Search

Jana Steger,1 Alissa Jell,1,2 Stefanie Ficht,3 Daniel Ostler,1 Markus Eblenkamp,3 Petra Mela,3 Dirk Wilhelm1,2 1Technical University of Munich, TUM School of Medicine, Chair of Research Group Minimally Invasive Interdisciplinary Therapeutical Intervention (MITI), Munich, Germany; 2Technical University of Munich, TUM School of Medicine, Clinic and Polyclinic for Surgery, Munich, Germany; 3Technical University of Munich, TUM School of Engineering and Design, Department of Mechanical Engineering and Munich Institute of Biomedical Engineering, Chair of Medical Materials and Implants, Garching, GermanyCorrespondence: Jana Steger, Tel +49 89 4140-5898, Email jana.steger@tum.dePurpose: Anastomosis creation after resective gastrointestinal surgery is a crucial task. The present review examines the techniques and implants currently available for anastomosis creation and analyses to which extent they already address our clinical needs, with a special focus on their potential to enable further trauma minimization in visceral surgery.Methods: A multi-database research was conducted in MEDLINE, Scopus, and Cochrane Library. Comparative controlled and uncontrolled clinical trials dealing with anastomosis creation techniques in the intestinal tract in both German and English were included and statistically significant differences in postoperative complication incidences were assessed using the RevMan5.4 Review Manager (Cochrane Collaboration, Oxford, UK).Results: All methods and implant types were analyzed and compared with respect to four dimensions, assessing the techniques’ current performances and further potentials for surgical trauma reduction. Postoperative outcome measures, such as leakage, stenosis, reoperation and mortality rates, as well as the tendency to cause bleeding, wound infections, abscesses, anastomotic hemorrhages, pulmonary embolisms, and fistulas were assessed, revealing the only statistically significant superiority of hand-suture over stapling anastomoses with respect to the occurrence of obstructions.Conclusion: Based on the overall complication rates, it is concluded that none of the anastomosis systems addresses the demands of operative trauma minimization sufficiently yet. Major problems are furthermore either low standardization potentials due to dependence on the surgeons’ levels of experience, high force application requirements for the actual anastomosis creation, or large and rigid device designs interfering with flexibility demands and size restrictions of the body’s natural access routes. There is still a need for innovative technologies, especially with regard to enabling incisionless interventions.Keywords: anastomotic technique, postoperative complications, ideal anastomosis, intraoperative trauma

Katharina Kapoor,1 Dorothea Wilhelm,1 Claudia Neumeister,2 Marcus Rudolf Götz,2 Ulrich Schwantes,2 Gabriele Bleckert,3 Lilli Gerstenmaier,4 Alen Jambrecina4 1Clinical Research, Proderm GmbH, Schenefeld/Hamburg, Germany; 2Research and Development, Dr. Pfleger Arzneimittel GmbH, Bamberg, Germany; 3Statistics, Staburo GmbH, München, Germany; 4Clinical Research, CTC North GmbH & Co. KG at the University Medical Center Hamburg-Eppendorf, Hamburg, GermanyCorrespondence: Claudia Neumeister, Dr. Pfleger Arzneimittel GmbH, Dr.-Robert-Pfleger-Str. 12, Bamberg, 96052, Germany, Tel +49 951 6043-161, Fax +49 951 6043-226, Email Claudia.Neumeister@dr-pfleger.dePurpose: Acute oropharyngeal symptoms, such as sore throat, difficulty swallowing, hoarseness, tickly throat, and dry mouth, cause great discomfort. Moistening of the impaired mucosa, caused, for example, by the common cold, air-conditioning, heated rooms, and pollen, can be achieved by providing a protective barrier through the local administration of mucoadhesives. This study investigated whether sucking and chewing a medical device (pastille) containing a specific mixture of four different polysaccharides provides instantaneous symptom-relieving effects.Methods: This clinical study enrolled 40 patients with a sore throat (plus at least one additional acute oropharyngeal symptom). A single dose of either the new pastille or a placebo (each n = 20) was administered. The oropharyngeal symptoms, sore throat, difficulty swallowing, hoarseness, tickly throat and dry mouth were monitored on a visual analog scale at baseline and 3, 6, 10, 15, and 30 minutes after beginning sucking and chewing.Results: Of the patients in the test group, 70% showed at least a 10% improvement regarding sore throat intensity over the observation period. Only 25% of the patients in the placebo group reported the same result. Clear improvements in symptom intensity were also found in dry mouth, tickly throat, and difficulty swallowing. For the symptom hoarseness, the effects were less pronounced.Conclusion: Sucking and chewing of the new polysaccharides-containing pastille resulted in instant relieving effects of oropharyngeal symptoms. The effects lasted for the entire period of sucking and beyond.Keywords: oropharyngeal symptoms, sore throat, dry mouth, polysaccharides, pastille, visual analog scale

Hubertus Feussner,1 Valentin Becker,2 Margit Bauer,1 Michael Kranzfelder,1 Rebekka Schirren,1 Tim Lüth,3 Alexander Meining,2 Dirk Wilhelm1 1Department of Surgery, 22nd Medical Department, 3Institute of Microtechnology and Medical Device Technology, Klinikum rechts der Isar, Technische Universität München, Germany Abstract: Flexible endoscopy is increasingly developing into a therapeutic instead of a purely diagnostic discipline. Improved visualization makes early lesions easily detectable and allows us to decide ad hoc on the required treatment. Deep enteroscopy allows the exploration of even the small bowel – for long a "white spot" for gastrointestinal endoscopy – and to perform direct treatment. Endoscopic submucosal dissection is a considerable step forward in oncologically correct endoscopic treatment of (early) malignant lesions. Though still technically challenging, it is increasingly facilitated by new manipulation techniques and tools that are being steadily optimized. Closure of wall defects and hemostasis could be improved significantly. Even the anatomy beyond the gastrointestinal wall is being explored by the therapeutic use of endoluminal ultrasound. Endosonographic-guided surgery is not only a suitable fallback solution if conventional endoscopic retrograde cholangiopancreatography fails, but even makes necrosectomy procedures, abscess drainage, and neurolysis feasible for the endoscopist. Newly developed endoscopic approaches aim at formerly distinctive surgical domains like gastroesophageal reflux disease, appendicitis, and cholecystitis. Combined endoscopic/laparoscopic interventional techniques could become the harbingers of natural orifice transluminal endoscopic surgery, whereas pure natural orifice transluminal endoscopic surgery is currently still in its beginnings. Keywords: flexible endoscopic surgery, endoscopic ultrasound, advanced techniques, natural orifice transluminal endoscopic surgery

A proposed solution to address increasing scarcity of operating room (OR) nurses is the deployment of robotic scrub nurses (RSNs). One of the primary responsibilities of these robots is the handover of surgical instruments to the surgeon. Despite this tasks’ apparent simplicity, it requires great precision and timing, while seamless execution is essential for the surgical workflow. This paper outlines the unique challenges of the instrument handover process between a RSN and a surgeon taking place during laparoscopic surgery. After customizing existing solutions from different domains to meet the specific needs of laparoscopic surgery, we introduced these solutions to medical professionals in a simulated OR scenario, and performed a utility analysis to identify the most suitable solutions.

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.

Swallowing problems (dysphagia) is associated with significant morbidity and mortality therefore diagnosis and treatment of dysphagia is important. Diagnostic tests include screening procedures, clinical swallowing examinations, and instrumental examination procedures. A non-invasive diagnostic option is auscultation of the swallowing act. However, there are different statements about the reliability and validity of the manual execution of this test. We developed a mobile hardware system to record cervical sounds using two microphones on the neck to acquire audio a data set. To generate ground truth data, fiberendoscopic swallow examinations were performed simultaneously to identify dysphagia. In order to diagnostically assess the swallowing sounds a spectrogram based classification pipeline was developed. In a first step this enabled us to identify different swallowing patterns in healthy individuals. With an accuracy of ~95%, we were able to reliably detect swallows within audio recordings, while the classification of types of swallow (dry, water, solid food) indicate the need for further improvements within the project ahead. In the future, we anticipate AI based analysis of auscultated swallowing sounds to detect swallowing disorders and aspirations.

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.