Development of a human machine interface for robotically assisted surgery optimized for laparoscopic workflows.

Introduction: In robotic-assisted surgery (RAS), the input device is the primary site for the flow of information between the user and the robot. Most RAS systems remove the surgeon's console from the sterile surgical site. Beneficial for performing lengthy procedures with complex systems, this ultimately lacks the flexibility that comes with the surgeon being able to remain at the sterile site.

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.

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.

Development of an image-based Random Forest classifier for prediction of surgery duration of laparoscopic sigmoid resections.

Purpose: Sigmoid diverticulitis is a disease with a high socioeconomic burden, accounting for a high number of left-sided colonic resections worldwide. Modern surgical scheduling relies on accurate prediction of operation times to enhance patient care and optimize healthcare resources. This study aims to develop a predictive model for surgery duration in laparoscopic sigmoid resections, based on preoperative CT biometric and demographic patient data.

Toward telemedical diagnostics-clinical evaluation of a robotic examination system for emergency patients.

Introduction: The SARS-CoV-2 pandemic has affected global public healthcare for several years. Numerous medical professionals have been infected since the outbreak in 2019, resulting in a shortage of healthcare providers. Since traditional personal protective wear was insufficient to eliminate the virus transmission reliably, new strategies to avoid cross-infection were imperative while enabling high-quality medical care.

Versatile end effector for laparoscopic robotic scrub nurse.

Purpose: Integrating robotic scrub nurses in the operating room has the potential to help overcome staff shortages and limited use of available operating capacities in hospitals. Existing approaches of robotic scrub nurses are mainly focused on open surgical procedures, neglecting laparoscopic procedures. Laparoscopic interventions offer great potential for the context-sensitive integration of robotic systems due to possible standardization.

A nationwide population-based study on the clinical and economic burden of anastomotic leakage in colorectal surgery.

Aim: Anastomotic leakage (AL) is one of the most dreaded complications in colorectal surgery. In 2013, the International Classification of Diseases code K91.83 for AL was introduced in Germany, allowing nationwide analysis of AL rates and associated parameters.

Gastrectomy for cancer beyond life expectancy. A comprehensive analysis of oncological gastric surgery in Germany between 2008 and 2018.

Introduction: Major gastric surgery for distal esophageal and gastric cancer has a strong impact on the quality of life, morbidity, and mortality. Especially in elderly patients reaching their life expectancy, the responsible use and extent of gastrectomy are imperative to achieve a balance between harm and benefit. In the present study, the reimbursement database (German Diagnosis Related Groups (G-DRG) database) of the Statistical Office of the Federal Republic of Germany was queried to evaluate the morbidity and mortality of patients aged above or below 75 years following gastrectomy.

The colonoscopic vacuum model-simulating biomechanical restrictions to provide a realistic colonoscopy training environment.

Introduction: Practicing endoscopic procedures is fundamental for the education of clinicians and the benefit of patients. Despite a diverse variety of model types, there is no system simulating anatomical restrictions and variations in a flexible and atraumatic way. Our goal was to develop and validate a new modelling approach for adhesion forces between colon and abdominal wall.

Tactile Robotic Telemedicine for Safe Remote Diagnostics in Times of Corona: System Design, Feasibility and Usability Study.

The current crisis surrounding the COVID-19 pandemic demonstrates the amount of responsibility and the workload on our healthcare system and, above all, on the medical staff around the world. In this work, we propose a promising approach to overcome this problem using robot-assisted telediagnostics, which allows medical experts to examine patients from distance. The designed telediagnostic system consists of two robotic arms.

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.

Mobile service robots for the operating room wing: balancing cost and performance by optimizing robotic fleet size and composition.

Purpose: Integrating fleets of mobile service robots into the operating room wing (OR wing) has the potential to help overcome staff shortages and reduce the amount of dull or unhealthy tasks for humans. However, the OR wing has been little studied in this regard and the requirements for realizing this vision have not yet been fully identified. This includes fundamental aspects such as fleet size and composition, which we have now studied comprehensively for the first time.

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.

Telemedical percussion: objectifying a fundamental clinical examination technique for telemedicine.

Purpose: While demand for telemedicine is increasing, patients are currently restricted to tele-consultation for the most part. Fundamental diagnostics like the percussion still require the in person expertize of a physician. To meet today's challenges, a transformation of the manual percussion into a standardized, digital version, ready for telemedical execution is required.

New Method for Surgical Diagnostics - a Robotic Telemedical Approach.

Apart from the tremendous increase in the demand for telemedicine during the COVID-19 pandemic, the use of telemedical technology offers many advantages, such as better coverage of rural areas and improved access to specialists. While current telediagnostic possibilities are often limited to a verbal consultation, the field of surgery has already made use of robotics for one of the most challenging areas of medicine: invasive procedures. Since comprehensive diagnostics are a prerequisite for each surgery, we built upon the knowledge gained in telesurgery and developed a telediagnostic system that allows for an extensive perioperative and emergency examination.

COVID-19 and beyond: development of a comprehensive telemedical diagnostic framework.

Purpose: During the COVID-19 pandemic, a threatening bottleneck of medical staff arose due to a shortage of trained caregivers, who became infected while working with infectious patients. While telemedicine is rapidly evolving in the fields of teleconsultation and telesurgery, proper telediagnostic systems are not yet available, although the demand for contactless patient-doctor interaction is increasing.

Methods: In this project, the current limitations were addressed by developing a comprehensive telediagnostic system.

Design of a force-measuring setup for colorectal compression anastomosis and first ex-vivo results.

Purpose: The introduction of novel endoscopic instruments is essential to reduce trauma in visceral surgery. However, endoscopic device development is hampered by challenges in respecting the dimensional restrictions, due to the narrow access route, and by achieving adequate force transmission. As the overall goal of our research is the development of a patient adaptable, endoscopic anastomosis manipulator, biomechanical and size-related characterization of gastrointestinal organs are needed to determine technical requirements and thresholds to define functional design and load-compatible dimensioning of devices.

Crohn's disease: a population-based study of surgery in the age of biological therapy.

Purpose: Despite primary conservative therapy for Crohn's disease, a considerable proportion of patients ultimately needs to undergo surgery. Presumably, due to the increased use of biologics, the number of surgeries might have decreased. This study aimed to delineate current case numbers and trends in surgery in the era of biological therapy for Crohn's disease.

[Reconstruction following gastrectomy].

Minimally invasive surgical techniques with respect to the treatment of gastric cancer have progressed rapidly over the last few years. Especially in Asia, where the incidence of gastric cancer is ten times higher than in Europe, surgery for gastric cancer is steadily evolving, especially regarding laparoscopic and robot-assisted procedures. This review first discusses the different options for reconstruction of the gastrointestinal passage after gastrectomy, ranging from Billroth procedures to the latest developments, such as the double tract reconstruction.

Surgical oncology in the age of multimodality therapy for cancer of the upper and lower gastrointestinal tract.

Introduction: To date, all efforts to fight gastrointestinal cancer, regardless of its origin and entity, have resulted in complex therapeutic regimens involving a combination of systemic therapy, radiation therapy and surgery. It is generally accepted across all disciplines that not one, but the combination and the proper timing of all modalities result in the best oncologic outcome.

Areas Covered: Here, we provide insight into the current and future value of multimodal therapeutic approaches for upper and lower gastrointestinal cancer.