Virtual reality in surgery: minimizing stress and pain in patients undergoing minor-surgical procedures under local anesthesia-results of a feasibility study.

Background: Virtual reality (VR) technology has gained significant importance in medical practice, particularly as an innovative approach to enhance patient experience and comfort. This prospective feasibility study investigates the impact of using VR headsets on stress and pain reduction during port surgeries under local anesthesia.

Methods: In this prospective analysis, patients undergoing port implantation at the Klinikum rechts der Isar Technical University Munich were divided into two groups.

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.

Surgical reporting for laparoscopic cholecystectomy based on phase annotation by a convolutional neural network (CNN) and the phenomenon of phase flickering: a proof of concept.

Purpose: Surgical documentation is an important yet time-consuming necessity in clinical routine. Beside its core function to transmit information about a surgery to other medical professionals, the surgical report has gained even more significance in terms of information extraction for scientific, administrative and judicial application. A possible basis for computer aided reporting is phase detection by convolutional neural networks (CNN).

Emergency Telemedicine Mobile Ultrasounds Using a 5G-Enabled Application: Development and Usability Study.

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 (<1 ms), and high quality of service, enabling wireless real-time data transmission in telemedical emergency health care applications.

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.

Effective operating room (OR) utilization by performing low-complex surgical procedures during the 2020 corona pandemic.

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.

Machine Learning in the OR: A Collaborative Environment for Surgical Interventions in Visceral Medicine.

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.

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.

[Digitalization in surgery : What surgeons currently think and know about it-results of an online survey].

Background: The digitalization process is currently on everyone's lips and sweeping changes in the field of public health and especially in surgery are to be expected within the next few years. Besides general issues, such as electronic health records and medical information systems, artificial intelligence, robotics and model-based surgery will decisively impact on the daily routine. In order to provide the necessary knowledge base, to point out related risks and chances and also to define fields of action for surgery, the German Society of Surgery commissioned a position paper on digitalization.

[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".

Enhanced Visualization: From Intraoperative Tissue Differentiation to Augmented Reality.

Background: Optimal visualization of the operative field and methods that additionally provide supportive optical information form the basis for target-directed and successful surgery. This article strives to give an overview of current enhanced visualization techniques in visceral surgery and to highlight future developments.

Methods: The article was written as a comprehensive review on this topic and is based on a MEDLINE search and ongoing research from our own group and from other working groups.

Surgical data processing for smart intraoperative assistance systems.

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.

[Comprehensive system integration and networking in operating rooms].

Background: A comprehensive surveillance and control system integrating all devices and functions is a precondition for realization of the operating room of the future.

State Of The Art: Multiple proprietary integrated operation room systems are currently available with a central user interface; however, they only cover a relatively small part of all functionalities.

Innovative Approaches: Internationally, there are at least three different initiatives to promote a comprehensive systems integration and networking in the operating room: the Japanese smart cyber operating theater (SCOT), the American medical device plug-and-play interoperability program (MDPnP) and the German secure and dynamic networking in operating room and hospital (OR.

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).

Developments in flexible endoscopic surgery: a review.

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.

What Do We Really Need? Visions of an Ideal Human-Machine Interface for NOTES Mechatronic Support Systems From the View of Surgeons, Gastroenterologists, and Medical Engineers.

Purpose: To investigate why natural orifice translumenal endoscopic surgery (NOTES) has not yet become widely accepted and to prove whether the main reason is still the lack of appropriate platforms due to the deficiency of applicable interfaces.

Methods: To assess expectations of a suitable interface design, we performed a survey on human-machine interfaces for NOTES mechatronic support systems among surgeons, gastroenterologists, and medical engineers. Of 120 distributed questionnaires, each consisting of 14 distinct questions, 100 (83%) were eligible for analysis.

Design of a test system for the development of advanced video chips and software algorithms.

Background: Visual deterioration is a crucial point in minimally invasive surgery impeding surgical performance. Modern image processing technologies appear to be promising approaches for further image optimization by digital elimination of disturbing particles. To make them mature for clinical application, an experimental test environment for evaluation of possible image interferences would be most helpful.

Reliability of sensor-based real-time workflow recognition in laparoscopic cholecystectomy.

Purpose: Laparoscopic cholecystectomy is a very common minimally invasive surgical procedure that may be improved by autonomous or cooperative assistance support systems. Model-based surgery with a precise definition of distinct procedural tasks (PT) of the operation was implemented and tested to depict and analyze the process of this procedure.

Methods: Reliability of real-time workflow recognition in laparoscopic cholecystectomy ([Formula: see text] cases) was evaluated by continuous sensor-based data acquisition.

[Further technical and digital development in minimally invasive and conventional surgery].

Technological innovations have initiated a fundamental change in invasive therapeutic approaches which has led to a welcome reduction of surgical trauma but was also associated with a declining role of conventional surgery. Active utilization of future technological developments is decisive to promote new therapeutic strategies and to avoid a further loss of importance of surgery. This includes individualized preoperative therapy planning as well as intraoperative diagnostic work-up and navigation and the use of new functional intelligent implants.

3-D operation situs reconstruction with time-of-flight satellite cameras using photogeometric data fusion.

Minimally invasive procedures are of growing importance in modern surgery. Navigation and orientation are major issues during these interventions as conventional endoscopes only cover a limited field of view. We propose the application of a Time-of-Flight (ToF) satellite camera at the zenith of the pneumoperitoneum to survey the operation situs.

A probe-based electromagnetic navigation system to integrate computed tomography during upper gastrointestinal endoscopy.

Background And Study Aims: For preoperative work-up, an examination tool that visualizes separately compiled diagnostics in augmented reality would be desirable. We developed a probe-based electromagnetic navigation system, which can be passed through the working channel of an endoscope, to integrate computed tomography (CT) information during upper gastrointestinal endoscopy.

Patients And Methods: The target registration error (TRE) of the system was evaluated experimentally and clinically.

Real-time instrument detection in minimally invasive surgery using radiofrequency identification technology.

Background: A key part of surgical workflow recording is recognition of the instrument in use. We present a radiofrequency identification (RFID)-based approach for real-time tracking of laparoscopic instruments.

Methods: The system consists of RFID-tagged instruments and an antenna unit positioned on the Mayo stand.

Chylothorax after esophagectomy for cancer: impact of the surgical approach and neoadjuvant treatment: systematic review and institutional analysis.

Background: Esophagectomy is a challenging operation with considerable potential for postoperative complications, including chylothorax.

Methods: 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.

Results: The overall institutional chylothorax rate was 2 % (n = 39).

Toward increased autonomy in the surgical OR: needs, requests, and expectations.

Background: The current trend in surgery toward further trauma reduction inevitably leads to increased technological complexity. It must be assumed that this situation will not stay under the sole control of surgeons; mechanical systems will assist them. Certain segments of the work flow will likely have to be taken over by a machine in an automatized or autonomous mode.