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In a highly competitive environment, surgery is forced to continuously improve the outcome and, simultaneously to reduce costs. These contradicting aims can only be reached by the combined use of cyber-physical systems . Digitalization of surgery may be denominated as “surgery 4.0 ”. This process will be primarily focussed on the surgical operation room which is the “profit centre” of any surgical unit. The aim is to transform it into a “collaborative environment”. Based upon a multitude of continuous real-time data, a support system should be capable to interpret the actual situation (context sensivity) and to predict the next steps required. In addition to the necessary medical and organizational structured knowledge which has to be provided before, the system should be able to learn from repeated procedures. Thus, it should offer active assistance to the surgical team to use the technical environment adequately, to smoothen the workflow, to avoid mistakes, and to improve the safety level. To reach this goal, some preconditions have still to be met: Comprehensive systems integration, the development of surgical and patient models, and a perfect communication not only between the devices and instruments but also with the human user. Making this vision mature for regular clinical care is challenging but first promising approaches have already been developed.

Identifying and recognizing the workflow of surgical interventions is a field of growing interest. Several methods have been developed to identify intra-operative activities, detect common phases in the surgical workflow and combine the gained knowledge into Surgical Process Models. Numerous applications of this knowledge are conceivable, from semi-automatic report generation, teaching and objective surgeon evaluation to context-aware operating rooms and simulation of interventions to optimize the operating room layout.