Fractal analysis of extracellular matrix for observer-independent quantification of intestinal fibrosis in Crohn's disease.

Prevention of intestinal fibrosis remains an unresolved problem in the treatment of Crohn's disease (CD), as specific antifibrotic therapies are not yet available. Appropriate analysis of fibrosis severity is essential for assessing the therapeutic efficacy of potential antifibrotic drugs. The aim of this study was to develop an observer-independent method to quantify intestinal fibrosis in surgical specimens from patients with CD using structural analysis of the extracellular matrix (ECM). We performed fractal analysis in fibrotic and control histological sections of patients with surgery for CD (n = 28). To specifically assess the structure of the collagen matrix, polarized light microscopy was used. A score to quantify collagen fiber alignment and the color of the polarized light was established. Fractal dimension as a measure for the structural complexity correlated significantly with the histological fibrosis score whereas lacunarity as a measure for the compactness of the ECM showed a negative correlation. Polarized light microscopy to visualize the collagen network underlined the structural changes in the ECM network in advanced fibrosis. In conclusion, observer-independent quantification of the structural complexity of the ECM by fractal analysis is a suitable method to quantify the degree of intestinal fibrosis in histological samples from patients with CD.

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. METHODS: This retrospective single-center cohort study included 85 patients who underwent laparoscopic sigmoid resection for diverticular disease. Potentially relevant procedure-specific anatomical parameters recommended by a surgical expert were measured in preoperative CT imaging. After random split into training and test set (75% / 25%) multiclass logistic regression was performed and a Random Forest classifier was trained on CT imaging parameters, patient age, and sex in the training cohort to predict categorized surgery duration. The models were evaluated in the test cohort using established performance metrics including receiver operating characteristics area under the curve (AUROC). RESULTS: The Random Forest model achieved a good average AUROC of 0.78. It allowed a very good prediction of long (AUROC = 0.89; specificity 0.71; sensitivity 1.0) and short (AUROC = 0.81; specificity 0.77; sensitivity 0.56) procedures. It clearly outperformed the multiclass logistic regression model (AUROC: average = 0.33; short = 0.31; long = 0.22). CONCLUSION: A Random Forest classifier trained on demographic and CT imaging biometric patient data could predict procedure duration outliers of laparoscopic sigmoid resections. Pending validation in a multicenter study, this approach could potentially improve procedure scheduling in visceral surgery and be scaled to other procedures.

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. In the project ProteCT, we investigated the potential of robotic-assisted examination in providing medical examination via a telemedical approach. Material and Methods: We constructed a fully functional examination cabin equipped with cameras, microphones, screens and robotic arms to evaluate usability and perception. Therefore, we conducted a preliminary study with 10 healthy volunteers and 10 physicians to gain first insights and optimize the setup. In a second step, we performed telemedical examinations of actual patients from the local emergency department to compare the robotic approach with the classical method of measuring vital signs, auscultation, palpation and percussion. Results: The preliminary study identified basic requirements, such as the need for force-feedback and telemedical training for physicians. In the main study, acceptance was high and most patients indicated they would use a telemedical system again. Our setup enabled the physician to make the same diagnoses as by classic examination in the emergency department in most cases. Discussion: The potential acceptance of a telemedical system such as ProteCT is high. Robotic telemedical approaches could complement future healthcare beyond the Corona pandemic to reach rural areas or even war zones. Moreover, the daily clinical use of robotic telemedicine could improve patients' safety, the quality of perioperative management and the workflow in any medical facility. Conclusion: The development of telemedical and telerobotic systems is a multidisciplinary and complex challenge. However, acceptance of the proposed system was high among patients and physicians, indicating the potential use of similar systems for future healthcare.

Autonomous swab robot for naso- and oropharyngeal COVID-19 screening.

The COVID-19 outbreak has triggered a global health and economic crisis, necessitating widespread testing to control viral spread amidst rising cases and fatalities. The recommended testing method, a combined naso- and oropharyngeal swab, poses risks and demands limited protective gear. In response to the COVID-19 pandemic, we developed and tested the first autonomous swab robot station for Naso- and Oropharyngeal Coronavirus Screening (SR-NOCS). A force-sensitive robot running under a Cartesian impedance controller is employed to drive the swab to the sampling area. This groundbreaking device underwent two clinical studies-one conducted during the initial pandemic lockdown in Europe (early 2021) and the other, more recently, in a public place after the pandemic had subsided earlier in the year 2023. In total, 52 patients suspected of COVID-19 infection were included in these clinical studies. The results revealed a complete positive correlation between autonomous and manual sampling. The test subjects exhibited a high acceptance rate, all expressing a willingness to undergo future tests with SR-NOCS. Based on our findings, such systems could enhance testing capabilities, potentially conducting up to 300 tests per robot per day with consistent precision. The tests can be carried out with minimal supervision, reducing infection risks and effectively safeguarding patients and healthcare workers.

[Mobile C-arm-Radiation exposure and workflow killer? : Potential of an innovative assistance system for intraoperative positioning]. / Mobiler C-Bogen ­ Strahlenbelastung und Workflow-Killer? : Potenzial eines innovativen Assistenzsystems für die intraoperative Positionierung.

Despite its versatile applicability the intraoperative use of a mobile C­arm is often problematic and potentially associated with increased radiation exposure for both the patient and the personnel. In particular, the correct positioning for adequate imaging can become a problem as the nonsterile circulating nurse has to coordinate the various maneuvers together with the surgeon without having a good view of the surgical field. The sluggishness of the equipment and the intraoperative setting (sterile borders, additional hardware, etc.) pose further challenges. A light detection and ranging (LIDAR)-based assistance system shows promise to provide accurate and intuitive repositioning support as part of an initial series of experimental trials. For this purpose, the sensors are attached to the C­arm base unit and enable navigation of the device in the operating room to a stored target position using a simultaneous localization and mapping (SLAM) algorithm. An improvement of the workflow as well as a reduction of radiation exposure represent the possible potential of this system. The advantages over other experimental approaches are the lack of external hardware and the ease of use without isolating the operator from the rest of the operating room environment; however, the suitability for daily use in the presence of additional interfering factors should be verified in further studies.

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. However, the first step is to ensure the safe manipulation of laparoscopic instruments. METHODS: A robotic platform with a universal gripper system was designed to pick up and place laparoscopic as well as da Vinci[Formula: see text] instruments in an efficient workflow. The robustness of the gripper system was studied using a test protocol, which included a force absorption test to determine the operational safety limits of the design and a grip test to determine the system performance. RESULTS: The test protocol shows results regarding force and torque absorption capabilities of the end effector, which are essential when transferring an instrument to the surgeon to enable a robust handover. The grip tests show that the laparoscopic instruments can be safely picked up, manipulated and returned independent of unexpected positional deviations. The gripper system also enables the manipulation of da Vinci[Formula: see text] instruments, opening the door for robot-robot interaction. CONCLUSION: Our evaluation tests have shown that our robotic scrub nurse with the universal gripper system can safely and robustly manipulate laparoscopic and da Vinci[Formula: see text] instruments. The system design will continue with the integration of context-sensitive capabilities.

Demographic overview of pilonidal sinus carcinoma: updated insights into the incidence.

PURPOSE: There are only rough estimates of the worldwide incidence of pilonidal sinus carcinoma. The purpose of the study is to explore the demographic characteristics of this disease and to provide more precise information about its incidence. METHODS: The study included questioning the surgeons and pathologists in Germany in addition to a literature research. The literature investigation included all published articles about pilonidal carcinoma in all languages. The questionnaire included 1050 pathologists and all 834 hospitals with a surgical division in Germany. The outcome measures included the total number of cases, the language of publication, gender, age, country of origin, interval until the diagnosis of carcinoma, and reported incidence based on local studies. RESULTS: From 1900 to 2022, we found 140 cases of pilonidal sinus carcinoma in 103 articles. The investigation revealed two additional unpublished cases from Germany. The male-to-female ratio was 7.75:1. The countries with the most cases were the USA (35 cases, 25.0%), Spain (13 cases, 9.3%), and Turkey (11 cases, 7.6%). The average age was 54.0 ± 11.8 years and the interval between the diagnosis of the disease and the development of carcinoma was 20.1 ± 14.1 years. There was a parallel increase in reported cases of pilonidal sinus disease and pilonidal carcinoma over the last century. The reported incidence varied from 0.03% to 5.56%. The worldwide calculated incidence equaled 0.17%. CONCLUSION: Due to underreporting and other causes, the incidence of carcinoma emerging on the background of pilonidal sinus disease is higher than reported.

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. The aim of this population-based study was to investigate the current incidence, risk factors, mortality, clinical management, and associated costs of AL in colorectal surgery. METHODS: A data query was performed based on diagnosis-related group data of all hospital cases of inpatients undergoing colon or sphincter-preserving rectal resections between 2013 and 2018 in Germany. RESULTS: A total number of 690,690 inpatient cases were included in this study. AL rates were 6.7% for colon resections and 9.2% for rectal resections in 2018. Regarding the treatment of AL, the application of endoluminal vacuum therapy increased during the studied period, while rates of relaparotomy, abdominal vacuum therapy, and terminal enterostomy remained stable. AL was associated with significantly increased in-house mortality (7.11% vs. 20.11% for colon resections and 3.52% vs. 11.33% for rectal resections in 2018) and higher socioeconomic costs (mean hospital reimbursement volume per case: 14,877€ (no AL) vs. 37,521€ (AL) for colon resections and 14,602€ (no AL) vs. 30,606€ (AL) for rectal resections in 2018). CONCLUSIONS: During the studied time period, AL rates did not decrease, and associated mortality remained at a high level. Our study provides updated population-based data on the clinical and economic burden of AL in Germany. Focused research in the field of AL is still urgently necessary to develop targeted strategies to prevent AL, improve patient care, and decrease socioeconomic costs.

Perioperative Low-Dose Prednisolone Treatment Has Beneficial Effects on Postoperative Recovery and Anastomotic Healing in a Murine Colitis Model.

BACKGROUND AND AIMS: High-dose glucocorticoid treatment has been identified as a risk factor for anastomotic leakage in patients with inflammatory bowel disease [IBD] undergoing bowel resection surgery. By contrast, active disease during surgery is also associated with elevated morbidity. Perioperative low-dose treatment might be beneficial regarding postoperative outcomes by controlling disease activity. The present study is the first to investigate the dose-dependent effect of perioperative prednisolone therapy in a murine IBD model combining dextran sodium sulphate [DSS] colitis with intestinal anastomosis surgery. METHODS: In 84 10-week-old wild-type mice, a colorectal anastomosis was performed using a microsurgical technique. Half the animals received induction of chemical colitis with 2% DSS via drinking water prior to surgery. In both groups, one-third of the animals received daily oral administration of high-dose [0.533 mg/kg] and one-third low-dose [0.133 mg/kg] prednisolone. Evaluation was performed on postoperative days 3 and 7. RESULTS: While high-dose prednisolone treatment led to an increased anastomotic leakage rate in mice under colitis, low-dose prednisolone treatment limited preoperative disease activity and did not influence the leakage rate. Histological examination showed a beneficial effect of low-dose prednisolone treatment on microscopic abscess formation at the anastomotic site in DSS mice as well as an increased anastomotic healing score. CONCLUSIONS: We demonstrate a beneficial effect of perioperative short-term low-dose prednisolone treatment on intestinal anastomotic healing in the context of colitis. Perioperative use of short-term low-dose prednisolone treatment might be beneficial in IBD patients who need to undergo surgery during active disease.

Development and Validation of a Deep Learning Algorithm to Differentiate Colon Carcinoma From Acute Diverticulitis in Computed Tomography Images.

Importance: Differentiating between malignant and benign etiology in large-bowel wall thickening on computed tomography (CT) images can be a challenging task. Artificial intelligence (AI) support systems can improve the diagnostic accuracy of radiologists, as shown for a variety of imaging tasks. Improvements in diagnostic performance, in particular the reduction of false-negative findings, may be useful in patient care. Objective: To develop and evaluate a deep learning algorithm able to differentiate colon carcinoma (CC) and acute diverticulitis (AD) on CT images and analyze the impact of the AI-support system in a reader study. Design, Setting, and Participants: In this diagnostic study, patients who underwent surgery between July 1, 2005, and October 1, 2020, for CC or AD were included. Three-dimensional (3-D) bounding boxes including the diseased bowel segment and surrounding mesentery were manually delineated and used to develop a 3-D convolutional neural network (CNN). A reader study with 10 observers of different experience levels was conducted. Readers were asked to classify the testing cohort under reading room conditions, first without and then with algorithmic support. Main Outcomes and Measures: To evaluate the diagnostic performance, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for all readers and reader groups with and without AI support. Metrics were compared using the McNemar test and relative and absolute predictive value comparisons. Results: A total of 585 patients (AD: n = 267, CC: n = 318; mean [SD] age, 63.2 [13.4] years; 341 men [58.3%]) were included. The 3-D CNN reached a sensitivity of 83.3% (95% CI, 70.0%-96.6%) and specificity of 86.6% (95% CI, 74.5%-98.8%) for the test set, compared with the mean reader sensitivity of 77.6% (95% CI, 72.9%-82.3%) and specificity of 81.6% (95% CI, 77.2%-86.1%). The combined group of readers improved significantly with AI support from a sensitivity of 77.6% to 85.6% (95% CI, 81.3%-89.3%; P < .001) and a specificity of 81.6% to 91.3% (95% CI, 88.1%-94.5%; P < .001). Artificial intelligence support significantly reduced the number of false-negative and false-positive findings (NPV from 78.5% to 86.4% and PPV from 80.9% to 90.8%; P < .001). Conclusions and Relevance: The findings of this study suggest that a deep learning model able to distinguish CC and AD in CT images as a support system may significantly improve the diagnostic performance of radiologists, which may improve patient care.

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. METHODS: An inlay for a standard mechanical trainer was designed and 3D printed. Colon specimens were fixed to the inlay along colon ascendens (CA) and colon descendens (CD) by a vacuum. Our system, which we refer to as Colonoscopy Vacuum Model (CoVaMo), was validated with 11 test persons with varying level of expertise. Each performed one colonoscopy and one polypectomy in the CoVaMo and in the Endoscopic Laparoscopic Interdisciplinary Training Entity (ELITE). Achieved adhesion forces, times required to fulfill different tasks endoscopically and a questionnaire, assessing proximity to reality, were recorded. RESULTS: Mean adhesion forces of 37 ± 7 N at the CA and 30 ± 15 N at the CD were achieved. Test subjects considered CoVaMo more realistic than ELITE concerning endoscope handling and the overall anatomy. Participants needed statistically significantly more time to maneuver from anus to flexura sinistra in CoVaMo (377 s ± 244 s) than in ELITE (58 s ± 49 s). CONCLUSION: We developed a training environment enabling anatomically and procedural realistic colonoscopy training requiring participants to handle all endoscope features in parallel. Fixation forces compare to forces needed to tear pig colon off the mesentery. Workflow and inlay can be adapted to any arbitrary ex vivo simulator.

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. 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.

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. METHODS: Using simulation, 150 different scenarios with varying fleet compositions, robot speeds and workloads were studied for a setup based on a real-life OR wing. The simulation included battery recharging cycles and queueing due to shared resources. RESULTS: For all simulated scenarios we report results regarding total duration of execution, average task response times and fleet utilization. The relationship between these performance measures and global scenario parameters-such as fleet size, fleet composition, robot velocity and the number of operating rooms to be served-is visualized. CONCLUSION: Our simulation-based studies have proven to be a valuable tool for individualized dimensioning of mobile robotic fleets, based on realistic workflows and environmental models. Thereby, important implications for future developments of mobile robots have been identified and a basis of decision-making regarding fleet size, fleet composition, robot capabilities and robot velocities can be provided. Due to costs, space limitations and safety requirements, these aspects must be carefully considered to successfully integrate mobile robotic technology into real-world OR wing environments.

Towards the OR of the future: introducing an adaptive and technology-embracing OR wing layout.

PURPOSE: Overageing and climate change cause a need for making processes in the operating room wing (OR wing) more efficient. While many promising technologies are available today, traditional OR wings are not designed for seamlessly integrating these aids. To overcome this discrepancy, we present and motivate multiple ideas on how to transform current architectural design strategies. METHODS: The presented concepts originate from expert discussions and studies of the available literature, but also from experiences made in the course of daily care delivery. Additionally, a comprehensive evaluation of current and historic OR theatre designs and the problems which are encountered herein has been conducted. RESULTS: We present three innovative concepts regarding the restructuring of traditional OR wing layouts. To achieve better process optimization, hygiene, and energy efficiency, we propose to divide the OR wing into separate "patient", "procedure" and "staff" zones. For better flexibility regarding perioperative needs and technology integration, we propose to use a hexagon shape combined with reconfigurable walls for designing operating rooms. CONCLUSION: The concepts presented herein provide a solid foundation for further considerations regarding perioperative process optimization and seamless integration of technology into modern OR wing facilities. We aim at expanding on these results to develop a comprehensive vision for the OR wing of the future.

Bacterial content of the human pancreatic duct: An observational study.

Background: Pancreatic fistula/PF is a challenging surgical complication. We could recently show that intestinal bacteria such as Enterobacterales colonize the PF fluid even after a "sterile" operation like distal pancreatectomy/DP. Therefore, we explored the bacterial flora of the human pancreatic duct in a patient collective undergoing pancreatic surgery. Methods: In this observational study, upon transection of the pancreas during surgery, a swab was inserted into the main duct, and the micro-organismal content was correlated with clinical characteristics. Results: Between February 2017 and February 2020, an intraoperative swab from the pancreatic duct was obtained from a total of 54 patients who underwent pancreatico-duodenectomy/PD or DP. The swabs were sterile in 39 cases (72.2%), detected intestinal bacteria in 10 cases (18.5%), and other bacteria in 5 cases (9.3%). There was no correlation of the micro-organismal content of the pancreatic duct swab with bacteria detected in the PF fluid or bile. Preoperative ERCP was associated with a higher frequency of bacterial colonization of the pancreatic duct (33.3% vs. 6.7%, p = 0.005). There was no correlation of the pancreatic duct swabs with postoperative complications. Discussion: The human main pancreatic duct is usually sterile, and its bacterial colonization does not correlate with the occurrence of PF. Therefore, the mechanisms leading to infection of PF warrant in-depth, mechanistic investigation.

The Effect of Anti-Tumor Necrosis Factor-Alpha Therapy within 12 Weeks Prior to Surgery on Postoperative Complications in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis.

The rate of abdominal surgical interventions and associated postoperative complications in inflammatory bowel disease (IBD) patients is still substantially high. There is an ongoing debate as to whether or not patients who undergo treatment with anti-tumor necrosis factor-alpha (TNF-α) agents may have an increased risk for general and surgical postoperative complications. Therefore, a systematic review and meta-analysis was conducted in order to assess the effect of anti-TNF-α treatment within 12 weeks (washout period) prior to abdominal surgery on 30-day postoperative complications in patients with IBD. The results of previously published meta-analyses examining the effect of preoperative anti-TNF-α treatment on postoperative complications reported conflicting findings which is why we specifically focus on the effect of anti-TNF-α treatment within 12 weeks prior to surgery. PubMed, Cochrane, Scopus, Web of Science, World Health Organization Trial Registry, ClinicalTrials.gov and reference lists were searched (June 1995−February 2022) to identify studies, investigating effects of anti-TNF-α treatment prior to abdominal surgery on postoperative complications in IBD patients. Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated and subgroup analyses were performed. In this case, 55 cohort studies (22,714 patients) were included. Overall, postoperative complications (OR, 1.23; 95% CI, 1.04−1.45; p = 0.02), readmission (OR, 1.39; 95% CI, 1.11−1.73; p = 0.004), and intra-abdominal septic complications (OR, 1.89; 95% CI, 1.44−2.49; p < 0.00001) were significantly higher for anti-TNF-α-treated patients. Significantly higher intra-abdominal abscesses and readmission were found for anti-TNF-α-treated CD patients (p = 0.05; p = 0.002). Concomitant treatment with immunosuppressives in <50% of anti-TNF-α-treated patients was associated with significantly lower mortality rates (OR, 0.32; 95% CI, 0.12−0.83; p = 0.02). Anti-TNF-α treatment within 12 weeks prior to surgery is associated with higher short-term postoperative complication rates (general and surgical) for patients with IBD, especially CD.

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. Each robot is located at the doctor and patient sites. Such a system enables the doctor to have a direct conversation via telepresence and to examine patients through robot-assisted inspection (guided tactile and audiovisual contact). The proposed bilateral teleoperation system is redundant in terms of teleoperation control algorithms and visual feedback. Specifically, we implemented two main control modes: joint-based and displacement-based teleoperation. The joint-based mode was implemented due to its high transparency and ease of mapping between Leader and Follower whereas the displacement-based is highly flexible in terms of relative pose mapping and null-space control. Tracking tests between Leader and Follower were conducted on our system using both wired and wireless connections. Moreover, our system was tested by seven medical doctors in two experiments. User studies demonstrated the system's usability and it was successfully validated by the medical experts.

Electromagnetic tool for the endoscopic creation of colon anastomoses-development and feasibility assessment of a novel anastomosis compression implant approach.

BACKGROUND: Colorectal anastomoses are among the most commonly performed interventions in abdominal surgery, while associated patient trauma is still high. Most recent trends of endoscopic anastomosis devices integrate magnetic components to overcome the challenges of minimally invasive surgery. However, the mutual attraction between magnetic implant halves may increase the risk of inadvertently pinching healthy structures. Thus, we present a novel anastomosis device to improve system controllability and flexibility. METHODS: A magnetic implant and an applicator with electromagnetic control units were developed. The interaction of magnetic implants with the electromagnets bears particular challenges with respect to the force-related dimensioning. Here, attraction forces must be overcome by the electromagnet actuation to detach the implant, while the attraction force between the implant halves must be sufficient to ensure a stable connection. Thus, respective forces were measured and the detachment process was reproducibly investigated. Patient hazards, associated with resistance-related heating of the coils were investigated. RESULTS: Anastomosis formation was reproducibly successful for an implant, with an attraction force of 1.53 [Formula: see text], resulting in a compression pressure of [Formula: see text]. The implant was reproducibly detachable from the applicator at the anastomosis site. Coils heated up to a maximum temperature of [Formula: see text]. Furthermore, we were able to establish a neat reconnection of intestinal bowel endings using our implant. DISCUSSION: As we achieved nearly equal compression forces with our implant as other magnetic anastomosis systems did (Magnamosis™: 1.48 N), we concluded that our approach provides sufficient holding strength to counteract the forces acting immediately postoperatively, which would eventually lead to an undesired slipping of the implant halves during the healing phase. Based on heat transfer investigations, preventive design specifications were derived, revealing that the wall thickness of a polymeric isolation is determined rather by stability considerations, than by heat shielding requirements.

Surgomics: personalized prediction of morbidity, mortality and long-term outcome in surgery using machine learning on multimodal data.

BACKGROUND: Personalized medicine requires the integration and analysis of vast amounts of patient data to realize individualized care. With Surgomics, we aim to facilitate personalized therapy recommendations in surgery by integration of intraoperative surgical data and their analysis with machine learning methods to leverage the potential of this data in analogy to Radiomics and Genomics. METHODS: We defined Surgomics as the entirety of surgomic features that are process characteristics of a surgical procedure automatically derived from multimodal intraoperative data to quantify processes in the operating room. In a multidisciplinary team we discussed potential data sources like endoscopic videos, vital sign monitoring, medical devices and instruments and respective surgomic features. Subsequently, an online questionnaire was sent to experts from surgery and (computer) science at multiple centers for rating the features' clinical relevance and technical feasibility. RESULTS: In total, 52 surgomic features were identified and assigned to eight feature categories. Based on the expert survey (n = 66 participants) the feature category with the highest clinical relevance as rated by surgeons was "surgical skill and quality of performance" for morbidity and mortality (9.0 ± 1.3 on a numerical rating scale from 1 to 10) as well as for long-term (oncological) outcome (8.2 ± 1.8). The feature category with the highest feasibility to be automatically extracted as rated by (computer) scientists was "Instrument" (8.5 ± 1.7). Among the surgomic features ranked as most relevant in their respective category were "intraoperative adverse events", "action performed with instruments", "vital sign monitoring", and "difficulty of surgery". CONCLUSION: Surgomics is a promising concept for the analysis of intraoperative data. Surgomics may be used together with preoperative features from clinical data and Radiomics to predict postoperative morbidity, mortality and long-term outcome, as well as to provide tailored feedback for surgeons.