MEDICA PREVIEW 2016
age or your body composition, identify dysfunctional body areas with electromagnetic fields on site, analyse resting metabolismis via calorimetry and check your lung function via spirometry.
Imaging advances
There have been many exciting advances in imaging technology. For example, in modern surgical procedures, real-time medical images are now available for the surgeon during a procedure and data from imaging solutions is flowing into the controls of surgical assistance systems.
3D laparoscopy is also finding its way into the operating theatre. Two image sensors are precisely aligned with each other at the end of an endoscope to provide the surgeon with a lifelike endoscopic 3D image during minimally invasive surgery. Thanks to intraoperative imaging techniques major medical procedures are now being replaced by minimally invasive surgery because physicians are able to monitor the results immediately. According to Professor Clemens Bulitta, of the East Bavarian Technical University of Applied Sciences, hybrid operating rooms will become standard in modern vascular surgery. He believes that intraoperative imaging offers three advantages: in the case of aortic valve stenosis, for example, where many patients are not suitable for conventional medical procedure due to their underlying disease, there is now a treatment option available. “This treatment option is also more precise,” said Prof Bulitta. “The less I can directly see and feel with minimally-invasive procedures, the more I need other options to understand the
anatomical setting correctly and properly place implants. Ultimately, the quality of the treatment success is also improved because control images are already being captured during the intervention and complications are being avoided.”
The technology also means that major incisions are often not necessary. With aorta surgery, for example, when treating an aortic aneurysm a vascular endoprosthesis is inserted through an abdominal incision. This major incision can now be avoided with a minimally-invasive procedure via the femoral arteries. Intraoperative imaging will, however, fundamentally change the surgical procedure and the new equipment will require a restructuring of operational procedures, as well as changes in education and staff training. Prof Bulitta believes that the added benefit of these systems will outweigh the cost factors involved. He said: “Intraoperative imaging enables surgeries with fewer complications, which makes fewer revisions necessary. This makes the overall treatment gentler, shorter in duration and on the whole more cost-effective. It also creates new treatment options that were previously not available. From my perspective, intraoperative imaging systems have become an essential part of modern surgery.” Prof Bullita also believes that intraoperative imaging will also be used increasingly outside
of the cardiovascular field, for example, in surgical oncology or surgical procedures of the musculoskeletal system.
Robotics in the operating room
Professor Erwin Keeve of the Department of Navigation and Robotics, Charité Berlin, believes that mechanically controlled robotic systems will find increasing applications in the operating room. However, he does not believe that robots will act autonomously. “They are only intended to support the surgeon,” he said. “It is not enough to transfer industrial robotic concepts into medicine. This type of robot is too powerful and to heavy. A surgeon would not be able to control them in an easy and manageable way. What’s more, these robots were originally designed to undertake set, predictable tasks which certainly is not the case in a surgical environment.” To overcome the shortcomings of existing robotic technologies Charité Berlin has developed a lightweight endoscope surgery robot that can be mounted on the side of the surgical table. It weighs just 7.5 kilograms and moves when the surgeon exerts a force of 0.5 kilograms which is approximately the force required to hold an endoscope. This enables the robot to do the job of the surgical assistant who traditionally needed to hold the instrument to ensure the surgeon has a full view of the surgical site.
Commenting on the obstacles that need to be overcome to implement the operating room of the future, Prof Keeve said: “It is technically difficult to make the systems easy enough to ensure they do not overwhelm the surgeon. I believe the human machine interface is the biggest challenge. Engineers must realise that tools need to be more intuitive and easier to use. The other problem is the need for consolidation in hospitals. We need to break through the existing structures between individual medical disciplines and build surgical interdisciplinary centres. Today, hospitals are only able to operate efficiently if they set up large structures and diversify their operations.”
Focus on telemedicine
Telemedicine will be another big focus at MEDICA this year. The Education Conference on 16 November will include a discussion on ‘Internal Medicine: Future Technologies and Remote Patient Management’. In cardiology, telemedicine has been proven in two large clinical trials to increase life expectancy and quality of life for patients. In the Champion study1
heart values of the
participants were monitored via telecardiology on a daily basis and the drug dose was adjusted accordingly. The number
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Thanks to intraoperative imaging techniques major medical procedures are now being replaced by minimally invasive surgery.
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