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HyperSpectral Imaging (HSI) technology enables quantitative tissue analyses beyond the limitations of the human eye. Thus, it serves as a new diagnostic tool for optical properties of diverse tissues. In contrast to other intraoperative imaging methods, HSI is contactless, noninvasive, and the administration of a contrast medium is not necessary. The duration of measurements takes only a few seconds and the surgical procedure is only marginally disturbed. Preliminary HSI applications in visceral surgery are promising with the potential of optimized outcomes. Current concepts, possibilities and new perspectives regarding HSI technology together with its limitations are discussed in this article.

Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a new tool in the treatment of patients with peritoneal carcinomatosis. The aerosol containing chemotherapeutic drugs is administered laparoscopically into the abdominal cavity to achieve a local treatment effect. This can be carried out in combination with systemic chemotherapy.Within the framework of a register study, we prospectively documented and evaluated the data of our first 111 PIPAC procedures. The analysis focused on perioperative patient safety and safety at the workplace. Perioperative clinical patient data were analyzed and the platinum concentration in the operating room was checked by wipe samples.A total of 62 patients were scheduled for PIPAC and 121 operations were carried out. In 9 procedures a secure access to the abdomen could not be found and 54 patients received 111 PIPAC treatments. One patient died as a result of intestinal perforation, six bowel lesions were treated immediately and healed without further complications. A further patient developed a postoperative renal failure. Otherwise, there was no major complications and no cases of toxicity.The PIPAC procedure can be used as a supplement to systemic drug treatment for peritoneal carcinomatosis. An exact selection of suitable patients is important. The PIPAC is a low-risk procedure when performed under strict inclusion criteria and under standardized conditions, for the patients and also the surgical staff.

Anastomotic insufficiency (AI) remains the most feared surgical complication in gastrointestinal surgery, which is closely associated with a prolonged inpatient hospital stay and significant postoperative mortality. Hyperspectral imaging (HSI) is a relatively new medical imaging procedure which has proven to be promising in tissue identification as well as in the analysis of tissue oxygenation and water content. Until now, no data exist on the in vivo HSI analysis of gastrointestinal anastomoses.Intraoperative images were obtained using the TIVITA™ tissue system HSI camera from Diaspective Vision GmbH (Pepelow, Germany). In 47 patients who underwent gastrointestinal surgery with esophageal, gastric, pancreatic, small bowel or colorectal anastomoses, 97 assessable recordings were generated. Parameters obtained at the sites of the anastomoses included tissue oxygenation (StOObtaining and analyzing the intraoperative images with this non-invasive imaging system proved practicable and delivered good results on a consistent basis. A NIR gradient along and across the anastomosis was observed and, furthermore, analysis of the tissue water and oxygenation content showed specific changes at the site of anastomosis.The HSI method provides a non-contact, non-invasive, intraoperative imaging procedure without the use of a contrast medium, which enables a real-time analysis of physiological anastomotic parameters, which may contribute to determine the "ideal" anastomotic region. In light of this, the establishment of this methodology in the field of visceral surgery, enabling the generation of normal or cut off values for different gastrointestinal anastomotic types, is an obvious necessity.

Laparoscopic restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) constitutes a curative treatment option for therapy-refractory ulcerative colitis. A two-stage procedure with loop ileostomy at the time of IPAA is the most frequent variant of surgery. The aim of the procedure is the complete removal of the colon and rectum with simultaneous restoration of gastrointestinal continuity and preservation of continence functions. Long-term quality of life following laparoscopic proctocolectomy with IPAA is good and comparable with a healthy reference population. The surgical technique is demonstrated in detail with the help of a video of the operation, which is available online.

Restorative proctocolectomy with an ileoanal pouch anastomosis (IAPA) is the surgical therapy of choice for patients with refractory ulcerative colitis and/or associated (pre)neoplastic lesions. It is predominantly performed laparoscopically. Reconstruction with a J‑pouch is the most frequently applied variant due to the ideal combination of technical simplicity and good long-term results. In the present review, potential postoperative pouch complications, their risk factors, diagnostics and surgical management, as well as mid-term and long-term quality of life after pouch construction are differentially presented based on the current literature.

The analysis of blood plasma or serum as a non-invasive alternative to tissue biopsies is a much-pursued goal in cancer research. Various methods and approaches have been presented to determine a patient’s tumour status, chances of survival, and response to therapy from serum or plasma samples. We established PNB-qPCR (Pooled, Nested, WT-Blocking qPCR), a highly specific nested qPCR with various modifications to detect and quantify minute amounts of circulating tumour DNA (ctDNA) from very limited blood plasma samples. PNB-qPCR is a nested qPCR technique combining ARMS primers, blocking primers, LNA probes, and pooling of multiple first round products for sensitive quantification of the seven most frequent point mutations in KRAS exon 2. Using this approach, we were able to characterize ctDNA and total cell-free DNA (cfDNA) kinetics by selective amplification of KRAS mutated DNA fragments in the blood plasma over the course of tumour resection and the surrounding days. Whereas total cfDNA concentrations increased over the surgical and regenerative process, ctDNA levels showed a different scheme, rising only directly after tumour resection and about three days after the surgery. For the first time, we present insights into the impact of surgery on the release of ctDNA and total cfDNA.

Background Despite improvements in liver surgery over the past decades, hemostasis during hepatic resections remains challenging. This multicenter randomized study compares the hemostatic effect of a collagen hemostat vs. a carrier-bound fibrin sealant after hepatic resection. Methods Patients scheduled for elective liver resection were randomized intraoperatively to receive either the collagen hemostat (COLL) or the carrier-bound fibrin sealant (CBFS) for secondary hemostasis. The primary endpoint was the proportion of patients with hemostasis after 3 min. Secondary parameters were the proportions of patients with hemostasis after 5 and 10 min, the total time to hemostasis, and the complication rates during a 3 months follow-up period. Results A total of 128 patients were included. In the COLL group, 53 out of 61 patients (86.9 %) achieved complete hemostasis within 3 min after application of the hemostat compared to 52 out of 65 patients (80.0 %) in the CBFS group. The 95 % confidence interval for this difference [−6.0 %, 19.8 %] does not include the lower noninferiority margin (−10 %). Thus, the COLL treatment can be regarded as noninferior to the comparator. The proportions of patients with hemostasis after 3, 5, and 10 min were not significantly different between the two study arms. Postoperative mortality and morbidity were similar in both treatment groups. Conclusion The collagen hemostat is as effective as the carrier-bound fibrin sealant in obtaining secondary hemostasis during liver resection with a comparable complication rate. Electronic supplementary material The online version of this article (doi:10.1007/s00423-014-1203-9) contains supplementary material, which is available to authorized users.