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A core principle of modern health care is the compliance of hygienic and aseptic techniques in areas that are sensitive to contamination through bacteria, dust, aerosols, and fallout, primarily in operating theatres or around patients with contagious diseases. Keeping track of potentially contaminated surfaces in an environment is a major concern, especially when protecting from COVID-19. This work proposes a novel concept in using 3D sensing technology to track human movement within an indoor area and identifying high-risk contaminated surfaces in real-time. It combines recent Augmented Reality display technology, which allows keeping track of decontaminated surfaces during the cleaning process using an interactive visualization method. The proposed concept of Clean- AR is implemented in a clinical environment used for observation in COVID-19 scenarios. We discuss key challenges and outline further research direction in effectively reducing the risk of contamination using the proposed concept.

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.

Die digitale Transformation des Gesundheitswesens wird unseren Berufszweig wesentlich verandern und schickt sich an, die onkologische Chirurgie zu revolutionieren. Die vorliegende Arbeit ist bemuht, eine neutrale Ubersicht uber die zentral betroffenen Bereiche und die hier bereits umgesetzten und in Zukunft zu erwartenden Veranderungen zu geben. Der Ubersichtsbeitrag berucksichtigt die aktuelle Literatur, Expertendiskussionen und Kongressinhalte. Der Fokus liegt hierbei auf der Indikationsstellung und der operativen Versorgung, wohingegen allgemeine Aspekte nur kurz abgehandelt werden. Digitalisierung bedeutet primar eine umfassende Bereitstellung von Daten, die im Rahmen des Behandlungsprozesses kontinuierlich und strukturiert erganzt werden. Diese erlauben eine fundierte Entscheidungsunterstutzung und die Einbindung assistierender Funktionen. Insbesondere im chirurgischen Operationssaal ergeben sich potente Werkzeuge der Prazisionsmedizin. Die Digitalisierung der onkologischen Chirurgie bietet zahlreiche Ansatze, die Behandlung unserer Patienten zu verbessern. Eine aktive, aber auch kritische Begleitung ist gefordert, der Patient muss hierbei im Fokus der Bemuhungen stehen.

Verfahren der kunstlichen Intelligenz werden auch in der Allgemein- und Viszeralchirurgie spezielle Anwendungsfelder finden, die nicht nur auf die eigentliche Tatigkeit im chirurgischen Operationssaal begrenzt sind, sondern sich auch auf alle perioperativen Prozesse, die Edukation und das Training, sowie die wissenschaftliche Weiterentwicklung erstrecken. Besondere Impulse werden fur die Bereiche Entscheidungsunterstutzung, kognitives kollaborierendes Interventionsumfeld und neue Formen der wissenschaftlichen Evidenzgewinnung erwartet. Die praktische Implementierung verlangt nicht nur profunde informationswissenschaftliche Kenntnisse, sondern auch die souverane Beherrschung der chirurgischen Wissensdomane, sodass eine neue Kultur der Kooperation zwischen Chirurgen und Forschern/Entwicklern gefordert werden muss.

Das „magische Dreieck“ in der Chirurgie und anderen Fachern besteht aus der Forderung nach immer schonenderen Therapieformen, gleichzeitiger Kostenreduktion und dem prinzipiellen Primat der Verbesserung der Ergebnisqualitat. Die Digitalisierung der Medizin bietet hierbei, auch im Sinne der „Chirurgie 4.0“, eine aussichtsreiche Chance, dem gerecht zu werden. Ziel ist hier die Schaffung einer kognitiven, kollaborativen Diagnose- und Therapieumgebung zur Unterstutzung des Chirurgen. Die Modellbildung bildet im Sinne eines „Theoriegebaudes“ fur Analyse und Planung den Grundpfeiler einer modernen Therapieplanung. Hier soll vor allem zwischen Patientenmodell und Behandlungsmodell unterschieden werden. Auch der Ablauf der eigentlichen chirurgischen Behandlung kann modelliert werden: Prinzipiell ist es moglich, den Verlauf einer Operation so feingranular zu beschreiben, dass der Operationsablauf bis auf den einzelnen Einsatz einer Pinzette abgebildet und nachvollzogen werden kann. In Grundzugen ist dies bereits jetzt schon verwirklicht. Auch sog. „neuronale Netze“ eroffnen vollig neue Formen des Erkenntnisgewinns, des maschinellen Lernens und der flexiblen Reaktion auf alle fast nur denkbaren Moglichkeiten in hochkomplexen Ablaufen. „Digitalisierung“ stellt eine notwendige Entwicklung in der Chirurgie dar. Sie bietet nicht nur unzahlige Moglichkeiten der Unterstutzung des Chirurgen in seinem Tatigkeitsfeld, sondern auch die Chance der exakteren Datenerfassung im Hinblick auf die akademische Chirurgie. Die Modellbildung ist hierbei unverzichtbarer Bestandteil und muss hierzu stringent durchgefuhrt und weiterentwickelt werden.

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.

Purpose During the COVID-19 pandemic, a threatening bottleneck of medical staff arose due to a shortage of trained caregivers, who became infected while working with infectious patients. While telemedicine is rapidly evolving in the fields of teleconsultation and telesurgery, proper telediagnostic systems are not yet available, although the demand for contactless patient–doctor interaction is increasing. Methods In this project, the current limitations were addressed by developing a comprehensive telediagnostic system. Therefore, medical examinations have been assessed in collaboration with medical experts. Subsequently, a framework was developed, satisfying the relevant constraints of medical-, technical-, and hygienic- aspects in order to transform in-person examinations into a contactless procedure. Diagnostic steps were classified into three groups: assisted procedures carried out by the patient, teleoperated examination methods, and adoptions of conventional methods. Results The Telemedical Diagnostic Framework was implemented, resulting in a functional proof of concept, where potentially infectious patients could undergo a full medical examination. The system comprises, e.g., a naso-pharyngeal swab, an inspection of the oral cavity, auscultation, percussion, and palpation, based on robotic end-effectors. The physician is thereby connected using a newly developed user-interface and a lead robot, with force feedback control, that enables precise movements with the follower robot on the patient’s side. Conclusion Our concept proves the feasibility of a fully telediagnostic system, that consolidates available technology and new developments to an efficient solution enabling safe patient-doctor interaction. Besides infectious situations, this solution can also be applied to remote areas.

PurposeWhile 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.MethodsIn conjunction with a comprehensive telemedical diagnostic system, in which patients can get examined by aremote-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.ResultsThe 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.ConclusionThe 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.

A common treatment for malignant hepatic tumors is radiofrequency thermal ablation (RFA); however this procedure is often exhausting and error-prone, when performed only with hand held devices. In this work, we present a new concept for a computer- and mechatronic-arm-assisted treatment of hepatic tumor with RFA. Challenging factors of state-of-the-art RFA procedures are tackled by utilizing a prototype, which combines state-of-the-art ultrasound image guidance with a mechatronic support arm system. Physicians can image and examine the human abdomen using an ultrasound capturing device which is guided by the mechatronic support arm. The mechatronic arm allows to track the ultrasound transducer via joint position encoders, so that the recorded images’ exact positions are acquired and the patient is automatically registered during imaging. Consequently, physicians can use the acquired ultrasound images to navigate in the imaged abdomen area. The established prototype enables preplanning and semi-automatic alignment of trajectories with sufficient accuracy. In addition, the arm system supports the usually lengthy, exhausting and error-prone holding of the needle during the ablation process. Based on the results of accuracy examination and expert assessments by surgeons, the established concept could be proven to be advantageous for the considered use case.

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.

Introduction: Esophageal motility disorders have a severe impact on patients’ quality of life. While high-resolution manometry (HRM) is the gold standard in the diagnosis of esophageal motility disorders, intermittently occurring muscular deficiencies often remain undiscovered if they do not lead to an intense level of discomfort or cause suffering in patients. Ambulatory long-term HRM allows us to study the circadian (dys)function of the esophagus in a unique way. With the prolonged examination period of 24 h, however, there is an immense increase in data which requires personnel and time for evaluation not available in clinical routine. Artificial intelligence (AI) might contribute here by performing an autonomous analysis. Methods: On the basis of 40 previously performed and manually tagged long-term HRM in patients with suspected temporary esophageal motility disorders, we implemented a supervised machine learning algorithm for automated swallow detection and classification. Results: For a set of 24 h of long-term HRM by means of this algorithm, the evaluation time could be reduced from 3 days to a core evaluation time of 11 min for automated swallow detection and clustering plus an additional 10–20 min of evaluation time, depending on the complexity and diversity of motility disorders in the examined patient. In 12.5% of patients with suggested esophageal motility disorders, AI-enabled long-term HRM was able to reveal new and relevant findings for subsequent therapy. Conclusion: This new approach paves the way to the clinical use of long-term HRM in patients with temporary esophageal motility disorders and might serve as an ideal and clinically relevant application of AI.

Telemedicine has become a valuable asset in emergency responses for assisting paramedics in decision making and first contact treatment. Paramedics in unfamiliar environments or time-critical situations often encounter complications for which they require external advice. Modern ambulance vehicles are equipped with microphones, cameras, and vital sensors, which allow experts to remotely join the local team. However, the visual channels are rarely used since the statically installed cameras only allow broad views at the patient. They neither allow a close-up view nor a dynamic viewpoint controlled by the remote expert. In this paper, we present EyeRobot, a concept which enables dynamic viewpoints for telepresence using the intuitive control of the user’s head motion. In particular, EyeRobot utilizes the 6 degrees of freedom pose estimation capabilities of modern head-mounted displays and applies them in real-time to the pose of a robot arm. A stereo-camera, installed on the end-effector of the robot arm, serves as the eyes of the remote expert at the local site. We put forward an implementation of EyeRobot and present the results of our pilot study which indicates its intuitive control.

Tracking of surgical instruments is an essential step towards the modernization of the surgical workflow by a comprehensive surgical landscape guidance system (COMPASS). Real-time tracking of a laparoscopic camera used in minimally-invasive surgery is required for applications in surgical workflow documentation, machine learning, image-localization, and intra-operative visualization. In our approach, an inertial measurement unit (IMU) assists the tool tracking in situations when no line-of-sight is available for infrared (IR) based tracking of the laparoscopic camera. The novelty of this approach lies in the localization method adjusted for the laparoscopic visceral surgery, particularly when the line-of-sight is lost. It is based on IMU tracking and the positioning of the trocar entry point. The trocar entry point is the remote center of motion (RCM), reducing degrees of freedom. We developed a method to tackle localization and a real-time tool for position and orientation estimation. The main error sources are given and evaluated in a test scenario. It reveals that for small changes in penetration length (e.g., pivoting), the IMU’s accuracy determines the error.

Die Fortschritte in der Digitalisierung und der Informationsverarbeitung nehmen auch Einfluss auf die interventionelle Medizin. Sich dieser Entwicklung anzupassen, wird eine zentrale Herausforderung der modernen (onkologischen) Chirurgie sein, um weiterhin optimierte Therapieverfahren anbieten zu konnen. Im Hinblick auf die technologische Entwicklung innerhalb und auch auserhalb der Medizin schlagen die Autoren eine „Chirurgie 4.0“ vor, die ein besonderes Augenmerk auf die Sammlung, Aufbereitung und Analyse von perioperativen Daten legt, um durch intelligente Assistenzsysteme die Eingriffe effizienter und sicherer zu machen. Hierzu werden – bezogen auf die 3 operativen Phasen Planung, Durchfuhrung und Nachbehandlung – die Bedeutung der Datengenerierung, Analyse und Interpretation und die moglichen Anwendungen fur kontextsensitive mechatronische oder softwarebasierte Unterstutzungssysteme dargestellt.

Minimal-invasive Eingriffe werden immer komplexer – eine entsprechende Weiterentwicklung der menschlichen Geschicklichkeit ist jedoch nicht moglich. Mechatronische Assistenzsysteme haben das Potenzial, die Geschicklichkeit uber naturliche Grenzen hinaus zu erweitern. Die aktuelle Verwendung von universellen Chirurgiesystemen ermoglicht es jedoch noch nicht, auf eingriffs- und patientenspezifische Besonderheiten einzugehen. Ziel ist es daher, die Auslegung mechatronischer Supportsysteme und deren Integration in den chirurgischen Workflow als Teil einer prazisen, praoperativen Therapieplanung einzubeziehen. Es soll erreicht werden, dass nicht mehr der Patient einer Operationsmethode angepasst, sondern vielmehr die Operation individuell an die besonderen Patientenvoraussetzungen adaptiert wird. Nach der Analyse bestehender Robotersysteme in der Chirurgie werden aktuelle Forschungsarbeiten auf diesem Gebiet vorgestellt und in den aktuellen Kontext gesetzt. Moglichkeiten fur zukunftige Anwendungen werden aufgezeigt. Mittels automatisierter Auslegung und additiver Fertigung lassen sich individualisierte Manipulatorsysteme fur minimal-invasive Eingriffe realisieren. In Kombination mit angepassten Softwaremodulen entstehen somit adaptive mechatronische Supportsysteme, die individuell auf Patient, Operateur und Eingriff zugeschnitten sind. Individualisierbare Medizintechnik wird durch neue Technologien immer realistischer. Derzeit erfolgt die erste klinische Evaluierung individuell angepasster Hardwarelosungen. Erste Softwarekonzepte zeigen zudem den Weg hin zu kognitiven Assistenzsystemen und zu deren Integration in ein vernetztes OP-Umfeld auf.

Die laparoskopische Cholezystektomie (CHE) ist heute eine hochstandardisierte, wenig traumatisierende und sichere Behandlungsform der Cholelithiasis. Dessen ungeachtet wurde immer wieder nach neueren interventionellen Optionen gesucht. Der Einsatz von mechatronischen Systemen („Roboter“) wurde fur die Kamerafuhrung und sogar fur die Ausfuhrung aller Operationsschritte untersucht. Kamerafuhrungssysteme der 1. und 2. Generation haben sich nicht durchsetzen konnen. Intelligente Gerate der 3. Generation haben kunftig moglicherweise das Potenzial fur eine deutliche Kostenreduktion. Der Einsatz von Telemanipulationssystemen ist heute weder von den Kosten noch durch irgendwelche Vorteile bei der Durchfuhrung der Operation zu rechtfertigen. Dies konnte sich erst andern, wenn wesentlich preisgunstigere, aber leistungsfahigere „kollaborative“ Systeme den operativen Workflow optimieren und das Sicherheitsniveau heben wurden. Modifikationen der laparoskopischen Technik wurden in Form der Reduced-Port- (Einsparung von 1 oder 2 Trokaren) oder der Monoporttechnik untersucht. Der instrumentelle und zeitliche Aufwand ist ebenso wie bei der sog. „Minilaparoskopie“ deutlich hoher, ohne dass ein echter Vorteil fur den Patienten bisher belegt werden konnte. Eine wirklich disruptive Option schien sich vor etwa 10 Jahren mit dem Konzept der narbenlosen CHE abzuzeichnen. Inzwischen ist klar, dass dieser Ansatz – auch in der Variante als sog. „starre“ CHE im Rahmen einer „natural orifice transluminal endoscopic surgery“ (NOTES) bisher noch keinen Durchbruch erzielen konnte. Die inzwischen aber bereits erreichten Fortschritte bei der technischen Realisierung lassen annehmen, dass bald eine uberzeugende neue Option fur die CHE klinisch verfugbar sein wird.

Background A reliable and sterile access through the intestinal wall to ease flexible endoscopic transluminal interventions is still appealing but lacks a suitable port system. Methods In a granted industry cooperation, we developed the MIEO-Port, a flexible three components overtube system that provides a temporary hermetic sealing of the intestinal wall to allow endoscopic disinfection and manipulation to gain access to the abdominal cavity. The port features an innovative head part which allows for coupling the port to the intestinal wall by vacuum suction and for controlled jetting the isolated intestinal surface with a disinfectant. The device was tested in vivo in 6 pigs for acute and long-term usability. All animal tests were approved by the local ethics committee. Results In the acute experiment, the port system supported sealed endoscopic mucosa resection and transluminal cholecystectomy. In the survival study on 5 animals, the MIEO-Port proved its reliability after transcolonic peritoneoscopy. In one animal, a port dislocation occurred after extensive retroperitoneal preparation, one animal revealed bacterial contamination at necropsy; however, all animals showed a favourable course over ten days and offered no signs of peritonitis or abscedation during post-mortem examination. Discussion To the best of our knowledge, the MIEO-Port system is the first device to provide a reliable and sterile flexible access to the peritoneal cavity that can be used throughout the entire gastrointestinal tract regardless of the access route and which combines hermetic sealing with local sterilization. Further studies are warranted.

The anastomosis of two bowel segments is one of the core competences in visceral surgery. However, postoperative complication rates and intraoperative trauma are still too high despite numerous methods and products available. The aim of this paper is to show the first approach towards the development of a transluminal system to enable micro invasive anastomosing just using natural orifices. In this context a requirements analysis based on expert discussions and literature evaluation focusing on postoperative complications was carried out. A testing model was developed and a pressure test setup was designed to derive optimal compression zone geometry, based on the material behavior of porcine bowel tissue. For the task of transluminal anastomization a highly adaptable and flexible system must be developed. From some initial experimental trials within an abstracted bowel model, we were able to reveal first promising results concerning feasibility of transluminal anastomosis generation. In the following an experimental protocol has to be developed to assess relevant parameters as a basis for an objective comparison of the different implant models.

High resolution manometry (HRM) is the gold standard in the diagnosis of esophageal motility disorders. In clinical practice HRM is only performed for about 30 minutes with a very standardized protocol. Esophageal motility disorders can cause severe discomfort and symptoms even if they only occur spontaneously. Such temporary motility disorders are often not detectable in conventional HRM. Longterm HRM is a unique way to study the circadian behavior of the esophagus and thus will contribute to a more effective treatment of esophageal motility disorders. Prolonging the time of measurement to a full of 24 hours leads to an exponential increase in data and work, which makes longterm HRM not yet feasible in clinical routine. 40 longterm HRM measurements of patients and healthy volunteers were meticulously tagged by hand and used as training and validation data for our machine learning model. As each longterm HRM dataset consists of at least 155 million datapoints at total amount of 6 billon datapoints big data in medicine can no longer be handled without support by artificial intelligence. Therefore, we implemented an automated swallow detection and a first classification system to help medi-cal professionals gain faster and easier insight in circadian (dys) motility of the esophagus. This significantly reduces the time and manpower required for longterm HRM evaluation and paves the way for a broad clinical use in the future in patients with temporary symptoms of esophageal motility disorders but though high levels of distress.

Die Realisierung des Operationssaals der Zukunft setzt die Integration aller Gerate in ein umfassendes Uberwachungs- und Steuerungssystem voraus. Heute existieren zahlreiche monolithische integrierte Operationssaalsysteme als proprietare Losungen, die alle aber nur einen relativ geringen Teil der Gesamtfunktionalitat abdecken. Weltweit gibt es derzeit mindestens drei Initiativen mit dem Ziel, eine wirklich umfassende Systemintegration und Vernetzung im Operationssaal zu verwirklichen: das japanische Smart Cyber Operating Theater (SCOT), das amerikanische Medical Device „Plug-and-Play“ Interoperability Programme (MDPnP) und das „Sichere und dynamische Vernetzung in Operationssaal und Klinik“ OR.NET-Projekt in Deutschland, gefordert durch das Bundesministerium fur Bildung und Forschung. Im Rahmen des wohl auch international fuhrenden OR.NET-Programms konnten prototypisch Losungsansatze realisiert werden, die kurz- bis mittelfristig einen umfassenden Daten- und Informationszufluss an ein zentrales Uberwachungs- und Steuerungssystem erwarten lassen. Eine aktive, unter Umstanden sogar autonome Kontrolle der Peripheriegerate durch das zentrale Uberwachungs- und Steuerungssystem im Sinne einer „closed loop“ wird dagegen vor allem aufgrund der regulatorischen Hurde erst langfristig zu erwarten sein.

Die Diagnostik osophagealer Funktionsstorungen ist seit vielen Jahren etabliert, allerdings bestehen immer noch erhebliche Wissensdefizite bez. des zirkadianen Motilitatsverhaltens. Bisher stand die sog. High-Resolution-Manometrie (HRM) mit der Moglichkeit einer simultanen Messung der Druckverhaltnisse in der gesamten Speiserohre nur als Kurzzeituntersuchung zur Verfugung. Ein derartiges Verfahren erfasst ein sehr begrenztes Zeitfenster. Es gibt jedoch sichere Hinweise darauf, dass Storungen der Speiserohrenmotilitat auch dann zu extremen Beschwerden fuhren konnen, wenn sie sporadisch auftreten. Mit einer Kurzzeitmessung werden diese nicht detektiert. Daher ist anzunehmen, dass die Langzeitfunktionsanalyse der Speiserohre wertvolle neue Erkenntnisse erbringen wird, die nicht nur zu einer Entwicklung wirkungsvollerer medikamentoser Behandlungsverfahren, sondern auch zu einer verbesserten Indikationsstellung operativer Therapieansatze beitragt. Seit Juni 2014 ist es in unserem Funktionsdiagnostischen Labor moglich, die Osophagusmotilitat in hoher Auflosung uber 24 Stunden zu bestimmen. Es wurden eine Drucksonde mit 36 Sensoren und ein tragbarer Datenlogger eingesetzt. Dieser Artikel beschreibt unsere ersten Erfahrungen im klinischen Einsatz der Langzeit-HR-Manometrie und diskutiert die Aus- und Verwertbarkeit von Langzeit-HR-Messungen im Kontext der zugrundeliegenden osophagogastralen Funktionsstorung.

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.

Metastatic Merkel Cell carcinoma (MCC) is a highly unusual and aggressive skin cancer that presents as a small, pink to violet skin lesion and metastasizes early in its growth. Metastatic MCC is generally treated with small cell lung cancer chemotherapy regimens, because the tumor consists of neuroendocrine cells, but patients generally do not have durable responses. The pathogenesis of MCC has recently been attributed to the Merkel Cell polyoma virus. This virus activates the cellular retinoblastoma oncoprotein and cell cycle machinery, triggering continual cellular proliferation. A 77-year-old man developed extensive MCC metastases, involving more than one fourth of his scalp and numerous cervical lymph nodes. Following failure of initial chemotherapy and radiation, effective palliation was achieved by using a sequence of electron-beam radiotherapy, low dose gemcitabine, and etoposide, resulting in significant periods of tumor regression and prolonged survival. A novel circulating tumor cell (CTC) culture assay was performed on four separate clinic visits during the treatment period. Tumor colonies were cultured from the patient’s peripheral blood and CTC colony counts were correlated with clinical treatment response. Not only did the patient respond to palliative cell cycle directed chemotherapy and electron beam radiation, but we demonstrated that CTC can be cultured from peripheral blood of MCC patients and serve as a predictive marker to monitor treatment response.

Single-Port Surgery is a recent development in minimally invasive surgery and denotes abdominal surgery where all instruments are inserted through a single incision. Further progress in the field of surgical intervention can solely be achieved by combined benefits regarding both surgical and technical improvements. The reduction of trauma as well as improvements in ergonomics compared to laparoscopic surgery can be recognized as main objectives. To comply with these requirements, a realtime controlled mechatronic-assisted single-port manipulator SISTUM with sufficient workspace and applied forces for precise tissue manipulation is proposed. With regard to sterility and biocompatibility aspects, the manipulating part of this system — the bio-inspired bending structure — is manufactured using selective laser sintering (SLS) with biocompatible polymers.