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

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Abstract

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.

Methods

In addition to the analysis of our own surgical practice, a literature search of the Medline database was performed to identify important aspects, methods, and technologies for increased operating room (OR) autonomy.

Results

Robotic surgical systems can help to increase OR autonomy by camera control, application of intelligent instruments, and even accomplishment of automated surgical procedures. However, the important step from simple task execution to autonomous decision making is difficult to realize. Another important aspect is the adaption of the general technical OR environment. This includes adaptive OR setting and context-adaptive interfaces, automated tool arrangement, and optimal visualization. Finally, integration of peri- and intraoperative data consisting of electronic patient record, OR documentation and logistics, medical imaging, and patient surveillance data could increase autonomy.

Conclusions

To gain autonomy in the OR, a variety of assistance systems and methodologies need to be incorporated that endorse the surgeon autonomously as a first step toward the vision of cognitive surgery. Thus, we require establishment of model-based surgery and integration of procedural tasks. Structured knowledge is therefore indispensable.

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Acknowledgments

Supported in part by DFG project “Single-Port-Technologie für gastroenterologische und viszeralchirurgische endoskopische Interventionen” (FOR 1321).

Disclosures

Dr. med. Kranzfelder, Dipl. Inf. Staub, Dipl. Ing. Fiolka, Dr. Ing. Schneider, PD Dr. med. Gillen, Dr. med. Wilhelm, Prof. Dr. med. Friess, Prof. Dr. Ing. Knoll and Prof. Dr. med. Feussner have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, 81675, München, Germany

    Michael Kranzfelder, Sonja Gillen, Dirk Wilhelm, Helmut Friess & Hubertus Feussner

  2. Workgroup MITI (Minimally Invasive Interdisciplinary Therapeutical Intervention), Klinikum Rechts der Isar, Technische Universität München, 81675, München, Germany

    Michael Kranzfelder, Adam Fiolka, Armin Schneider, Sonja Gillen, Dirk Wilhelm & Hubertus Feussner

  3. Department of Informatics, Robotics and Embedded Systems, Technische Universität München, 85748, Garching, Germany

    Christoph Staub & Alois Knoll

Authors
  1. Michael Kranzfelder
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  2. Christoph Staub
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  3. Adam Fiolka
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  4. Armin Schneider
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  5. Sonja Gillen
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  6. Dirk Wilhelm
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  7. Helmut Friess
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  8. Alois Knoll
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  9. Hubertus Feussner
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Corresponding author

Correspondence to Michael Kranzfelder.

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Kranzfelder, M., Staub, C., Fiolka, A. et al. Toward increased autonomy in the surgical OR: needs, requests, and expectations. Surg Endosc 27, 1681–1688 (2013). https://doi.org/10.1007/s00464-012-2656-y

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  • DOI: https://doi.org/10.1007/s00464-012-2656-y

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