Search

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.

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).We evaluated 5G performance in two different medical applications (person/asset tracktracing 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.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 tracktrace 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.5G data transmission volume, rate, and latency met the requirements for real-time tracktrace and telemedicine applications. Especially for the latter, 5G data transmission offers a high potential and further research should be carried out.

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.

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.

With the emergence of new technologies, the surgical working environment becomes increasingly complex and comprises many medical devices that have to be taken cared of. However, the goal is to reduce the workload of the surgical team to allow them to fully focus on the actual surgical procedure. Therefore, new strategies are needed to keep the working environment manageable. Existing research projects in the field of intelligent medical environments mostly concentrate on workflow modeling or single smart features rather than building up a complete intelligent environment. In this article, we present the concept of intelligent digital assistance for clinical operating rooms (IDACO), providing the surgeon assistance in many different situations before and during an ongoing procedure using natural spoken language. The speech interface enables the surgeon to concentrate on the surgery and control the technical environment at the same time, without taking care of how to interact with the system. Furthermore, the system observes the context of the surgery and controls several devices autonomously at the appropriate time during the procedure.

Innovationen in der Medizintechnik sind einerseits eine globale Herausforderung, andererseits mussen diese aber auch den lokalen Notwendigkeiten und Problemen angepasst werden. Universitaten und Hochschulen haben sich diesen Gegebenheiten und der Anpassung der akademischen Ausbildung hinsichtlich interdisziplinarer Innovationsgenerierung in der Zusammenarbeit von Medizinern, Ingenieuren, Wissenschaftlern und der Okonomie noch nicht ausreichend gestellt. Wir denken, handeln und bilden immer noch in Fakultaten aus, anstatt problemorientiert. Fruh in der Ausbildung konnten Techniken und Methoden erlernt werden sowie Studenten herangefuhrt werden, um die nachste Generation an Medizintechnikunternehmen als Entrepreneur und Chief Executive Officer (CEO) anzufuhren. Bereits gut etabliert sind Angebote und Veranstaltungen u. a. von Entrepreneurshipzentren und Master-of- Business-Administration(MBA)-Programmen. Wir haben ein neuartiges Ausbildungskonzept eingefuhrt, das seit 2011 an der Technischen Universitat Munchen (TUM) und seit 2014 an der Otto-von-Guericke-Universitat (OvGU) in Magdeburg unterrichtet und stets verbessert wird. Die essenziellen Bestandteile und Unterscheidungsmerkmale zu existierenden Veranstaltungen sind hierbei Praxisnahe, Durchfuhrung mit und von Unternehmern sowie der Blick uber den eigenen Tellerrand hinweg hinsichtlich personlicher und nationaler Grenzen. Die Ausbildung ist in drei Blocke unterteilt und lehnt sich an das Biodesign-Konzept der Stanford Universitat an. In einem ersten Block steht das Finden der Idee im Vordergrund (Identify). Hierfur werden die technischen Studenten relativ naiv in die klinische Umgebung geschickt, um die Arbeitsschritte zu beobachten. Dabei sollen Probleme und Herausforderungen, die sogenannten Unmet Clinical Needs, identifiziert werden. Diese werden dann beschrieben und nachfolgend in einem zweiten Vorlesungsblock hinsichtlich der Innovationsfahigkeit gepruft, nach eigenen Kriterien bewertet und uber Interviews auf den Kundennutzen hin uberpruft und prazisiert. Im dritten und letzten Block werden dann Losungsideen entwickelt (Invent), validiert und zu einem Business Case samt Business-Plan entwickelt (Implement). Die Vorlesung versucht zudem, die notwendigen Hard- und Softskills eines Entrepreneurs von praktischer Seite her zu vermitteln. Dabei stellt der Erfahrungsaustausch mit Unternehmern durch Vortrage in den Kursen sowie Diskussionen ein zentrales Element dar.

In der Medizintechnik ist es ein langer Weg von der Idee zum am Markt erfolgreichen Produkt. Fur neue Ideen wird dies haufig in kleinen und mittelstandischen Firmen oder durch Ausgrundungen aus dem klinischen oder technischen Umfeld der Universitaten und Hochschulen realisiert. In dem Kapitel werden wir zwei Wege darstellen, zum einen von einer Analyse des Problems bis zur Lizenzierung der validierten Idee an einen industriellen Partner, zum anderen die Ausgrundung eines technologiegetriebenen Unternehmens fur die navigierte Tumorchirurgie. Das Kapitel beinhaltet drei wesentliche Teile: Die Ideenfindung, die Validierung des Potenzials und die Umsetzung einer Idee zu einer Innovation durch eine Ausgrundung und die damit verbundenen Aufgaben und Herausforderungen.

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.

Different components of the newly defined field of surgical data science have been under research at our groups for more than a decade now. In this paper, we describe our sensor-driven approaches to workflow recognition without the need for explicit models, and our current aim is to apply this knowledge to enable context-aware surgical assistance systems, such as a unified surgical display and robotic assistance systems. The methods we evaluated over time include dynamic time warping, hidden Markov models, random forests, and recently deep neural networks, specifically convolutional neural networks.

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.

Location tracking systems have become popular in recent years and have been in use in many areas such as logistics, transportation and medicine. In healthcare, various companies have been offering real time location system solutions to hospitals with great success. These systems are used for asset management, workflow improvement as well as patient and staff tracking. For test runs we decided on a low-cost location tracking system based on proximity detection and the technology Bluetooth Low Energy. The system was developed for the use in OR environments which comes with specific requirements. The goal of this work is to evaluate if people with Bluetooth Low Energy tags are reliably tracked and detected. These tests were conducted in the first stages of a development phase to see, how the tracking system behaved in a controlled office environment. Problems such as the inactivity of the tag and random changes into other nearby rooms because of multipath effects arise and are discussed.

The striving for cognitive operating rooms (OR) and their optimization towards patient safety and room occupancy raises the importance of detailed assessments of various data, which is available in the OR. In order to model surgical workflows it is necessary to acquire the actions of the surgical staff and the data from peripheral devices, surgical lights, operating tables as well as further information present in the OR. In this work, we present a centralized framework, which allows on the one hand the assessment and visualization of various device- and sensor information in real-time and on the other hand additional human workflow annotations in a collaborative manner during the operation. The network based system is fully integrated in a clinical OR and able to record data of the most principle devices during laparoscopic surgeries. Additional information assessed by human observers can be annotated easily via a web-based frontend in real-time on any handheld device like tablets or laptops. Due to its modular design the system is under constant development to expand its scope regarding further devices, sensors and manual annotation possibilities.