Towards multimodal visualization of esophageal motility: fusion of manometry, impedance, and videofluoroscopic image sequences.

Purpose: Dysphagia is the inability or difficulty to swallow normally. Standard procedures for diagnosing the exact disease are, among others, X-ray videofluoroscopy, manometry and impedance examinations, usually performed consecutively. In order to gain more insights, ongoing research is aiming to collect these different modalities at the same time, with the goal to present them in a joint visualization.

Robotic scrub nurse to anticipate surgical instruments based on real-time laparoscopic video analysis.

Background: Machine learning and robotics technologies are increasingly being used in the healthcare domain to improve the quality and efficiency of surgeries and to address challenges such as staff shortages. Robotic scrub nurses in particular offer great potential to address staff shortages by assuming nursing tasks such as the handover of surgical instruments.

Methods: We introduce a robotic scrub nurse system designed to enhance the quality of surgeries and efficiency of surgical workflows by predicting and delivering the required surgical instruments based on real-time laparoscopic video analysis.

Extra-abdominal trocar and instrument detection for enhanced surgical workflow understanding.

Purpose: Video-based intra-abdominal instrument tracking for laparoscopic surgeries is a common research area. However, the tracking can only be done with instruments that are actually visible in the laparoscopic image. By using extra-abdominal cameras to detect trocars and classify their occupancy state, additional information about the instrument location, whether an instrument is still in the abdomen or not, can be obtained.

Towards multimodal graph neural networks for surgical instrument anticipation.

Purpose: Decision support systems and context-aware assistance in the operating room have emerged as the key clinical applications supporting surgeons in their daily work and are generally based on single modalities. The model- and knowledge-based integration of multimodal data as a basis for decision support systems that can dynamically adapt to the surgical workflow has not yet been established. Therefore, we propose a knowledge-enhanced method for fusing multimodal data for anticipation tasks.

Model-based individual life-spanning documentation in visceral surgery: a proof of concept.

Introduction: Surgical documentation has many implications. However, its primary function is to transfer information about surgical procedures to other medical professionals. Thereby, written reports describing procedures in detail are the current standard, impeding comprehensive understanding of patient-individual life-spanning surgical course, especially if surgeries are performed at a timely distance and in diverse facilities.

Audio-based event detection in the operating room.

Purpose: Even though workflow analysis in the operating room has come a long way, current systems are still limited to research. In the quest for a robust, universal setup, hardly any attention has been given to the dimension of audio despite its numerous advantages, such as low costs, location, and sight independence, or little required processing power.

Methodology: We present an approach for audio-based event detection that solely relies on two microphones capturing the sound in the operating room.

Protocol for the Development and Analysis of the Oxford and Reading Cognitive Comorbidity, Frailty and Ageing Research Database-Electronic Patient Records (ORCHARD-EPR).

Background: Hospital electronic patient records (EPRs) offer the opportunity to exploit large-scale routinely acquired data at relatively low cost and without selection. EPRs provide considerably richer data, and in real-time, than retrospective administrative data sets in which clinical complexity is often poorly captured. With population ageing, a wide range of hospital specialties now manage older people with multimorbidity, frailty and associated poor outcomes.

Prospective clinical cohort study: low incidence of Barrett esophagus but high rate of reflux disease at 5-year follow-up after sleeve gastrectomy versus Roux-en-Y gastric bypass.

Background: Gastroesophageal reflux disease seems more frequent after laparoscopic sleeve gastrectomy (LSG) than Roux-en-Y gastric bypass (LRYGB). Retrospective case series have raised concerns about a high incidence of Barrett esophagus (BE) after LSG.

Objective: This prospective clinical cohort study compared the incidence of BE ≥5 years after LSG and LRYGB.

The impact of prior endoscopic or surgical therapy on open Zenker's diverticulum surgery: analysis on a large single center cohort : Comparison of primary and revisional open surgery for Zenker's diverticulum.

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.

Long-term outcome of patients with epiphrenic diverticula: A retrospective single-center analysis over 20 years.

Background: Epiphrenic diverticula are extremely rare. Evidence-based treatment recommendations are scarce. The primary study outcome was to examine whether surgical treatment in patients with epiphrenic diverticula leads to improved quality of life by outweighing the perioperative risks compared with conservative treatment.

Systematic Review and Meta-Analysis on Colorectal Anastomotic Techniques.

Purpose: 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.

Robotic Endoscope Control - State of the Art of Voice Control and Other Options for Laparoscopic Camera Robot Guidance.

In video-based surgery (VBS), the surgeon is no longer the master of his or her view. Visualization of the surgical field is mediated by a video camera guided by an assistant. The separation of visualization and surgical activities leads to significant drawbacks.

[Clinical value of alternative technologies to standard laparoscopic cholecystectomy - single port, reduced port, robotics, NOTES].

Surgical interventions should ideally treat an existing disease curatively and achieve this with a low complication rate and minimal trauma. In this sense, laparoscopic cholecystectomy has become established as the recognized standard for the treatment of cholecystolithiasis. Newer procedures, such as single-port surgery or natural orifice transluminal endoscopic surgery (NOTES) have recently emerged to reduce the already low interventional trauma even further and to provide a better cosmetic outcome.

Kidney Transplantation After Rescue Allocation-the Eurotransplant Experience: A Retrospective Multicenter Outcome Analysis.

Background: At Eurotransplant (ET), kidneys are transferred to "rescue allocation" (RA), whenever the standard allocation (SA) algorithms Eurotransplant Kidney Allocation System (ETKAS) and Eurotransplant Senior Program (ESP) fail. We analyzed the outcome of RA.

Methods: Retrospective patient clinical and demographic characteristics association analyses were performed with graft outcomes for 2422 recipients of a deceased donor renal transplantation (DDRT) after RA versus 25 481 after SA from 71 centers across all ET countries from 2006 to 2018.

How to Cope with Big Data in Functional Analysis of the Esophagus.

Introduction: Esophageal motility disorders have a severe impact on patients' quality of life. While high-resolution manometry (HRM) is the gold standard in the diagnosis of esophageal motility disorders, intermittently occurring muscular deficiencies often remain undiscovered if they do not lead to an intense level of discomfort or cause suffering in patients. Ambulatory long-term HRM allows us to study the circadian (dys)function of the esophagus in a unique way.

MIEO: a micro-invasive endoscopic operation port system for transluminal interventions-an acute and survival porcine study.

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.

5th-Generation Mobile Communication: Data Highway for Surgery 4.0.

Introduction: 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.

[Model-based treatment in surgery].

Background: The "magic triangle" in surgery and other disciplines consists of the demand for increasingly gentler forms of treatment, simultaneous cost reduction and the fundamental primacy of improving the quality of results. The digitalization of medicine offers a promising opportunity to do justice to this, also in the sense of "Surgery 4.0".

24-hour monitoring of transient lower esophageal sphincter relaxation events by long-term high-resolution impedance manometry in normal volunteers: The "mirror phenomenon".

Background: The aim of this study was to investigate the frequency and circadian changes in transient lower esophageal sphincter relaxations (TLESRs) in normal volunteers using 24-hour high-resolution impedance manometry (HRIM).

Methods: Fifteen volunteers underwent HRIM. TLESRs were recorded during the mealtime, 2-hour postprandial, daytime, and supine periods.

[Surgical treatment of esophageal diverticula : Endoscopic or open approach?].

Esophageal diverticula are comparatively rare. The majority are Zenker's diverticula but parabronchial and epiphrenic diverticula can also occur. Parabronchial diverticula are of low clinical relevance, whereas Zenker's and epiphrenic diverticula both belong to the group of pulsion diverticula and can become clinically apparent by dysphagia and regurgitation.

[Long-term HR-Manometry of the Esophagus: first findings in clinical use].

Diagnosis of oesophageal motility disorders has been well established for many years now, although circadian gastrointestinal motility is still purely understood. So far, high-resolution manometry (HRM) is only available for short-term measurement in clinical practice to evaluate simultaneous pressure conditions throughout the esophagus. Thus, only a very limited period of time can be investigated.

Pharyngeal pH monitoring in gastrectomy patients - what do we really measure?

Aim: Diagnosis of laryngopharyngeal reflux (LPR) has dramatically increased over the last years. For diagnosis of gastroesophageal reflux, a newly designed pharyngeal probe (Dx-pH) was recently introduced. It is also recommended to guide therapy decision in antireflux surgery.

Endoluminal perforation of a magnetic antireflux device.

Background: 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).