[Image-based supportive measures for future application in surgery]. / Bildbasierte Unterstützungsmethoden für die zukünftige Anwendung in der Chirurgie.

BACKGROUND: The development of assistive technologies will become of increasing importance in the coming years and not only in surgery. The comprehensive perception of the actual situation is the basis of every autonomous action. Different sensor systems can be used for this purpose, of which video-based systems have a special potential. METHOD: Based on the available literature and on own research projects, central aspects of image-based support systems for surgery are presented. In this context, not only the potential but also the limitations of the methods are explained. RESULTS: An established application is the phase detection of surgical interventions, for which surgical videos are analyzed using neural networks. Through a time-based and transformative analysis the results of the prediction could only recently be significantly improved. Robotic camera guidance systems will also use image data to autonomously navigate laparoscopes in the near future. The reliability of the systems needs to be adapted to the high requirements in surgery by means of additional information. A comparable multimodal approach has already been implemented for navigation and localization during laparoscopic procedures. For this purpose, video data are analyzed using various methods and these data are fused with other sensor modalities. DISCUSSION: Image-based supportive methods are already available for various tasks and will become an important aspect for the surgery of the future; however, in order to be able to be reliably implemented for autonomous functions, they must be embedded in multimodal approaches in the future in order to provide the necessary security.

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). In this article we propose a workflow to generate operative notes based on the output of the TeCNO CNN. METHODS: Video recordings of 15 cholecystectomies were used for inference. The annotation of TeCNO was compared to that of an expert surgeon (HE) and the algorithm based annotation of a scientist (HA). The CNN output then was used to identify aberrance from standard course as basis for the final report. Moreover, we assessed the phenomenon of 'phase flickering' as clusters of incorrectly labeled frames and evaluated its usability. RESULTS: The accordance of the HE and CNN was 79.7% and that of HA and CNN 87.0%. 'Phase flickering' indicated an aberrant course with AUCs of 0.91 and 0.89 in ROC analysis regarding number and extend of concerned frames. Finally, we created operative notes based on a standard text, deviation alerts, and manual completion by the surgeon. CONCLUSION: Computer-aided documentation is a noteworthy use case for phase recognition in standardized surgery. The analysis of phase flickering in a CNN's annotation has the potential of retrieving more information about the course of a particular procedure to complement an automated report.

[Clinical value of alternative technologies to standard laparoscopic cholecystectomy - single port, reduced port, robotics, NOTES]. / Klinischer Stellenwert alternativer Technologien zur standardmäßigen laparoskopischen Cholezystektomie ­ Single-Port, Reduced-Port, Roboter, 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. With all new methods the main aim is the reduction of the transabdominal access points. Based on published results and diagnosis-related groups (DRG) data, this article examines whether this goal has been achieved, also with respect to the overall quality of treatment and the complication rates. In this context and in addition to the already mentioned approaches, robotic cholecystectomy and the reduced port approach are also considered.

Closure using a surgical closure device of inadvertent subclavian artery punctures during central venous catheter placement.

Severe complications can and do occur when central venous catheters are inadvertently placed into subclavian arteries. Two cases are discussed that describe how these inadvertent arterial punctures can be closed using the Perclose device (Abbott Laboratories, Redwood City, CA, USA).

Serendipitous discovery and embolization of pulmonary arteriovenous malformations as a lifesaving procedure in a patient with pulmonary emboli.

A patient--with a history of postlaparoscopic deep venous thrombosis and rectus abdominis hematoma--experienced sudden respiratory decompensation requiring mechanical ventilation at an FIO2 of 100%. Initial PaO2 was 32 mm Hg. Pulmonary angiography revealed three unexpected pulmonary arteriovenous malformations as well as pulmonary emboli. Two pulmonary arteriovenous malformations were successfully embolized, and an inferior vena cava filter placed. The PaO2 immediately after the procedure was 458.4 mm Hg.