in an artificial endoscopic training model (ELITE training model). Third, in vivo measurements were taken to correlate ex vivo data with parameters of a realistic patient setting. RESULTS With the presented setup, we were able to assess insertion force and pressure levels in an artificial stricture using different sizes of commercially available standard bougies. In all models, there was a relevant increase in insertion force with higher stricture pressure levels. Insertion force levels in the ELITE model show higher levels compared to the linear stenosis model. Having regard to the maximum forces in patients, there is also a constant increase in mean insertion force according to higher bougie sizes, but lower forces were measured as in the ELITE model. DISCUSSION The applied models are suitable to appraise mechanical properties of esophageal bougination in an ex vivo model and patient setting. Forces could be constituted reliable, significant increase was documented according to stenosis level and results were comparable to patient data. This was comparable to patient data. Further clinical evaluation in different kinds of stenosis is necessary.
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Affiliation(s)
- V Becker
- II. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany.
| | - D Ostler
- MITI, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - H Feussner
- MITI, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - S Nennstiel
- II. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
| | - B Haller
- Institut für Medizinische Statistik und Epidemiologie, Technische Universität München, Munich, Germany
| | - R M Schmid
- II. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
| | - M Bajbouj
- II. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany
| | - A Schneider
- MITI, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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29
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Schneider A, Wilhelm D, Doll D, Rauschenbach U, Finkenzeller M, Wirnhier H, Illgner K, Feussner H. Wireless live streaming video of surgical operations: an evaluation of communication quality. J Telemed Telecare 2016; 13:391-6. [DOI: 10.1258/135763307783064386] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We evaluated a mobile video system for surgical teleconsultation. A video streaming server in the operating room transmitted video and audio to a hand-held computer (personal digital assistant [PDA]) over a wireless local area network. Two groups of 20 surgeons (each with 12 qualified surgeons and eight surgeons between the 2nd and the 4th year of training) participated in the tests. For voice transmission, correct understanding of numbers was achieved in 100% of the cases ( n = 1000) and 98% of medical terms ( n = 400). The quality of the video displayed on the PDA was assessed by the recognition of different operating room scenarios. Only 62% (SD 17) of the structures were identified clearly on the hand-held device ( n = 400). The accuracy improved to 78% (SD 15) ( n = 400) if the same scenario was observed on a larger (50 cm) video screen ( p < 0.001). Accuracy was significantly better if audio conversation was possible. The quality evaluation by the consultants showed that the PDA display size and quality were sufficient for clinical use.
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Affiliation(s)
| | - Dirk Wilhelm
- Workgroup MITI, Munich, Germany; Department of Surgery, Klinikum r. d. Isar, Technische Universität München, Munich, Germany
| | - Dietrich Doll
- Department of Surgery, Klinikum r. d. Isar, Technische Universität München, Munich, Germany
| | | | | | | | | | - Hubertus Feussner
- Workgroup MITI, Munich, Germany; Department of Surgery, Klinikum r. d. Isar, Technische Universität München, Munich, Germany
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30
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Wilhelm D, Jell A, Feussner H, Schmid RM, Bajbouj M, Becker V. Pharyngeal pH monitoring in gastrectomy patients - what do we really measure? United European Gastroenterol J 2015; 4:541-5. [PMID: 27536364 DOI: 10.1177/2050640615617637] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 10/24/2015] [Indexed: 12/19/2022] Open
Abstract
AIM Diagnosis of laryngopharyngeal reflux (LPR) has dramatically increased over the last years. For diagnosis of gastroesophageal reflux, a newly designed pharyngeal probe (Dx-pH) was recently introduced. It is also recommended to guide therapy decision in antireflux surgery. However, diagnostic results are questionable. Therefore, we establish a reliable reference group with asymptomatic patients after total gastrectomy and, thus, complete extinction of gastric acid production. METHODS Pharyngeal pH monitoring was performed in 10 consecutive patients with history of total gastrectomy. All patients were off proton pump inhibitor (PPI) therapy and followed a non-acid diet during the complete measurement period. RESULTS All procedures were performed without any complication. Six of the 10 asymptomatic gastrectomy patients (60%) had pathological results derived from the validated reference values (Ryan score) in pharyngeal pH monitoring. CONCLUSION Pathological pH values assessed by the Dx-pH device, usually interpreted as pathological aerosolized acidic gastroesophageal and/or laryngopharyngeal reflux, are obviously dissociated from gastric acid production. Further studies are required to determine diagnostic value of the new system. Therefore, the pharyngeal pH monitoring system seems currently not to be useful to guide any diagnostic or therapeutic decisions, in particular if surgical therapy is considered.
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Affiliation(s)
- Dirk Wilhelm
- Chirurgische Klinik, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Alissa Jell
- Chirurgische Klinik, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Hubertus Feussner
- Chirurgische Klinik, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Roland M Schmid
- Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Monther Bajbouj
- Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Valentin Becker
- Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Germany
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Bauer M, Meining A, Kranzfelder M, Jell A, Schirren R, Wilhelm D, Friess H, Feussner H. Endoluminal perforation of a magnetic antireflux device. Surg Endosc 2015; 29:3806-10. [PMID: 25877789 DOI: 10.1007/s00464-015-4145-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 01/24/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND The history of surgical antireflux treatment is coined by the search for better alternatives to Nissen fundoplication. Implantable devices are one option, beginning with the "Angelchik" prosthesis 30 years ago. However, this procedure was left soon because of the high rate of foreign body connected problems (migration, perforation). A modern approach is a magnetic sphincter augmentation device (LINX Reflux Management System, Torax Medical, Shoreview, MN, USA), a magnetic chain which is implanted laparoscopically. Advantages reported are simplicity to apply and good results in reflux control, with up to now only rare complication rates as reported in the literature (Lipham et al. in Dis Esophagus, 2014). METHODS We report one case of erosion of the esophagus by a LINX system resulting in severe dysphagia. RESULTS A complete endoluminal removal could be achieved by a prototype OTSC-clip remover. Complete remission could be achieved. The technique is presented in detail (video). CONCLUSIONS In principle, total endoscopic removal of the LINX device is feasible in case of major erosion.
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Affiliation(s)
- Margit Bauer
- Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Alexander Meining
- Department of Internal Medicine I, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Michael Kranzfelder
- Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Alissa Jell
- Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Rebekka Schirren
- Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Dirk Wilhelm
- Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Hubertus Feussner
- Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.
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Feussner H, Fiolka A, Schneider A, Cuntz T, Coy J, von Tiesenhausen C, Höller K, Weede O, Konietschke R, Borchard JH, Ellrichmann M, Reiser S, Ortmaier T. The "Iceberg Phenomenon": As Soon as One Technological Problem in NOTES Is Solved, the Next One Appears! Surg Innov 2015; 22:643-50. [PMID: 25733547 DOI: 10.1177/1553350615573578] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Though already proclaimed about 7 years ago, natural orifice transluminal endoscopic surgery (NOTES) is still in its early stages. A multidisciplinary working team tried to analyze the technical obstacles and identify potential solutions. METHODS After a comprehensive review of the literature, a group of 3 surgeons, 1 gastroenterologist, 10 engineers, and 1 representative of biomedical industry defined the most important deficiencies within the system and then compiled as well as evaluated innovative technologies that could be used to help overcome these problems. These technologies were classified with regard to the time needed for their implementation and associated hindrances, where priority is based on the level of impact and significance that it would make. RESULTS Both visualization and actuation require significant improvement. Advanced illumination, mist elimination, image stabilization, view extension, 3-dimensional stereoscopy, and augmented reality are feasible options and could optimize visual information. Advanced mechatronic platforms with miniaturized, powerful actuators, and intuitive human-machine interfaces could optimize dexterity, as long as enabling technologies are used. The latter include depth maps in real time, precise navigation, fast pattern recognition, partial autonomy, and cognition systems. CONCLUSION The majority of functional deficiencies that still exist in NOTES platforms could be overcome by a broad range of already existing or emerging enabling technologies. To combine them in an optimal manner, a permanent dialogue between researchers and clinicians is mandatory.
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Affiliation(s)
| | - Adam Fiolka
- Technical University of Munich, Munich, Germany
| | | | - Timo Cuntz
- Fraunhofer Project Group for Automation in Medicine and Biotechnology (PAMB), Mannheim, Germany
| | | | | | - Kurt Höller
- Friedrich-Alexander University, Erlangen-Nürnberg, Germany
| | - Oliver Weede
- Karlsruhe Institute of Technology, Karlsruhe, Germany
| | | | | | - Mark Ellrichmann
- University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Abstract
Flexible endoscopy is increasingly developing into a therapeutic instead of a purely diagnostic discipline. Improved visualization makes early lesions easily detectable and allows us to decide ad hoc on the required treatment. Deep enteroscopy allows the exploration of even the small bowel - for long a "white spot" for gastrointestinal endoscopy - and to perform direct treatment. Endoscopic submucosal dissection is a considerable step forward in oncologically correct endoscopic treatment of (early) malignant lesions. Though still technically challenging, it is increasingly facilitated by new manipulation techniques and tools that are being steadily optimized. Closure of wall defects and hemostasis could be improved significantly. Even the anatomy beyond the gastrointestinal wall is being explored by the therapeutic use of endoluminal ultrasound. Endosonographic-guided surgery is not only a suitable fallback solution if conventional endoscopic retrograde cholangiopancreatography fails, but even makes necrosectomy procedures, abscess drainage, and neurolysis feasible for the endoscopist. Newly developed endoscopic approaches aim at formerly distinctive surgical domains like gastroesophageal reflux disease, appendicitis, and cholecystitis. Combined endoscopic/laparoscopic interventional techniques could become the harbingers of natural orifice transluminal endoscopic surgery, whereas pure natural orifice transluminal endoscopic surgery is currently still in its beginnings.
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Affiliation(s)
- Hubertus Feussner
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Valentin Becker
- 2nd Medical Department, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Margit Bauer
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Michael Kranzfelder
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Rebekka Schirren
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Tim Lüth
- Institute of Microtechnology and Medical Device Technology, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Alexander Meining
- 2nd Medical Department, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Dirk Wilhelm
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Germany
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Kranzfelder M, Schneider A, Fiolka A, Koller S, Wilhelm D, Reiser S, Meining A, Feussner H. What Do We Really Need? Visions of an Ideal Human-Machine Interface for NOTES Mechatronic Support Systems From the View of Surgeons, Gastroenterologists, and Medical Engineers. Surg Innov 2014; 22:432-40. [PMID: 25249584 DOI: 10.1177/1553350614550720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To investigate why natural orifice translumenal endoscopic surgery (NOTES) has not yet become widely accepted and to prove whether the main reason is still the lack of appropriate platforms due to the deficiency of applicable interfaces. METHODS To assess expectations of a suitable interface design, we performed a survey on human-machine interfaces for NOTES mechatronic support systems among surgeons, gastroenterologists, and medical engineers. Of 120 distributed questionnaires, each consisting of 14 distinct questions, 100 (83%) were eligible for analysis. RESULTS A mechatronic platform for NOTES was considered "important" by 71% of surgeons, 83% of gastroenterologist,s and 56% of medical engineers. "Intuitivity" and "simple to use" were the most favored aspects (33% to 51%). Haptic feedback was considered "important" by 70% of participants. In all, 53% of surgeons, 50% of gastroenterologists, and 33% of medical engineers already had experience with NOTES platforms or other surgical robots; however, current interfaces only met expectations in just more than 50%. Whereas surgeons did not favor a certain working posture, gastroenterologists and medical engineers preferred a sitting position. Three-dimensional visualization was generally considered "nice to have" (67% to 72%); however, for 26% of surgeons, 17% of gastroenterologists, and 7% of medical engineers it did not matter (P = 0.018). CONCLUSION Requests and expectations of human-machine interfaces for NOTES seem to be generally similar for surgeons, gastroenterologist, and medical engineers. Consensus exists on the importance of developing interfaces that should be both intuitive and simple to use, are similar to preexisting familiar instruments, and exceed current available systems.
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Affiliation(s)
| | | | - Adam Fiolka
- Technische Universität München, Munich, Germany
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Falkinger M, Kranzfelder M, Wilhelm D, Stemp V, Koepf S, Jakob J, Hille A, Endress W, Feussner H, Schneider A. Design of a test system for the development of advanced video chips and software algorithms. Surg Innov 2014; 22:155-62. [PMID: 24902691 DOI: 10.1177/1553350614537563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Visual deterioration is a crucial point in minimally invasive surgery impeding surgical performance. Modern image processing technologies appear to be promising approaches for further image optimization by digital elimination of disturbing particles. To make them mature for clinical application, an experimental test environment for evaluation of possible image interferences would be most helpful. METHODS After a comprehensive review of the literature (MEDLINE, IEEE, Google Scholar), a test bed for generation of artificial surgical smoke and mist was evolved. Smoke was generated by a fog machine and mist produced by a nebulizer. The size of resulting droplets was measured microscopically and compared with biological smoke (electrocautery) and mist (ultrasound dissection) emerging during minimally invasive surgical procedures. RESULTS The particles resulting from artificial generation are in the range of the size of biological droplets. For surgical smoke, the droplet dimension produced by the fog machine was 4.19 µm compared with 4.65 µm generated by electrocautery during a surgical procedure. The size of artificial mist produced by the nebulizer ranged between 45.38 and 48.04 µm compared with the range between 30.80 and 56.27 µm that was generated during minimally invasive ultrasonic dissection. CONCLUSION A suitable test bed for artificial smoke and mist generation was developed revealing almost identical droplet characteristics as produced during minimally invasive surgical procedures. The possibility to generate image interferences comparable to those occurring during laparoscopy (electrocautery and ultrasound dissection) provides a basis for the future development of image processing technologies for clinical applications.
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Affiliation(s)
- Marita Falkinger
- Research Group MITI (Minimally invasive Interdisciplinary Therapeutical Intervention), Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Michael Kranzfelder
- Research Group MITI (Minimally invasive Interdisciplinary Therapeutical Intervention), Klinikum rechts der Isar, Technical University Munich, Munich, Germany Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Dirk Wilhelm
- Research Group MITI (Minimally invasive Interdisciplinary Therapeutical Intervention), Klinikum rechts der Isar, Technical University Munich, Munich, Germany Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Verena Stemp
- Research Group MITI (Minimally invasive Interdisciplinary Therapeutical Intervention), Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Susanne Koepf
- Research Group MITI (Minimally invasive Interdisciplinary Therapeutical Intervention), Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Judith Jakob
- C.R.S. iiMotion GmbH, Villingen-Schwenningen, Germany
| | - Andreas Hille
- C.R.S. iiMotion GmbH, Villingen-Schwenningen, Germany
| | | | - Hubertus Feussner
- Research Group MITI (Minimally invasive Interdisciplinary Therapeutical Intervention), Klinikum rechts der Isar, Technical University Munich, Munich, Germany Department of Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Armin Schneider
- Research Group MITI (Minimally invasive Interdisciplinary Therapeutical Intervention), Klinikum rechts der Isar, Technical University Munich, Munich, Germany
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Bajbouj M, Feussner H. [Diagnosis of atypical reflux: new probe - more problems]. Z Gastroenterol 2014; 52:603-5. [PMID: 24905113 DOI: 10.1055/s-0034-1366190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ott R, Bajbouj M, Feussner H, Graf S, Holzapfel K, Niestroy B, Tzavella K, Wagner-Sonntag E, München A. [Dysphagia--what is important for primary diagnosis in private practice?]. MMW Fortschr Med 2014; 156:54-7. [PMID: 24956660 DOI: 10.1007/s15006-014-2922-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kranzfelder M, Wilhelm D, Doundoulakis M, Schneider A, Bauer M, Reiser S, Meining A, Feussner H. A probe-based electromagnetic navigation system to integrate computed tomography during upper gastrointestinal endoscopy. Endoscopy 2014; 46:302-5. [PMID: 24254384 DOI: 10.1055/s-0033-1358814] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND STUDY AIMS For preoperative work-up, an examination tool that visualizes separately compiled diagnostics in augmented reality would be desirable. We developed a probe-based electromagnetic navigation system, which can be passed through the working channel of an endoscope, to integrate computed tomography (CT) information during upper gastrointestinal endoscopy. PATIENTS AND METHODS The target registration error (TRE) of the system was evaluated experimentally and clinically. A total of 24 study patients with upper gastrointestinal cancer were included in the study. The cancerous lesion was endoscopically located (mean duration 8.4 minutes, range 7.1 - 23.2) and the TRE (coronal, transverse, sagittal layer) was measured by comparing the distance between the navigation probe (at the tip of the endoscope) and the target lesion shown on the corresponding CT cross section. RESULTS Experimental evaluations showed an accuracy in line with the system's inherent failure rate, with a median TRE of 2.8 mm (IQR 1.8 - 4.3), 2.2 mm (0.4 - 3.7), and 2.8 mm (1.1 - 5.9) in the coronal, transverse, and sagittal planes, respectively. Clinical evaluation revealed a median TRE of 4.8 mm (1.9 - 10.1), 3.9 mm (0.7 - 7.1), and 4.2 mm (0.9 - 8.9), respectively. No complications occurred during navigated endoscopy. CONCLUSIONS The probe-based electromagnetic navigation system revealed high accuracy (TRE < 5 mm), facilitating improved interpretation of endoluminal imaging.
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Affiliation(s)
- Michael Kranzfelder
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Dirk Wilhelm
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Manos Doundoulakis
- Research group MITI (Minimally invasive Interdisciplinary Therapeutical Intervention), Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Armin Schneider
- Research group MITI (Minimally invasive Interdisciplinary Therapeutical Intervention), Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Margit Bauer
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Silvano Reiser
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Alexander Meining
- II. Department of Medicine, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Hubertus Feussner
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, München, Germany
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Wilhelm D, Reiser S, Kohn N, Witte M, Leiner U, Mühlbach L, Ruschin D, Reiner W, Feussner H. Comparative evaluation of HD 2D/3D laparoscopic monitors and benchmarking to a theoretically ideal 3D pseudodisplay: even well-experienced laparoscopists perform better with 3D. Surg Endosc 2014; 28:2387-97. [DOI: 10.1007/s00464-014-3487-9] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 02/14/2014] [Indexed: 02/06/2023]
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Bergen T, Münzenmayer C, Schneider A, Feussner H, Reiser S, Wittenberg T. Panorama-Endoskopie für die erweiterte Sicht in chirurgischen Eingriffen – Ein Update. ACTA ACUST UNITED AC 2014. [DOI: 10.1055/s-0034-1371072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Feussner H, Reiser SB, Bauer M, Kranzfelder M, Schirren R, Kleeff J, Wilhelm D. [Further technical and digital development in minimally invasive and conventional surgery]. Chirurg 2014; 85:178, 180-5. [PMID: 24522491 DOI: 10.1007/s00104-013-2596-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Technological innovations have initiated a fundamental change in invasive therapeutic approaches which has led to a welcome reduction of surgical trauma but was also associated with a declining role of conventional surgery. Active utilization of future technological developments is decisive to promote new therapeutic strategies and to avoid a further loss of importance of surgery. This includes individualized preoperative therapy planning as well as intraoperative diagnostic work-up and navigation and the use of new functional intelligent implants. The working environment "surgical operating room" has to be refurbished into an integrated cooperating functional system. The impact of new technological developments is particularly obvious in minimally invasive surgery. There is a clear tendency towards further reduction in trauma in the surgical access. The incision will become smaller and the number of ports will be further reduced, with the aim of ultimately having just one port (monoport surgery) or even via natural access routes (scarless surgery). Among others, improved visualization including, e.g. autostereoscopy, digital image processing and intelligent support systems, which are able to assist in a cooperative way, will enable these goals to be achieved.
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Affiliation(s)
- H Feussner
- Klinikum rechts der Isar, Chirurgische Klinik und Poliklinik, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland,
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Eypasch E, Neugebauer E, Fischer F, Troidl H, Blum AL, Collet D, Cuschieri A, Dallemagne B, Feussner H, Fuchs KH, Glise H, Kum CK, Lerut T, Lundell L, Myrvold HE, Peracchia A, Petersen H, van Lanschot JJB. Laparoscopic antireflux surgery for gastroesophageal reflux disease (GERD). Surg Endosc 2014. [DOI: 10.1007/s004649900382] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Meining A, Spaun G, Fernández-Esparrach G, Arezzo A, Wilhelm D, Martinek J, Spicak J, Feussner H, Fuchs KH, Hucl T, Meisner S, Neuhaus H. NOTES in Europe: summary of the working group reports of the 2012 EURO-NOTES meeting. Endoscopy 2013; 45:214-7. [PMID: 23446668 DOI: 10.1055/s-0032-1326205] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The sixth EURO-NOTES workshop (4 - 6 October 2012, Prague, Czech Republic) focused on enabling intensive scientific dialogue and interaction between surgeons, gastroenterologists, and engineers/industry representatives and discussion of the state of the practice and development of natural orifice transluminal endoscopic surgery (NOTES) in Europe. In accordance with previous meetings, five working groups were formed. In 2012, emphasis was put on specific indications for NOTES and interventional endoscopy. Each group was assigned an important indication related to ongoing research in NOTES and interventional endoscopy: cholecystectomy and appendectomy, therapy of colorectal diseases, therapy of adenocarcinoma and neoplasia in the upper gastrointestinal tract, treating obesity, and new therapeutic approaches for achalasia. This review summarizes consensus statements of the working groups.
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Affiliation(s)
- A Meining
- Medical Department II, Technische Universität München, Munich, Germany.
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Feussner H, Wilhelm D. [Reply]. Chirurg 2013; 84:904. [PMID: 24344425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Gillen S, Pletzer B, Heiligensetzer A, Wolf P, Kleeff J, Feussner H, Fürst A. Solo-surgical laparoscopic cholecystectomy with a joystick-guided camera device: a case-control study. Surg Endosc 2013; 28:164-70. [PMID: 23990155 DOI: 10.1007/s00464-013-3142-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 07/22/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND This study aimed to evaluate the implementation of a joystick-controlled camera holder (Soloassist; Actormed, Barbing, Germany) in laparoscopic cholecystectomy as so-called solo-surgery compared with the standard operation. METHODS Of the 123 patients included in this study, 63 underwent laparoscopic cholecystectomy using the Soloassist system and were compared with 60 patients who underwent laparoscopic cholecystectomy with human assistance. The two groups did not differ significantly in terms of age, sex, body mass index, or American Society of Anesthesiology classification. The surgeons were divided into those highly experienced and those experienced with the new camera holder. The operation times were measured, including setup and dismantling of the system. The assessment also included complications, postoperative hospital stay, measurement of human resources in terms of personnel/minutes/operation, and subjective evaluation of the camera-guiding device by the surgeons. RESULTS The hospital stay and operation-related complications were not enhanced in the Soloassist group. The differences in core operation time (p = 0.008) and total operating time (p = 0.001) significantly favored the human assistant. Whereas the absolute duration of surgery was longer, the relative operating time (in personnel/minutes/operation) was significantly shorter (p < 0.001). In 4.8 % of the cases, the operation could not be performed completely with the camera-holding device. Clinically relevant postoperative complications did not occur. The experience of the surgeons did not differ significantly. The subjective evaluation regarding handling, image quality, effort, and satisfaction demonstrated high acceptance of the Soloassist system. CONCLUSIONS The camera-guiding device can be implemented without increased complications. The Soloassist system is safe and can be operated even by colleagues without system experience. All the surgeons rated their satisfaction with the system as very good to excellent. Although the operating times were longer than with the standard camera guidance, the absolute overall staff time was reduced.
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Affiliation(s)
- Sonja Gillen
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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Kranzfelder M, Schneider A, Fiolka A, Schwan E, Gillen S, Wilhelm D, Schirren R, Reiser S, Jensen B, Feussner H. Real-time instrument detection in minimally invasive surgery using radiofrequency identification technology. J Surg Res 2013; 185:704-10. [PMID: 23859134 DOI: 10.1016/j.jss.2013.06.022] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 04/17/2013] [Accepted: 06/07/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND A key part of surgical workflow recording is recognition of the instrument in use. We present a radiofrequency identification (RFID)-based approach for real-time tracking of laparoscopic instruments. METHODS The system consists of RFID-tagged instruments and an antenna unit positioned on the Mayo stand. For reliability analysis, RFID tracking data were compared with the assessment of the perioperative video data of instrument changes (the reference standard for instrument application detection) in 10 laparoscopic cholecystectomies. When the tagged instrument was on the Mayo stand, it was referred to as "not in use." Once it was handed to the surgeon, it was considered to be "in use." Temporal miscounts (incorrect number of instruments "in use") were analyzed. The surgeons and scrub nurses completed a questionnaire after each operation for individual system evaluation. RESULTS A total of 110 distinct instrument applications ("in use" versus "not in use") were eligible for analysis. No RFID tag failure occurred. The RFID detection rates were consistent with the period of effective instrument application. The delay in instrument detection was 4.2 ± 1.7 s. The highest percentage of temporal miscounts occurred during phases with continuous application of coagulation current. Surgeons generally rated the system better than the scrub nurses (P = 0.54). CONCLUSIONS The feasibility of RFID-based real-time instrument detection was successfully proved in our study, with reliable detection results during laparoscopic cholecystectomy. Thus, RFID technology has the potential to be a valuable additional tool for surgical workflow recognition that could enable a situation dependent assistance of the surgeon in the future.
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Affiliation(s)
- Michael Kranzfelder
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, München, Germany; Research Group, Minimally invasive Interdisciplinary Therapeutical Intervention, Klinikum rechts der Isar, Technische Universität München, München, Germany.
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47
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Abstract
BACKGROUND AND STUDY AIMS Endoscopic resection of gastric subepithelial tumors (SETs) carries a high risk of perforation. New techniques such as use of the over-the-scope clip (OTSC) may enable secure endoscopic closure of perforations. We aimed to evaluate the feasibility of endoscopic resection of small gastric SETs using a grasp-and-snare technique followed by OTSC closure of the gastric wall if necessary. PATIENTS AND METHODS In this prospective study 20 consecutive patients who presented with gastric SETs ≤ 3 cm were enrolled. Endoscopic resection was performed using a double-channel endoscope, a tissue anchor and a monofilament snare. If perforation occurred, the aim was to achieve complete closure with a tissue twin grasper and the OTSC. Procedures were performed under laparoscopic control using a 5-mm optic, which was introduced via a single 5-mm trocar through the umbilicus. All patients were followed up for 3 months after the procedure. RESULTS In 6 /20 patients a pure endoscopic approach was impossible and a switch to laparoscopic wedge resection was necessary (large tumor size in 2 /6 patients; mainly extraluminal growth in 4 /6 patients). Solely endoscopic resection was successfully performed in the remaining 14 patients. Amongst these, laparoscopic control was impossible in two cases. Perforation occurred in 6 /14 patients but gastric closure with the OTSC was performed successfully in all these cases. No complications occurred and follow-up was unremarkable. CONCLUSION Endoscopic snare resection enables safe treatment of small gastric SETs (diameter ≤ 3 cm) and seems faster and easier to perform than other endoscopic resection techniques, such as endoscopic submucosal dissection (ESD) or submucosal tunneling. Perforations occurring after full-thickness resection can be adequately managed by OTSC closure. Solely endoscopic resection without laparoscopic control seems possible in selected patients with tumors known to have purely intraluminal growth.
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Affiliation(s)
- C Schlag
- Technische Universität München, Munich, Germany.
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48
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Sodergren MH, Warren A, Nehme J, Clark J, Gillen S, Feussner H, Teare J, Darzi A, Yang GZ. Endoscopic horizon stabilization in natural orifice translumenal endoscopic surgery: a randomized controlled trial. Surg Innov 2013; 21:74-9. [PMID: 23686394 DOI: 10.1177/1553350613489187] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Spatial orientation in natural orifice translumenal endoscopic surgery (NOTES) has been identified as a potential barrier to clinical application. We aim to evaluate a triaxial inertial sensor and software that automatically corrects any movements on the roll axis of the flexible endoscope, allowing for stabilization of the image horizon during NOTES operations in a randomized controlled trial. METHODS A total of 18 participants (11 surgeons/7 gastroenterologists) performed a transgastric task in the ELITE simulator, which included navigation to the appendix and gallbladder, diathermy of the appendix base and gallbladder fossa, and clipping of the cystic duct using a single-channel gastroscope. Each participant performed the task twice with randomization to horizon stabilization occurring at the second attempt. The primary end point was change in overall performance (time taken and errors made) between the first and second attempt, and secondary end points were absolute performances in the second attempt and subjective evaluation. RESULTS Without horizon stabilization, there was a median improvement of 42.4% in time taken and 38% in number of errors made from the first to the second attempt; however, with the software turned on, there was a statistically significant deterioration of 4.9% (P = .038) in time taken and an increase in errors made of 183% (P = ns). CONCLUSIONS Although the software corrects the view to that preferred during surgery, the endoscopic control mechanism as well as the exit point of the instrument are altered in this process, leading to a deterioration of overall performance. Potential solutions include deploying intermittent horizon stabilization or using a robotic interface to achieve fully aligned perceptual-motor control.
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Kranzfelder M, Staub C, Fiolka A, Schneider A, Gillen S, Wilhelm D, Friess H, Knoll A, Feussner H. Toward increased autonomy in the surgical OR: needs, requests, and expectations. Surg Endosc 2012; 27:1681-8. [PMID: 23239307 DOI: 10.1007/s00464-012-2656-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Accepted: 10/10/2012] [Indexed: 11/24/2022]
Affiliation(s)
- Michael Kranzfelder
- Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, 81675 München, Germany.
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50
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Pehl C, Keller J, Allescher HD, Feussner H, Frieling T, Goebel-Stengel M, Gschossmann J, Kuhlbusch-Zicklam R, Mönnikes H, Nguyen HN, Müller M, Schirra J, Storr M, van der Voort I, Yüce B. [Diagnosis of oesophageal reflux by PH, impedance, and bilirubin measurement: recommendations of the German Society of Neurogastroenterology and of the working group for neurogastroenterology of the German Society for Digestive and Metabolic Diseases]. Z Gastroenterol 2012; 50:1310-32. [PMID: 23225560 DOI: 10.1055/s-0032-1325483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The current recommendations on indications, technical performance, and interpretation of diagnostic techniques for oesophageal reflux update the German recommandations about 24 hour pH measurement of 2003. The recommendations encompass conventional pH measurement, wireless pH measurement, pH and impedance measurements, and bilirubin measurement (duodenogastro-oesophageal reflux).
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Affiliation(s)
- C Pehl
- Medizinische Klinik, Kreiskrankenhaus Vilsbiburg, Vilsbiburg.
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