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Kernel-based regularized risk minimizers, also called support vector machines (SVMs), are known to possess many desirable properties but suffer from their super-linear computational requirements when dealing with large data sets. This problem can be tackled by using localized SVMs instead, which also offer the additional advantage of being able to apply different hyperparameters to different regions of the input space. In this paper, localized SVMs are analyzed with regards to their consistency. It is proven that they inherit $L_p$- as well as risk consistency from global SVMs under very weak conditions and even if the regions underlying the localized SVMs are allowed to change as the size of the training data set increases., Comment: 29 pages, 1 figure

As a predictor's quality is often assessed by means of its risk, it is natural to regard risk consistency as a desirable property of learning methods, and many such methods have indeed been shown to be risk consistent. The first aim of this paper is to establish the close connection between risk consistency and $L_p$-consistency for a considerably wider class of loss functions than has been done before. The attempt to transfer this connection to shifted loss functions surprisingly reveals that this shift does not reduce the assumptions needed on the underlying probability measure to the same extent as it does for many other results. The results are applied to regularized kernel methods such as support vector machines., Comment: 33 pages, 1 figure

This work consists of three original articles and is focused on the overall question: How can hyperspectral imaging contribute to patient safety and improve outcomes during abdominal surgery? The hypothesis was that HSI is suitable for the intraoperative assessment of tissue structures and decision support in routine clinical use. Spectral imaging was performed with the TIVITA Tissue for open surgery or TIVITA Mini system for laparoscopic HSI from Diaspective Vision GmbH (Am Salzhaff-Pepelow, Germany). Both HSI systems use pushbroom mode and provide 100 spectral channels in the visible and near-infrared spectral range from 500 - 1000 nm. The Number of Effective Pixels is at least 640 × 480 (x-, y-axis), while the field of view and spatial resolution depend on the measurement distance and the used focal length of the objective. Illumination is done by halogen spots for open surgery and broadband LED in the laparoscopic system. The first part of this work aimed to evaluate HSI for the measurement of ischemic conditioning effects of the gastric conduit during esophagectomy. Ischemic preconditioning by dividing major blood vessels of the stomach prior to gastric pull-up is performed to improve the perfusion at the later esophagogastric anastomosis to reduce the risk of leaks. Intraoperative hyperspectral records of the gastric tube were acquired from 22 patients through the mini-thoracotomy. Fourteen of them underwent ischemic conditioning of the stomach several days before the two-step transthoracic esophagectomy and gastric pull-up with intrathoracic anastomosis was performed. The tip of the gastric tube (later esophago-gastric anastomosis) was measured with HSI. These in vivo records showed that the tissue oxygenation of the gastric conduit was significantly higher in patients who underwent ischemic conditioning (78% vs. 66%; p = 0.03). In the second part of this work, a novel hyperspectral imaging system for MIS is described and evaluated to address the requirements

Simple Summary Good oxygenation of both bowel ends is an important prerequisite to promote anastomotic healing after colorectal resections. Bowel oxygenation is usually assessed clinically. Hyperspectral imaging is a contactless and contrast-free tool that allows quantifying tissue oxygen intraoperatively. In this study, the results of 105 colorectal resections with hyperspectral imaging are reported. Abstract Background: A perfusion deficit is a well-defined and intraoperatively influenceable cause of anastomotic leak (AL). Current intraoperative perfusion assessment methods do not provide objective and quantitative results. In this study, the ability of hyperspectral imaging (HSI) to quantify tissue oxygenation intraoperatively was assessed. Methods: 115 patients undergoing colorectal resections were included in the final analysis. Before anastomotic formation, the bowel was extracted and the resection line was outlined and imaged using a compact HSI camera, in order to provide instantaneously quantitative perfusion assessment. Results: In 105 patients, a clear demarcation line was visible with HSI one minute after marginal artery transection, reaching a plateau after 3 min. In 58 (55.2%) patients, the clinically determined transection line matched with HSI. In 23 (21.9%) patients, the clinically established resection margin was entirely within the less perfused area. In 24 patients (22.8%), the HSI transection line had an irregular course and crossed the clinically established resection line. In four cases, HSI disclosed a clinically undetected lesion of the marginal artery. Conclusions: Intraoperative HSI is safe, well reproducible, and does not disrupt the surgical workflow. It also quantifies bowel surface perfusion. HSI might become an intraoperative guidance tool, potentially preventing postoperative complications.

Background: Novel intraoperative imaging techniques, namely, hyperspectral (HSI) and fluorescence imaging (FI), are promising with respect to reducing severe postoperative complications, thus increasing patient safety. Both tools have already been used to evaluate perfusion of the gastric conduit after esophagectomy and before anastomosis. To our knowledge, this is the first study evaluating both modalities simultaneously during esophagectomy. Methods: In our pilot study, 13 patients, who underwent Ivor Lewis esophagectomy and gastric conduit reconstruction, were analyzed prospectively. HSI and FI were recorded before establishing the anastomosis in order to determine its optimum position. Results: No anastomotic leak occurred during this pilot study. In five patients, the imaging methods resulted in a more peripheral adaptation of the anastomosis. There were no significant differences between the two imaging tools, and no adverse events due to the imaging methods or indocyanine green (ICG) injection occurred. Conclusions: Simultaneous intraoperative application of both modalities was feasible and not time consuming. They are complementary with regard to the ideal anastomotic position and may contribute to better surgical outcomes. The impact of their simultaneous application will be proven in consecutive prospective trials with a large patient cohort.

Innovations and new advancements in intraoperative real-time imaging have gained significant importance in the field of gastric cancer surgery in the recent past. Currently, the most promising procedures include indocyanine green fluorescence imaging (ICG-FI) and hyperspectral imaging or multispectral imaging (HSI, MSI). ICG-FI is utilized in a broad range of clinical applications, e.g., assessment of perfusion or lymphatic drainage, and additional implementations are currently investigated. HSI is still in the experimental phase and its value and clinical relevance require further evaluation, but initial studies have shown a successful application in perfusion assessment, and prospects concerning non-invasive tissue and tumor classification are promising. The application of machine learning and artificial intelligence technologies might enable an automatic evaluation of the acquired image data in the future. Both methods facilitate the accurate visualization of tissue characteristics that are initially indistinguishable for the human eye. By aiding surgeons in optimizing the surgical procedure, image-guided surgery can contribute to the oncologic safety and reduction of complications in gastric cancer surgery and recent advances hold promise for the application of HSI in intraoperative tissue diagnostics.