(Stuttgart/Tübingen) – Once again, the Stuttgart and Tübingen Inter-University Centre for Medical Technology (IZST) and the Verein zur Förderung der Biotechnologie und Medizintechnik e. V. (Society for the Promotion of Biotechnology and Medical Technology) in conjunction with BioRegio STERN Management GmbH (http://www.bioregio-stern.de/en/) played host to developers from medtech companies at the “Incisions and insights” workshop. The event, which focused on abdominal surgery, adopted an interdisciplinary approach and brought together disciplines such as general, visceral, transplant and paediatric surgery, paediatric urology, clinical anatomy and cell analysis, diagnostic and interventional radiology, thoracic and cardiovascular surgery, urology and gynaecology.

With live streaming of surgery and practical exercises in the clinical anatomy operating theatre, the “Incisions and insights” event is anything other than ordinary. To highlight typical operating theatre problems to developers from medtech companies and work with them to look for solutions, a total of six medical directors from the University Hospital of Tübingen discussed the issues at the operating table with the invited specialists – Prof. Jörg Fuchs, Medical Director of Paediatric Surgery and Paediatric Urology, Prof. Alfred Königsrainer, Medical Director of General, Visceral and Transplant Surgery, Prof. Christian Schlensak, Medical Director of Thoracic and Cardiovascular Surgery, Prof. Arnulf Stenzl, Medical Director of Urology, Prof. Bernhard Krämer, Deputy Medical Director of Gynaecology, and Prof. Fabian Bamberg, Deputy Medical Director of Diagnostic and Interventional Radiology. Prof. Bernhard Hirt, Director of the Institute of Clinical Anatomy and Cell Analysis at the University of Tübingen, hosted and chaired the workshop and welcomed the numerous guests in the auditorium and the students and medical practitioners linked via live stream with this statement of principle: “We aren”t showing you the perfect operation and anatomy – instead, we’re showing you the real challenges.”

Surgeons only have two hands too
The reality of intraperitoneal surgery in the abdominal structure covered by the peritoneum and in the retroperitoneum, the region behind the peritoneum and the abdomen itself, includes the need for retractors which keep the operating area open to remove a tumour in the kidneys or ovaries, for example. The surgeons` wish list for this standard medtech instrument was amazingly long. The retractors should be more adjustable to enable the position to be changed more easily during an operation. They should not be made only of metal, as this may damage tissue, but should instead be manufactured from softer materials. They should be translucent, provide a source of light themselves and have additional analysis functions. A surgeon summed up the demands in the following words: “We actually need eight hands. Multifunctional refractors would be better than assistants, who may get in the way in some circumstances.”

It’s dark down there
Two consultants demonstrated a “live” incision of an abdomen and the use of retractors in the Anatomy operating theatre in order to highlight the next challenge – “it’s dark down there,” as one of them put it, summing up the problem of visualisation and lighting. The solution from the consultants” perspective? The lighting should be combined with a camera system so that everyone involved in an operation has the same view of the patient. The camera should be able to follow the surgeon’s hand automatically. It would be best if loupes and headlights were combined into one small, lightweight system with a camera using chip technology. As in the first workshop, a clear desire was expressed for a tablet solution to visualise the operating theatre scenario so that surgeons do not need to turn to look at monitors during surgery: “The surgeon’s view of the abdomen should be transmitted directly to an iPad placed right next to the incision,” said Prof. Stenzl in a call to the developers and other guests.

Small instruments, patients too large – small patients, instruments too large
On one hand, instruments for minimally invasive operations, such as laparoscopy, are set to become increasingly smaller. On the other hand, patients in Central Europe are becoming more and more obese, and there is a lack of instruments that can be adjusted in size. The medtech sector also faces unresolved challenges for the smallest patients, as Prof. Fuchs regretted: “Unfortunately, no miniaturised instruments are available for minimally invasive surgery for babies. A lot still needs to be done in this area.”

Intelligent patching. Stitching that takes care of itself
Yet surgeons aren’t just looking for innovations for instruments but also for materials. While patches for closing arteries have for decades been made of synthetics, for a long time now intensive research has been carried out into tissue engineering solutions to biologise materials. Closing and, in particular, stitching are a genuinely controversial issue for surgeons. Ligatures, shutting off vessels etc., have to be performed under extremely difficult conditions in terms of light and the position in the abdomen. For the patient, it is essential that stitches are secure. The medtech engineers were thus called upon to look for alternatives to traditional vascular suture.

The medtech engineers and medical professionals therefore had much to discuss at the operating tables in Anatomy. “Once again, we struck a chord with this workshop,” said a delighted Dr. Klaus Eichenberg, co-organiser and Managing Director of BioRegio STERN Management GmbH. “Following the first event last year, concrete development projects have already been initiated at medtech companies. And I’m confident that head and throat surgery will also provide inspiration for new ideas among developers in the year ahead.”