Digitalisierung in der Chirurgie: Was Chirurgen darüber denken und was sie wissen – Ergebnisse einer Onlineumfrage

National survey on data governance and digital surgery: Challenges and opportunities for surgeons in the era of artificial intelligence

INTRODUCTION

This study evaluates the knowledge of Spanish surgeons regarding data governance and Digital Surgery, their usage, errors, and training deficiencies, as well as differences in knowledge between those who perform robotic surgery and those who do not.

METHODS

A descriptive study was conducted using a closed survey promoted by the Minimally Invasive Surgery and Technological Innovation Section of the Spanish Association of Surgeons, directed at its members between February and March 2024.

RESULTS

Out of 1086 surgeons contacted, 396 responded (36.46%). While 98.3% use electronic medical records, 45.4% lack organized data recording systems. Although 55.9% have access to robotic technology, 70.6% do not use it directly. Surgeons who perform robotic surgery show a higher general knowledge of Digital Surgery terms (7.2 vs 6.619; P = .215) and specifically of "Artificial Intelligence" (57.14% compared to less than 25% for other terms), although these differences are not significant. However, there are significant differences in interest in digital technology between those who perform robotic surgery and those who do not (P = .023). Additionally, surgeons who support training in digital technology during residency are nearly twice as likely to research Digital Surgery.

CONCLUSION

Surgeons are crucial for the digital transformation in surgery, but many are poorly prepared and insufficiently involved. Those who practice robotic surgery have more knowledge and interest in digital technology, highlighting the need for improved training and governance frameworks to better integrate surgeons into the digital era.

Technological advancements in surgical laparoscopy considering artificial intelligence: a survey among surgeons in Germany

PURPOSE

The integration of artificial intelligence (AI) into surgical laparoscopy has shown promising results in recent years. This survey aims to investigate the inconveniences of current conventional laparoscopy and to evaluate the attitudes and desires of surgeons in Germany towards new AI-based laparoscopic systems.

METHODS

A 12-item web-based questionnaire was distributed to 38 German university hospitals as well as to a Germany-wide voluntary hospital association (CLINOTEL) consisting of 66 hospitals between July and November 2022.

RESULTS

A total of 202 questionnaires were completed. The majority of respondents (88.1%) stated that they needed one assistant during laparoscopy and rated the assistants' skillfulness as "very important" (39.6%) or "important" (49.5%). The most uncomfortable aspects of conventional laparoscopy were inappropriate camera movement (73.8%) and lens condensation (73.3%). Selected features that should be included in a new laparoscopic system were simple and intuitive maneuverability (81.2%), automatic de-fogging (80.7%), and self-cleaning of camera (77.2%). Furthermore, AI-based features were improvement of camera positioning (71.3%), visualization of anatomical landmarks (67.3%), image stabilization (66.8%), and tissue damage protection (59.4%). The reason for purchasing an AI-based system was to improve patient safety (86.1%); the reasonable price was €50.000-100.000 (34.2%), and it was expected to replace the existing assistants' workflow up to 25% (41.6%).

CONCLUSION

Simple and intuitive maneuverability with improved and image-stabilized camera guidance in combination with a lens cleaning system as well as AI-based augmentation of anatomical landmarks and tissue damage protection seem to be significant requirements for the further development of laparoscopic systems.

Stressors, Resources, and Strain Associated with Digitization Processes of Medical Staff Working in Neurosurgical and Vascular Surgical Hospital Wards: A Multimethod Study

The digitization of German hospitals is proceeding continuously, leading to the implementation of new digital technologies, such as electronic health records (EHRs) or other technologies, used for the purpose of medical documentation tasks. Even though the replacement of paper documentation through digitized documentation in general promises to come along with plenty of benefits, the daily utilization of technologies might also lead to stresses and strains among the medical staff, eventually possibly leading to the development of different negative work and health-related outcomes. This study, therefore, aims at identifying persisting digitization-associated stressors and resources among medical hospital staff, examining their influences on different work and health-related outcomes, and finally, identifying potential needs for preventive measures. A quantitative study in the form of an online questionnaire survey was conducted among physicians working in the medical field of neuro- and vascular surgery in German hospitals. The study was carried out between June and October 2022 utilizing an online questionnaire based on several standardized scales, such as the technology acceptance model (TAM) and the technostress model, as well as on several scales from the Copenhagen Psychosocial Questionnaire (COPSOQ). The study found medium levels of technostress among the participating physicians (n = 114), as well as low to medium levels of persisting resources. The queried physicians, on average, reported low levels of burnout symptoms, generally described their health status as good, and were mostly satisfied with their job. Despite the prevalence of technostress and the low levels of resources among the surveyed physicians, there is little awareness of the problem of digital stress, and preventive measures have not been widely implemented yet in the clinics, indicating a needs gap and the necessity for the strategic and quality-guided implementation of measures to effectively prevent digital stress from developing.

Surgical data science - from concepts toward clinical translation

Recent developments in data science in general and machine learning in particular have transformed the way experts envision the future of surgery. Surgical Data Science (SDS) is a new research field that aims to improve the quality of interventional healthcare through the capture, organization, analysis and modeling of data. While an increasing number of data-driven approaches and clinical applications have been studied in the fields of radiological and clinical data science, translational success stories are still lacking in surgery. In this publication, we shed light on the underlying reasons and provide a roadmap for future advances in the field. Based on an international workshop involving leading researchers in the field of SDS, we review current practice, key achievements and initiatives as well as available standards and tools for a number of topics relevant to the field, namely (1) infrastructure for data acquisition, storage and access in the presence of regulatory constraints, (2) data annotation and sharing and (3) data analytics. We further complement this technical perspective with (4) a review of currently available SDS products and the translational progress from academia and (5) a roadmap for faster clinical translation and exploitation of the full potential of SDS, based on an international multi-round Delphi process.

[DeRAS I-German situation of robotic-assisted surgery-an online survey]

Hintergrund

Die robotische Assistenz hat sich in der Chirurgie etabliert, ist aber noch kein Standard. Der aktuelle Stand der klinischen Verbreitung in Deutschland ist weiter unklar. Industrieunabhängige Quellen sind rar.

Ziel der Arbeit

Ziel dieser Umfrage ist es, den aktuellen Stand der robotisch assistierten Chirurgie (RAS) fachübergreifend in Deutschland im Zeitraum von 2014 bis 2018 zu untersuchen.

Materialien und Methoden

Mit einer Internetrecherche wurden Krankenhäuser (KH) und Fachabteilungen (FA) mit Zugang zur RAS identifiziert. Die FA wurden aufgefordert, ihre Daten aus den Jahren 2014 bis 2018 zu teilen. Neben klinischen Daten wurden Daten zu Nutzung, Implementierung, Training und Finanzierung abgefragt.

Ergebnisse

Am 31.12.2018 wurde die RAS an 121 KH in Deutschland angeboten. 383 FA mit Zugang zur RAS wurden identifiziert. 26 % (n = 98) der FA haben geantwortet. Im Mittel verfügte jede FA über zwei Konsolenchirurgen. 10 % der KH verfügten über mehr als 1 RAS-System. 100 % der erfassten RAS-Systeme stammten von der Firma Intuitive Surgical Inc., CA, USA. Die RAS wurde zu 65 % in der Urologie implementiert, zu 12 % in der Viszeralchirurgie (VC). 21 % der Programme erfolgten interdisziplinär und 4 % multidisziplinär (> 3). 83 % der Systeme wurden gekauft, 17 % anderweitig finanziert. Bei den Operationsmehrkosten gaben 74 % der Kliniken an, diese selbst zu tragen. 14 % wählten eine Umlage. Seit 2014 steigerten sich die Eingriffe um den Faktor 4 auf ca. 8000. Der Anteil der VC steigerte sich um das Fünffache seit 2016.

Schlussfolgerung

Die RAS erlebte in Deutschland bis 2018 ein starkes Wachstum. Das Eingriffsspektrum entspricht dem der Laparoskopie. Bei aktuell fehlender Kostenerstattung für den technischen Mehraufwand, wird die RAS überwiegend im mittel- und hochkomplexen Bereich eingesetzt. Der Online-Survey ist eine gute Methode, ohne hohen administrativen Aufwand unabhängige Daten zu erheben.

[Digital OR]

BACKGROUND

Numerous processes are involved in the orthopedic and trauma surgery operating room (OR). Technical progress, particularly in the area of digitalization, is increasingly changing routine surgical procedures.

OBJECTIVE

This article highlights the possibilities and also limitations regarding this matter.

MATERIAL AND METHODS

Based on the current literature this article provides insights into innovations in the areas of digitalization of surgical devices, hybrid OR, machine-2-machine networking, management systems for perioperative efficiency improvement, 3D printing technology and robotics.

RESULTS

The technical possibilities for the use of digital applications in the surgical environment are rapidly increasing. Close cooperation with industrial partners is important in this context. Technologies from the automotive, gaming and mobile phone industries are being adopted.

CONCLUSION

Digital technology in the OR can improve treatment quality, patient and staff safety and cost efficiency; however, the networking of devices, implementation of innovations in existing structures and the sometimes high acquisition costs are still limiting factors.

[Robotic assistance systems for surgery : Current developments and focus of research]

As robotic systems are now technically mature and widely available, they also play an increasingly important role in the clinical environment. Thus, numerous robotic assistance systems for diagnosis and therapy have shown their potential for supporting patient care. After a brief review of the history, this article describes currently available robotic assistance systems for surgery, especially those originating in Germany and Europe as well as current focal topics of research. In addition, challenges in this field as well as possibilities for close active and interdisciplinary cooperation between stakeholders from hospitals, industry and science to overcome such challenges are presented.