EH 5_2015

Non-muscle-invasive bladder cancer (NMIBC) is characterised by a high-risk of recurrence after transurethral resection of an initial tumour; the 1-year recurrence rate is 15 to 61%, and the 5-year recurrence rate is 31 to 78%.1 In particular, early recurrence after transurethral resection of the bladder tumour (TURB) is most probably associated with missed lesions or inadequate resection at the time of initial TURB. Photodynamic diagnosis (PDD)-assisted TURB has been shown to reduce the risk of early recurrence compared with white-light TURB in several randomised controlled trials.2, 3 The randomised trial represents the most rigorous method of getting to the truth as to whether an intervention causes an outcome. However, these trials do not necessarily translate into real-life experience in a non-experimental setting.4 At this year’s DGU (German Society of Urology) congress in Hamburg, Professor Maximillian Burger presented the results of a prospective non-interventional study (OPTIC III), investigating optimised photodynamic diagnosis for TURB.5 From May 2013 to April 2014, 403 patients with suspected non-muscle-invasive bladder cancer undergoing TURB in daily clinical practice were involved in assessing the additional detection of bladder cancer using PDD-assisted TURB at 30 German sites. It was shown that hexaminolevulinate (HAL)-guided cystoscopy identified a vital number of additional CIS lesions (+25%, p<0.0001). Additionally, in 10.0% of patients with NMIBC, ≥1 positive lesions were detected with PDD only and 2.2% of NMIBC patients would have been missed with white-light cystoscopy. These results are in line with previously conducted randomised clinical trials demonstrating that HAL-guided cystoscopy significantly improves the detection of bladder cancer and provides a diagnostic benefit to patients with suspected NMIBC in daily clinical practice. Moreover, the findings of the OPTIC III trial are also in accordance with other recently published real world data (RWD) studies6, 7 showing the ability of PDD to reduce the risk of recurrence of NMIBC significantly under routine conditions. “The results of the OPTIC III study confirm previous data from controlled trials. Nevertheless, the OPTIC III data is data from daily clinical routine use and the results still demonstrate an advantage for blue-light cystoscopy. This is very exciting because we still have a higher rate of detected papillary tumour lesions compared to white-light cystoscopy. And we still do have a 25% difference in favour of blue-light cystoscopy with regard to CIS detection compared to white-light cystoscopy.” Professor Dirk Zaak during the DGU congress in Hamburg 2015 Recently published data confirm previous study results in daily clinical use and demonstrate that HAL-guided blue-light cystoscopy is an effective tool for improving NMIBC detection and management PHOTODYNAMIC DIAGNOSIS-ASSISTED TURB IN A REAL-LIFE SETTING 1 Van der Heijden et al., 2009 Eur Urol Suppl (8):556–62. 2 Jocham et al., J Urol. 2005 Sep;174(3):862-6. 3 Hermann et al., BJU Int. 2011 Oct;108(8 Pt 2):E297-303. 4 Sanson-Fisher et al., Am J Prev Med. 2007 Aug;33(2):155-61. 5 Burger et al., Optimized photodynamic diagnosis for Transurethral Resection of the Bladder (TURB) in clinical practice - Results of the Non-Interventional Study (NIS) OPTIC III (V 38.8, DGU 2015). 6 Palou et al., BJU Int. 2015 Jul;116(1):37-43. 7 Lykke et al., Scand J Urol. 2015 Jun;49(3):230-6. sponsoredfeature CIS lesion, blue-light vs. white-light, copyright of Professor Dirk Zaak, Traunstein, Germany EUROPEAN HOSPITAL  Vol 24 Issue 5/15 12 SURGERY Tomorrow’s operating theatre Speaking of the multitude of data generated in today’s hospitals – data from MRI and CT scans, endoscopy videos and electronic patient files – Matthias Lubkowitz pointed out that many hospitals ‘… make do with PCs on mobile technology trolleys, with the respective logistics, space and hygiene problems this causes’. Eizo GmbH, OR Solutions, offers monitors, video management and data transmission technology from one source,’ he explains. ‘The CuratOR surgical panels are centre- pieces of the installations. They facil- itate the administration of patient data, control of external devices or the transmission of image- and sound signals. The user or clinician respectively perceives the surgical panels as wall-mounted monitors with PC systems. Additionally, so- called monitor suspension systems or satellite monitors stream the required information to all relevant locations in the operating theatre or elsewhere.’ How do the surgical panels work? ‘The user decides what can be seen on the monitors. The CuratOR Caliop software, named after one of the nine muses in Greek mythology, allows the user to select the infor- mation required for each monitor. Not only that – the screen can be divided into several segments, so that all image sources, ranging from MRI or CT scans and digital X-rays, from the patient file to live images from the endoscope, ultrasound or surgical cameras to the display of vital parameters, can be displayed in selected combinations. ‘During surgery an operating theatre nurse usually controls the surgi- cal panels. Depending on instruc- tions received from the surgeon the nurse selects images for display on the monitors. The documentation can also be done via the surgical panels, such as information about which material is being used or whether complications occurred. A nurse usually loads the data into the hospital information system. ‘The customer normally decides on specific settings for different operat- ing theatre situations, so-called pre- sets. These pre-sets can be selected based on the type of surgery, the location and even on the individual. Indeed, the system can even be con- figured according to an individual surgeon’s ideas.’ How many different sources can the system include? ‘The system can receive and trans- mit the most varied types of media signals. It’s so flexible that we can configure it specifically around our customers’ desires and require- ments. All this is made possible by the technology that runs in the background. The central element of control is known as the large monitor manager. This important yet unimposing piece of equipment will be located in the technology room. ‘We differentiate between front and back end, with the customer mostly exposed to the front end. The entire system is independent of modali- ties and therefore compatible with equipment from different manufac- turers, and it can process all known analogue and digital signals.’ Why has Eizo entered the systems solutions field? ‘Our company has been known as a provider of high end monitors for more than 50 years,’ Lubkowitz reflected, and listed some of their presence in renowned design agen- cies, air traffic control centres, aero- space setups and the automotive industry. ‘In 2002 we made the move into the sensitive world of medicine and developed high quality moni- tors in cooperation with doctors, IT specialists and specialists in medical technology. With the CuratOR, Eizo is now moving into the field of solu- tion providers. ‘We offer system solutions for the operating theatre or, put even better, for the operating theatre of tomor- row. With our modular structure we are not only able to equip new settings with a complete infrastruc- ture but also to adapt to existing environments. We have seen that the requirements in the operating theatre, and in the world of medi- cine as a whole, including all the IT networking, have become very complex. Whilst other, larger provid- ers often feature complete solutions in their range we have designed our software very flexibly so that indi- vidual elements also can be easily adapted around the interfaces.’ How does this new division fit into the company? ‘Flexibility is something that’s also a feature of the corporate structure at Eizo. The company was founded in Japan in 1968, but is active worldwide. Our individual compa- nies can act relatively independently of one another and are particularly adept at reacting promptly in pro- ject business. This is part of the rea- son behind our company’s success. The different mainstays deliver their expertise, allowing us to fall back on a multitude of competencies for high-end monitors and information technology as well as for customised solutions and the industry. ‘This,’ he concludes, ‘is very helpful when new ventures such as ours are being launched.’ Previously known as a provider of high quality, high-end monitors, Eizo is developing into a systems solutions supplier. The company’s new division for operating theatre (OT) solutions is aimed at advancing technological networking in the OT. Matthias Lubkowitz, the company’s Vice President of this division, reports on the new requirements for intelligent operating theatre technology Matthias Lubkowitz is Vice President of the Eizo GmbH | OR Solution division. With a diploma in media technologies he worked as a research assistant at the Fraunhofer Institute, followed by a role at Bosch and later Panasonic, before entering the medical sphere in which he continues to operate today EIZO’s individually configu­rable wall consoles for operating theatres CuratOR Caliop is an all-in-one software to be controlled centrally

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