Medica2015_Mittwoch

WEDNESDAY @ MEDICA2 EH @ MEDICA No 3 2015 operating rooms was introduced in the Wisconsin State legislature. The proposed legislation would require hospitals to offer videotaping to patients, or their guardians, of surgi- cal procedures, and would also allow surgeons themselves to request this if the patient had no objections. Milwaukee-area State representa- tive Christine Sinicki introduced the bill so that plaintiffs in medical malpractice cases would have visual documentation. If the act is passed by the State legislature and signed by Wisconsin’s governor, the Julie Ayer Rubenzer law – named for a woman who died from an overdose of anaesthesia while undergoing breast implant surgery – will be the first of its kind in the USA. The proposed legislation sparked a national debate about the merits of taping surgeries. Patient advocate organisations, such as the National Organisation for Medical Malpractice Victims, which represented the esti- mated 400,000 individuals who die annually in the USA from medical errors and oversights, consider this breakthrough legislation. To date, professional medical associations declined to comment. Further details: http://www.gabrielbirgand. fr/en/2015/03/aribo-project-attitudes- risk-of-infection-and-behaviours-in-the- operating-room/ continued from page 1 Breakthrough law ... 3-D viewing benefits gastroenterology Report: Anja Behringer During many and various 2015 medi- cal congresses 3-D visualisation has been a key topic as the industry con- tinues to introduce improved hard- ware and software in ever-shorter intervals. Interventional medicine is entering a new dimension, was a pop- ular slogan. The crystal clear, coloured visualisation of body cavities previously only visible in cloudy black and white may be fascinating, but it does not replace the interpretation of images by an experienced doctor. Wide-angle and full-spectrum endoscopes may facilitate views behind folds and flexures during a colonoscopy but, from experience, the detection rate for the procedure is only around 58%. ‘Around 30% of polyps are not discovered during screening examinations,’ one experi- enced endoscopist pointed out. Stereoscopic imaging was con- troversial as far back as the 1990s, but this subsided over time due to improvements in visualisation technol- ogy, which, in the early days, had not been so advanced. The significantly improved quality of today’s imaging systems gives rise to hope because they are at least on a par with the cur- rent 2-D display systems. To check whether the user actu- ally benefits from a measurable added value with 3-D images, under Feussner the MITI Research Group in Munich carried out a prospective clinical study. The latest 3-D systems were compared to a high-end 2-D monitor system for laparoscopy. European Hospital had three ques- tions for the professor. Why were promising approaches from 20 years ago not pursued any further? Feussner: ‘The technical quality of stereoscopy back then was nowhere near as good as it is today. The cloudy view lead to tiredness and headaches for the users and the moni- tor glasses caused nausea.’ The study specifically focused on the difference between doctors with little surgical experience and experts with longstanding surgical experience. ‘However, Feussner immediately clari- fies, ‘Five percent of people cannot see stereoscopically.’ Even these days three-dimensional viewing is exhaust- ing and takes getting used to. Despite this, none of the participants of the study complained about visual impair- ments or paraesthesia, not even with the glasses-based 3-D system com- pared to a 2-D display. EH wanted to know about other particular results the study delivered. ‘The most surprising finding is that even experienced experts benefited from the visualisation, even though they did not perceive it subjective- ly. But, we were able to prove this increase in efficiency objectively.’ When these findings catch on in the future, 3-D will become standard, at least for laparoscopy, the surgeon foresees. Asked about further areas of application for this technology he referred to the first approaches in interventional, endoscopic manipula- tion in gastroenterology. ‘Theoretically our findings can be transferred here as well. However,’ Feussner stresses, ‘one limitation is that the technical require- ments for such 3-D systems in endolu- minal endoscopy are respectively even higher than in laparoscopic surgery, due to their significantly lower spatial depth.’ Nonetheless, he still believes that experimental and clinical studies on the subject will be beneficial for gastroenterology. Internist Hubertus Feussner MD pioneered MIS and was a founder/leader of the research group ‘Minimally Invasive Interdisciplinary Therapeutic Inter- vention’ (Institute MITI). He chairs the Section for Computer- and Telematics- Assisted Surgery at the German Society of Surgery (CTAC) and is a key figure at the Society for Computer- and Robot- assisted Surgery (CURAC). SourceOlympus Improving the a In 2012, Olympus reached another milestone in innovation with the introduction of EVIS EXERA III with improved narrow band imaging (NBI). Focusing on relevant colour spectra with NBI In narrow band imaging, specific col- our spectra are filtered out from the white light produced by the endo- scopic light source, which equates to the spectrum of our daylight. Inflamed regions, and particularly tumour cells, are characterised by excessive or uncontrolled produc- tion of new blood vessels, so-called neovascularisation. ‘NBI exploits the property of haemoglobin whereby light is absorbed in a specific colour spectrum. When a filter is used to ensure that only blue and a little green light, corresponding exactly to the absorption spectrum for haemo- globin, is shone on tissue containing blood vessels, this light is absorbed by the regions with blood flow- ing through them and they become black, thus providing a greater con- trast to the surrounding tissue. ‘This enhanced contrast between a vessel and the surrounding mucosa allows better differentiation between regions that are changed due to disease and healthy areas and thus support the physician in making an assessment and then taking a deci- sion on how to proceed,’ explains Mirko Feuring, GI Product Manager at Flexible Endoscopy. The previous series, EXERA II, already exploited NBI and supported the user in the assessment of tis- sue changes, both with reference to changes in gastric mucosa and in Barrett’s oesophagus. This was proved in multiple clinical trials. ‘However, some trials reached the conclusion that NBI did not consti- tute an advantage in the detection of malignant areas in the colon. What emerged over the course of the years was that the first generation NBI was simply not bright enough. That greatly challenged our Japanese engineers,’ Feuring said, describing the learning curve that the develop- ers went through. What has now been achieved in the EXERA III series is to get more light to the investigation site through optimised focusing of the xenon light beam and coupling into the light guide in the endoscope. In addition, Olympus has developed a new image sensor for the EXERA III series endo- scopes that is more sensitive to light. According to Feuring, the new image sensor is capable of far higher levels of performance than its pre- cursor model. This now means that extraordinarily bright and clear, high- resolution internal body images can be produced both in the white light and NBI modes. Above all, it is hoped that the rate of adenomas that are missed in screening colonoscopy can be substantially reduced from the current 20-25% through NBI with the EXERA III series. These and other The fields of application for endoscopy now extend far beyond gastroenterology, reaching through to pneumology, ENT and orthopaedics. Technical advances have enormously improved the options for seeing into bodily cavities and hollow organs and these options have therefore caught the interest of diverse medical specialists Olympus is at Medica Hall 10 / Stand D20 EH @ MEDICA No 32015

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