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The increase in staff shortage, particularly in urgently needed care professions, is becoming an immense problem in the German healthcare system. This critical issue is further intensified by the fact that the healthcare system is still a strongly human-dependent and often insufficiently interconnected environment. Automation, medical robotics and the concept of model-based medicine can play a key role not only in addressing these issues and supporting clinical staff, but also in enabling new applications to improve patient care. While many existing approaches aim to tackle these challenges, they are generally based on current network architectures and standards and are thus constrained by the limitations of these networks. This article highlights the need for a new network approach such as 6G, which offers flexible, dynamic structures, new communication classes and many other new features in order to leverage the true potential of these new technologies.

To help with the critical nurse staffing shortages in hospitals worldwide, robotic assistants are designed to handle frequently required tasks in the digital operating room (DOR), such as the guidance of the laparoscopic camera. To enable fluent collaboration between robots and clinicians, an intuitive and efficient communication interface is needed to allow for interaction using natural language. However, the demanding requirements of the surgical domain make it challenging to develop suitable solutions. A variety of different vocabulary or phrases may be used for expressing the same command. At the same time, surgical workflows may be highly dynamic - especially in emergency situations - and thus the system must be able to grasp the user’s intent both quickly and with high accuracy. This is especially true as only some clinicians may be authorized to request certain tasks, depending on their rank or field of expertise. To solve these challenges, our proposed communication system uses the fine-tuned deep learning model to recognize the speaker information, and the robot assistant takes action only when it detects the commands from the responsible clinician. Also, our proposed conversational functions enable the finetuned large language models to understand the current natural language command given previous command history. In this work, we present a communication system to recognize the speaking person and understand the intent of conversational commands quickly and accurately.

Aims: Wrist arthroscopy is a standard procedure in hand surgery for diagnosis and treatment of wrist injuries. Even though not generally recommended for similar procedures, general administration of perioperative antibiotic prophylaxis (PAP) is still widely used in wrist arthroscopy. Methods: A clinical ambispective dual-centre study was performed to determine whether PAP reduces postoperative infection rates after soft tissue-only wrist arthroscopies. Retrospective and prospective data was collected at two hospitals with departments specialized in hand surgery. During the study period, 464 wrist arthroscopies were performed, of these 178 soft-tissue-only interventions met the study criteria and were included. Signs of postoperative infection and possible adverse drug effects (ADEs) of PAP were monitored. Additionally, risk factors for surgical site infection (SSIs), such as diabetes mellitus and BMI, were obtained. Results: The overall infection rate of SSI was zero. Neither in the PAP group (n = 69) nor in the control group (n = 109) were signs of postoperative infection observed. Observed symptoms of ADEs were three-times higher in the PAP group when compared to the control-group (16.3 vs 5.5%; p = 0.043). No major ADEs were observed, but one in ten patients in the PAP group reported mild to severe intestinal or hypersensitivity symptoms. Conclusion: We demonstrate that the number needed to treat (NNT) with PAP to prevent one postoperative infection in soft-tissue arthroscopies of the wrist is > 109. Conversely, symptoms of ADEs were reported by one out of ten patients given PAP. Considering the high NNT to prevent postoperative infection and the large number of ADEs caused by PAP, we recommend not to use PAP routinely in soft-tissue arthroscopies of the wrist. Subsequent large-scale studies should be conducted to substantiate these results. Cite this article: Bone Jt Open 2023;4(4):219–225.

Laparoscopic cholecystectomy (LCHE) is a widely employed model for surgical instrument and phase recognition in the field of machine learning (ML), with the latter being assigned to identify critical events and to avoid complications. Although ML algorithms have been proven to be effective for this instance and in selected patients, it is questionable whether patients receiving LCHE in daily clinical routine would actually benefit from adverse event prediction by ML applications. We believe, that the statistical problem of low prevalence (PREV) of potential adverse events in an unselected population and consequential low diagnostic yield was not considered adequately in recent research. Therefore, we performed a query to the G-DRG (German Diagnosis Related Groups) database of the German Federal Statistical Office with the aim to calculate prevalence of surgical and postoperative adverse events coming along with LCHE. The results enable an estimation of positive (PPV) and negative (NPV) predictive values hypothetically achievable by ML applications aiming to predict an adverse surgical course.

This work presents a sterile concept for 3D cameras within sterile surgical environments. In the digital operating room (OR), such cameras can serve as a valuable data source for cognitive workflow assistance systems, e.g decision or mechatronic support systems. One recent example are robotic assistants for instrument handling, such as the robotic scrub nurse currently developed in the framework of the SASHA-OR research project1. In this context, we detect laparoscopic instruments and the surgical environment with a 3D camera, whereby hygienic requirements need to be met. Using a Zivid Two sensor, we generated point clouds of the laparoscopic instruments located in an instrument holder and a drop zone. We compared the effect of using different pane types and thicknesses for the sterile camera enclosure and compared the performance with and without protective pane in terms of the point cloud accuracy. When analyzing multiple pane types, polymethyl methacrylate with 0.5 mm thickness (PMMA 0.5) provided the best results. At a scan distance of 560 mm to the surface center, which is required for the complete acquisition of a laparoscopic instrument, PMMA 0.5 achieved the smallest Chamfer distance (CD) values for both the scans with the laparoscopic instruments in the instrument holder (0.23 ± 1.52 mm) and in the drop zone (0.12 ± 0.25 mm).

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.

Atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS) are rare histomorphological variants of a disease spectrum. After ruling out other tumor entities by immunohistochemistry, PDS can be differentiated from AFX by infiltration into the subcutis, while AFX remains confined to the dermis. The therapeutic approach is more aggressive in PDS as it can potentially metastasize. We assessed the usefulness of preoperative sonography in differentiating between the two tumor entities by identifying a potential subcutaneous infiltration. In our patients (n = 13), preoperative sonography identified and differentiated AFX and PDS with 100% accuracy and even changed the initial histological suspicion of AFX to PDS in 3 cases (23%), which was confirmed after tumor resection. Preoperative sonography of these tumors could strengthen the clinical diagnosis, avoid a delay in therapy initiation and improve patient counseling. While for AFX, micrographic‐controlled surgery suffices, for PDS, resection with 2 cm safety margins and lymph node sonography to rule out lymphonodal involvement is necessary. Hence, ultrasonography can improve clinical practice by providing helpful information for dermatosurgeons, which cannot be obtained during clinical examination. [ABSTRACT FROM AUTHOR]

Dysphagia, the difficulty in swallowing, is one of the most common and, at the same time, most heterogeneous symptom of the upper digestive tract. Due to its lifetime prevalence of about 5%, every 19th person is affected on average, especially with increasing age. Dysphagia occurs in both benign and malignant diseases of the esophagus and the oropharyngeal tract as well as in neuromuscular diseases. Even dysphagia caused by benign diseases can lead to significantly reduced quality of life.

Ultrasound and high-frequency ultrasound assessment of melanoma and non-melanoma skin cancer in the pre-therapeutical setting is becoming increasingly popular in the field of dermatosurgery and dermatooncology, as it can provide clinicians with relevant, "in vivo" parameters regarding tumor lateral and depth extension as well as potential locoregional spread, cancelling the need of more extensive imaging methods and avoiding a delay in diagnosis. Furthermore, preoperative sonography and color Doppler can aid in orienting the clinical diagnosis, being able in numerous situations to differentiate between benign and malignant lesions, which require a different therapeutic approach. This preoperative knowledge is of paramount importance for planning an individualized treatment regimen. Using sonography at the time of diagnosis, important surgical complications, such as neurovascular damage, can be avoided by performing a preoperative neurovascular mapping. Furthermore, sonography can help reduce the number of surgical steps by identifying the lesions' extent prior to surgery, but it can also spare unnecessary surgical interventions in cases of locally advanced lesions, which infiltrate the bone or already present with locoregional metastases, which usually require modern radiooncological therapies in accordance to European guidelines. With this review, we intend to summarize the current indications of sonography in the field of skin cancer surgery, which can help us improve the therapeutic attitude toward our patients and enhance patient counseling. In the era of modern systemic radiooncological therapies, sonography can help better select patients who qualify for surgical procedures or require systemic treatments due to tumoral extension. [ABSTRACT FROM AUTHOR]

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