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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.

A growing body of evidence supports Virtual Reality (VR) as an effective and safe strategy for management of pain and stress associated with medical procedures in both adults and children. We therefore initiated a feasibility study to investigate the effect of VR on pain, stress, and anxiety during elective surgery, e.g. implantation of a central-venous port catheter, hypothesizing that VR can reduce intraoperative pain, stress and anxiety of the patient. In this manuscript, the preliminary results of the first 20 (out of 6o planned) patients are presented. Baseline pain characteristics did not differ between the two study groups (VR group (n=10) and standard (no VR device) group (n=10)). System usability (“easy to use”, “easy to learn” and “safe”) was rated “good - very good” by the study participants. Selfassessment of anxiety components (Y-6 item questionnaire) revealed a calming (3.3 ± 0.5 vs. 2.4 ± 0.5, P= 0.009) and relaxing (2.7 ± 1.2 vs. 1.8 ± 0.4; P=0.09) effect of the VR device. Evaluation of pain level (Short form McGill questionnaire) during the procedure revealed a lower pain intensity (VAS) level (17.5 ± 12.1 vs. 19.5 ± 10.6; P= 0.834) and present pain intensity (PPI) score (0.9 ± 0.6 vs. 1.0 ± 0.5; P= 0.841) in the VR group Preliminary data of our feasibility study indicates a positive effect of VR towards reduction of pain and stress in patients undergoing minor surgery in local anaesthesia. However, further data is needed to substantiate these results.

ZUSAMMENFASSUNGDem Operationssaal fällt eine Schlüsselrolle bei der digitalen Entwicklung in der Chirurgie zu. Unter dem Schlagwort „digitaler OP“ ist dabei nicht die zunehmende Technisierung des OP-Equipments zu verstehen, sondern die Entwicklung einer verstehenden und den Chirurgen aktiv unterstützenden OP-Umgebung. Durch den Einsatz von künstlicher Intelligenz (KI) ist der OP in der Lage, OP-Abläufe zu verstehen und das OP-Team durch „Mitdenken“ zu unterstützen.Die Entwicklung des künstlich intelligenten Operationssaals erfordert 2 Voraussetzungen. Zum einen sollten (möglichst) alle technischen Geräte und Systemeinheiten, die in den operativen Workflow eingebunden sind, mit- und untereinander integriert bzw. vernetzt werden (Sensor-Operationssaal). Zum anderen muss der Ablauf des Eingriffs so abgebildet und die Operation so durchgeführt werden, dass eine computerisierte Beschreibung und Analyse des Eingriffs ermöglicht wird (Modellierung).Der Operationsablauf kann dann computerbasiert in Echtzeit abgebildet und die jeweilige OP-Phase automatisiert erkannt werden. Hierdurch ist es möglich, Vorhersagen über den weiteren OP-Verlauf zu treffen (Prädiktion) und das OP-Team (z. B. im Falle einer drohenden Komplikation) kooperativ zu unterstützen.

Purpose The SARS-CoV-2 pandemic has almost stopped all elective surgical treatment throughout the world. As operating room (OR) capacities are reduced everywhere to ensure availability of intensive care capacities, especially low-complex surgical procedures are often postponed. These include totally implantable central-venous access ports which are important for the oncologic treatment of cancer patients. Methods In our study, we investigated the potential of an outpatient surgical centre (OSC) in terms of workflow effectiveness compared to the central operating room complex (COR) of a university hospital using low-complex surgical procedures as an example. Data of 524 consecutive patients who received a Port-a-cath procedure (422 implantations (80.5%) and 102 explantations (19.5%)) in our department between February 2019 and February 2020 were evaluated. Results A total of 277 patients were operated in outpatient surgical centre (OSC), and 247 patients received the procedure in the central OR (COR) complex. Grade II and III complications according to the Clavien–Dindo classification occurred in 5.2% (OSC) and 7.3% (COR) of patients. Incision-to-suture time was significantly quicker in the OSC group (36 vs. 42 min., p p Conclusion In order to ensure effective OR utilization especially in times of the corona pandemic, the use of smaller decentralized OR units, e.g., outpatient surgical centres, for performing low-complex surgical cases is beneficial. Our study revealed shorter total OR and preparation-to-incision times.

BACKGROUND Digitalization affects almost every aspect of modern daily life, including a growing number of health care services along with telemedicine applications. Fifth-generation (5G) mobile communication technology has the potential to meet the requirements for this digitalized future with high bandwidths (10 GB/s), low latency ( OBJECTIVE The aim of this study is the development and clinical evaluation of a 5G usability test framework enabling preclinical diagnostics with mobile ultrasound using 5G network technology. METHODS A bidirectional audio-video data transmission between the ambulance car and hospital was established, combining both 5G-radio and -core network parts. Besides technical performance evaluations, a medical assessment of transferred ultrasound image quality and transmission latency was examined. RESULTS Telemedical and clinical application properties of the ultrasound probe were rated 1 (very good) to 2 (good; on a 6 -point Likert scale rated by 20 survey participants). The 5G field test revealed an average end-to-end round trip latency of 10 milliseconds. The measured average throughput for the ultrasound image traffic was 4 Mbps and for the video stream 12 Mbps. Traffic saturation revealed a lower video quality and a slower video stream. Without core slicing, the throughput for the video application was reduced to 8 Mbps. The deployment of core network slicing facilitated quality and latency recovery. CONCLUSIONS Bidirectional data transmission between ambulance car and remote hospital site was successfully established through the 5G network, facilitating sending/receiving data and measurements from both applications (ultrasound unit and video streaming). Core slicing was implemented for a better user experience. Clinical evaluation of the telemedical transmission and applicability of the ultrasound probe was consistently positive.

Background Endoscopic treatment of Zenker’s diverticulum is an attractive minimally invasive alternative compared to the classic open approach. However, increased recurrence rate were reported. In case of relapse, endoscopic therapy might be repeated, or alternatively open surgery is performed. This study aimed to identify potential differences in the outcomes between primary or secondary surgical treatment in Zenker’s diverticulum. Methods From January 2003 to April 2019, 227 subsequent patients underwent surgical diverticulectomy and cervical myotomy at the surgical department of TUM. 41 of 227 patients had received previous therapy, either open or endoscopic. Perioperative parameters in priorly untreated patients were retrospectively compared to those after previous therapy (mostly endoscopic) with special regard to perioperative data and postoperative complications. Univariate and multivariate regression analyses were performed to identify predictors for postoperative complications. Results We could show that the number of complications (p = 0.047) in pretreated patients is significant higher as well as the severity after Clavien–Dindo (p = 0.025). Stapler line leakage, wound infections, and operative revision rate was higher also pretreated group. Pretreatment and surgery time showed a significant association with postoperative complications in univariate analysis. In multivariate analysis, pretreatment remained a significant independent predictor of complications. Conclusion The present data indicate that endoscopic therapy might represent a risk factor for postoperative complications in case of relapse surgery. Therefore primary open surgery should be debated in patients with an increased high risk of relapse. Graphical abstract

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.

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.

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.

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.

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.

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.

The history of surgical antireflux treatment is coined by the search for better alternatives to Nissen fundoplication. Implantable devices are one option, beginning with the “Angelchik™” prosthesis 30 years ago. However, this procedure was left soon because of the high rate of foreign body connected problems (migration, perforation). A modern approach is a magnetic sphincter augmentation device (LINX® Reflux Management System, Torax Medical, Shoreview, MN, USA), a magnetic chain which is implanted laparoscopically. Advantages reported are simplicity to apply and good results in reflux control, with up to now only rare complication rates as reported in the literature (Lipham et al. in Dis Esophagus, 2014). We report one case of erosion of the esophagus by a LINX® system resulting in severe dysphagia. A complete endoluminal removal could be achieved by a prototype OTSC-clip remover. Complete remission could be achieved. The technique is presented in detail (video). In principle, total endoscopic removal of the LINX® device is feasible in case of major erosion.

This paper introduces Surgical Data Science as an emerging scientific discipline. Key perspectives are based on discussions during an intensive two-day international interactive workshop that brought together leading researchers working in the related field of computer and robot assisted interventions. Our consensus opinion is that increasing access to large amounts of complex data, at scale, throughout the patient care process, complemented by advances in data science and machine learning techniques, has set the stage for a new generation of analytics that will support decision-making and quality improvement in interventional medicine. In this article, we provide a consensus definition for Surgical Data Science, identify associated challenges and opportunities and provide a roadmap for advancing the field.

Innovative Technologien haben zu einem erheblichen Wandel in der invasiven Therapie gefuhrt, die zwar in wunschenswerter Weise zu einer signifikanten Minimierung des Behandlungstraumas fuhrten, aber auch die Bedeutung der klassischen Chirurgie reduzierten. Wenn chirurgische Optionen nicht weiter an Bedeutung verlieren sollen, mussen neue Behandlungskonzepte durch die konsequente Nutzung technischer Fortschritte entwickelt werden. Dies betrifft die individualisierte praoperative Therapieplanung ebenso wie die intraoperative Diagnostik und Navigation sowie den Einsatz neuer funktionaler, „intelligenter“ Implantate. Das Arbeitsumfeld „chirurgischer Operationssaal“ muss zu einem integrierten, kooperierenden Funktionssystem weiterentwickelt werden. Besonders weitreichend sind die technischen Entwicklungen in der minimal-invasiven Chirurgie. Hier geht die Tendenz eindeutig in Richtung der weiteren Traumareduktion beim Zugang: Die Inzisionen werden immer kleiner und die Anzahl geringer – bis hin zur Monoport-Chirurgie, eventuell sogar durch naturliche Zugangswege („narbenlose Chirurgie“). Ermoglicht werden wird das u. a. durch die verbesserte Visualisierung einschlieslich der autostereoskopischen Darstellung und der digitalen Bildverarbeitung sowie „intelligente“ Assistenzsysteme, die nicht nur passiv gesteuert werden, sondern auch aktiv mit dem Operateur kooperieren konnen.

Esophagectomy is a challenging operation with considerable potential for postoperative complications, including chylothorax. Because no randomized controlled trial or metaanalysis is available to clarify the incidence of chylothorax in esophageal cancer surgery, the authors analyzed their own institutional data for 1,856 patients and performed a systematic review using the MEDLINE database (9,794 patients) to identify risk factors, compare success rates of therapeutic approaches, and investigate long-term outcomes. The overall institutional chylothorax rate was 2 % (n = 39). Reoperation was performed for 69 % of the patients. No significant difference was noted between the transthoracic and transhiatal approaches. Regression analysis showed neoadjuvant treatment (odds ratio [OR], 0.302; p = 0.001) and tumor type (OR, 0.304; p = 0.002) to be independent risk factors. The systematic review included 12 studies. Chylothorax occurred for 2.6 % of the patients. Treatment favored reoperation in five studies (70–100 %) and a conservative approach in four studies (58–72 %), with equal mortality rates. No significant difference was found between the transthoracic and transhiatal approaches. Chylothorax rates are low in high-volume centers (2–3 %). No significant difference was noted between the transthoracic and transhiatal approaches. Neoadjuvant treatment and tumor type were shown to be independent risk factors. Treatment concept (reoperation vs conservative treatment) did not affect long-term survival.

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.

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.

Die laparoskopische Myotomie gilt heute als Verfahren der Wahl fur die Therapie der Stadien I und II der Achalasie, sofern es sich bei den Betroffenen um junge Patienten unter 40 Jahren handelt, wahrend bei alteren Patienten primar ein konservativer Behandlungsversuch (ein- bis zweimalige pneumatische Dilatation) infrage kommt. Im eigenen Krankengut wird etwa die Halfte der Patienten interventionell-endoskopisch und die andere Halfte chirurgisch behandelt. Der operative Eingriff der laparoskopischen Myotomie sollte mit einer Antirefluxmasnahme in Form einer Fundoplastik (nach Thal/Dor oder nach Toupet) kombiniert werden, um postoperativem Reflux vorzubeugen. Zudem soll sie narbenbedingte Rezidive verhindern. In der Literatur wird uber eine deutliche Verbesserung der klinischen Symptomatik nach diesem Eingriff in 74 – 95 % der nachuntersuchten Falle berichtet. Unter den Folgewirkungen sind Refluxbeschwerden relevant, die aber mit Protonenpumpenblockern gut behandelbar sind. Beim Stadium III der Achalasie („End-Stage-Achalasie“), das nach langjahrigem Verlauf der Krankheit etwa 5 % der Achalasie-Patienten betrifft, stellt eine Indikation fur ein radikaleres operatives Vorgehen im Sinne einer Osophagektomie dar. Grunde hierfur sind ein ausgedehnter und irreversibler Funktionsverlust der Speiserohre mit Syphonbildung, der durch eine Myotomie nicht mehr beeinflusst werden kann, sowie das deutlich erhohte Risiko, bei langjahrigem Verlauf der Achalasie ein Plattenepithelkarzinom zu entwickeln.

Telematisch gestutzte Interventionen finden eine breite Anwendung in allen Bereichen der modernen Onkologie. Neben intraoperativen Navigationsverfahren, welche v. a. in der Leberchirurgie und Neurochirurgie Bedeutung erlangen konnten, stellt die Robotik einen weiteren Schwerpunkt dar. Aber auch bei perkutanen und transluminalen Therapieverfahren ist eine Unterstutzung durch telematische Systeme nicht mehr wegzudenken. Der Beitrag gibt einen Uberblick uber die aktuellen Einsatzbereiche telematischer gestutzter Interventionen in der Onkologie und versucht diese jeweils hinsichtlich ihres effektiven Nutzens zu bewerten.

One of the main challenges in transluminal surgery is sterile and safe access. For many interventions, a transanal approach would be ideal but it is considered too risky because of contamination and the danger of secondary leakage. A new safe and sterile transanal access was developed, combining four basic principles: (i) the creation of a decontaminating hydroperitoneum, (ii) the use of an overtube, (iii) defining the entry point with ultrasound and (iv) dedicated closure technique. Applicability and reliability was first proven in extensive animal experiments. Feasibility of the concept in humans was subsequently demonstrated in cadavers.

The D-NOTES-group met in June 2009 for an evaluation of ongoing preclinical and clinical activities in natural orifice endoscopic surgery and the further coordination of research in Germany. Different working groups with various topics were formed. Consensus statements among various participants with different scientific and medical background were initiated. In summary, important topics were handled such as the correct handling of bacterial contamination and related complications, the question of the ideal entry point and a secure closure, interdisciplinary cooperation, and matters related to training and education. Furthermore, participants agreed on terminological basics. A to-do-list for medical engineering was formulated.

The informed consent is a legal requirement prior to surgery and should be based on an extensive preoperative interview. Multimedia productions can therefore be utilised as supporting tool. In a prospective randomised trial, we evaluated the impact of an extended education on patients undergoing cholecystectomy. For extended patient information, a professionally built DVD was used. After randomisation to either the DVD or the control group, patients were informed with or without additional presentation of the DVD. The quality of education was evaluated using a purpose-built questionnaire. One hundred fourteen patients were included in the DVD and 98 in the control group. Patient characteristics did not differ significantly despite a higher educational level in the DVD group. The score of correctly answered questions was higher in the DVD group (19.88 vs. 17.58 points, p

Ultrasound examination is a valuable diagnostic tool in almost all medical disciplines. However, the results are highly dependent on the experience and performance of the individual examiner and the technical conditions of the examination. Since computed tomography (CT) is not affected by these factors, the combination of real-time ultrasound images and previously compiled CT scans with identical cross-sections displayed simultaneously during transcutaneous ultrasonography could be advantageous. To evaluate the practical applicability and reliability of CT-supported transcutaneous ultrasonography, we examined 10 patients with a Real-Time Virtual Sonography Unit using a previously compiled CT scan as a reference. The results were evaluated by 10 sonographers with different levels of experience. By using the 3-point registration method almost identical ultrasound and CT cross-sections were displayed throughout the examination. However, there was a constant lateral and height deviation of the CT image detected. The crucial point is the correct and reliable referencing of the real-time ultrasound. In conclusion, the CT-navigated ultrasound seems not yet complete for clinical applications. Although helpful for training purposes, it is not accurate enough yet to play a role in routine clinical diagnostic work up.

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.