Tag Archives: medtech engineers

Science Research Technology

Ideas brought to life in Anatomy

Incisions and insights workshop series – „Heart, lungs, thorax“

Ideas brought to life in Anatomy

Workshop „Incisions and insights“ at the Institute of Clinical Anatomy and Cell Analysis (Source: M. Latz/BioRegio STERN Management GmbH)

(Stuttgart/Tübingen) – The „Incisions and insights – medtech engineers and medical practitioners in dialogue“ workshop series continued in June 2018, focusing on the heart, lungs and thorax. BioRegio STERN Management GmbH is organising this exceptional series of events in collaboration with the Inter-University Center for Medical Technologies Stuttgart-Tübingen (IZST) and the Verein zur Förderung der Biotechnologie und Medizintechnik e. V. (Society for the Promotion of Biotechnology and Medical Technology). This fourth event once again saw medical directors and senior consultants meet with medtech engineers directly at operating tables in Anatomy to discuss the innovations they desire and need.

The specialists from University Hospital Tübingen have already dubbed the series of events „Make a wish“, as it gives them the opportunity to express their wishes to medtech engineers for new or improved instruments and equipment unfiltered by purchasing or marketing departments. The fourth workshop in the series focused on the heart, lungs and thorax. Alongside the live streaming of surgery and practical exercises in the operating theatre at the Institute of Clinical Anatomy and Cell Analysis, the medical directors and senior consultants from University Hospital Tübingen Dr. Helene Häberle, Senior Consultant Surgeon at the Intensive Care Unit, Prof. Alfred Königsrainer, Medical Director of General, Visceral and Transplant Surgery, Prof. Christian Schlensak, Medical Director of Thoracic and Cardiovascular Surgery, and Prof. Roland Syha, Head of Interventional Radiology, discussed potential innovations. During this session, Prof. Peter P. Pott, Head of the Institute of Medical Device Technology at the University of Stuttgart, explained what is technically feasible. Prof. Arnulf Stenzl, Medical Director of the University Department of Urology and Head of the Inter-University Center for Medical Technologies Stuttgart-Tübingen (IZST), co-chaired the workshop together with the host Prof. Bernhard Hirt, Director of the Institute of Clinical Anatomy and Cell Analysis. Around 40 medtech company representatives attended the event, which offered them an impressive range of incisions and insights.

A surgeon got straight to work on artificial heart implantation and minimally invasive lung and oesophagus surgery on an anatomical specimen. While feeding a tube into the trachea, he explained to the medtech engineers – and to medical students linked via live stream – why a second working channel would be useful: „A further piece of equipment, such as forceps, often needs to be inserted. This may also result in bleeding, which blocks the one channel.“ During the subsequent demonstration of a minimally invasive lobectomy – the removal of an organ lobe – the operating team explained the need for a second camera in order to monitor inside the thorax from an additional angle. A stapler that can attach staples and bend 90 degrees was also added to the wish list, as was a cleaning function for the camera lens. However, the surgeons‘ discussion with Prof. Pott quickly revealed that much of what is technically feasible is not at all practicable in everyday surgery. „Extra functions require cables and switches. Yet at the same time, the equipment is expected to become increasingly smaller and easier to handle.“ Physical limitations also curb miniaturisation: „A camera lens can only be reduced in size to a certain extent, otherwise it no longer transmits anything,“ explained Prof. Pott.

The subsequent artificial heart transplant once again showed that the surgeons attach great importance to small and agile instruments to open up the chest as little as possible, as this is often associated with major discomfort for patients. To implant the 200-gramme artificial heart, just two incisions are needed. Unfortunately, one of these remains permanently open, as the control and battery power cables need to be fed outside. „Of course there’s already the option of a cable-free power supply for hearing aids, for example,“ said Prof. Pott. „If this fails, the patient no longer hears anything. But if this fails in the case of the heart, the patient expires.“

The demand for innovation is therefore high, giving developers and users plenty to discuss, and this is unlikely to be exhausted at the next event in February 2019, which will focus on „Extremities and the musculoskeletal system“. „As far as we know, there’s no comparable event anywhere else in the world,“ explained Dr. Klaus Eichenberg, co-organiser and Managing Director of BioRegio STERN Management GmbH. „Surgeons are calling for new processes and instruments. I’m confident the local medtech businesses will take up this challenge and bring to life some of the ideas that were first formulated here.“

About BioRegio STERN Management GmbH:
BioRegio STERN Management GmbH promotes economic development in the life sciences industry, helping to strengthen the region as a business location by supporting innovations and start-up companies in the public interest. It is the main point of contact for company founders and entrepreneurs in the Stuttgart and Neckar-Alb regions, including the cities of Tübingen and Reutlingen.
The STERN BioRegion is one of the largest and most successful bioregions in Germany. Its unique selling points include a mix of biotech and medtech companies that is outstanding in Germany and regional clusters in the fields of automation technology and mechanical engineering.

Company-Contact
BioRegio STERN Management GmbH
Dr. Klaus Eichenberg
Friedrichstrasse 10
70174 Stuttgart
Phone: +49 (0)711-870354-0
E-Mail: info@bioregio-stern.de
Url: http://www.bioregio-stern.de/en

Press
Zeeb Kommunikation GmbH
Anja Pätzold
Hohenheimer Strasse 58a
70184 Stuttgart
Phone: +49 (0)711-6070719
E-Mail: info@zeeb.info
Url: http://www.zeeb-kommunikation.de

Science Research Technology

Straight talking in the operating theatre

„Incisions and insights“ on the head and throat – medtech engineers and medical practitioners in dialogue

Straight talking in the operating theatre

„Incisions and insights“ workshop, which focused on the head and throat (Source: BioRegio STERN/Michael Latz)

(Stuttgart/Tübingen) – In January 2018, BioRegio STERN Management GmbH joined forces with 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) to organise the third workshop for medtech engineers in the „Incisions and insights“ series. Medical practitioners from the fields of ophthalmology, diagnostic and interventional neuroradiology, ENT, hand, plastic, reconstructive and burn surgery, mouth, jaw and facial surgery and neurosurgery were at the operating table in Tübingen to focus on the head and the throat.

The workshop with live streaming of three operations followed by practical exercises at different locations in the operating theatre of the Institute of Clinical Anatomy and Cell Analysis brought together a number of relevant disciplines in each case. Various details were shown using both endoscopic and open surgery on the anatomical specimen. The invited engineers from leading medtech companies avidly followed the surgeons‘ lively discussions on operating techniques and procedures. The participants were themselves then able to change places with the surgeons working on the anatomical specimen to develop new ideas for instruments and methods.

The event once again featured extremely high-profile individuals, including several medical directors and senior consultants from the University Hospital of Tübingen and Klinikum Stuttgart – Prof. Dr. Ulrich Bartz-Schmidt, Medical Director of the University Eye Hospital in Tübingen, Prof. Dr. Adrien Daigeler, Medical Director of the BG Trauma Clinic in Tübingen for Hand, Plastic, Reconstructive and Burn Surgery, Prof. Dr. Ulrike Ernemann, Medical Director of Diagnostic and Interventional Neuroradiology in Tübingen, Prof. Dr. Florian Gekeler, Medical Director of the Ophthalmic Clinic at Klinikum Stuttgart, Prof. Dr. Dr. med. Michael Krimmel, Senior Consultant at the University Department of Mouth, Jaw and Facial Surgery, Prof. Dr. Hubert Löwenheim, Medical Director of the University Hopsital Department of Otolaryngology, Prof. Dr. Arnulf Stenzl from the University Hospital Department of Urology and the Stuttgart and Tübingen Inter-University Centre for Medical Technology (IZST), and Prof. Dr. Marcos Tatagiba from the University Hospital Department of Neurosurgery.

Prof. Dr. Bernhard Hirt, Director of the Institute of Clinical Anatomy and Cell Analysis, both hosted and chaired the workshop and welcomed the guests in the auditorium as well as the numerous medical practitioners and students linked via live stream with the following words: „For the third time, we’d like to use this opportunity to actively encourage an intensive exchange of information and ideas between medical specialists and technical experts. We’d like to see the key players from the medtech sector go back to their companies with new ideas and approaches for developing and enhancing instruments and equipment.“

The endoscope – despite the „extra pair of eyes“, the surgeon still has only one hand free
The topic of visualisation using an endoscope, microscope and exoscope attracted high levels of interest in particular. During the live surgery, a malignant tumour was removed from an anatomical specimen. The tumour was in an awkward position in the centre of the skull, which presented the surgeon with the question of access. „The endoscope has become increasingly popular and the quality is already very high. Nevertheless, the camera and the streaming process need to be improved further,“ he explained to the audience. He sees a real shortcoming in handling the equipment. „If I use a microscope, I have two hands free for the operation. If I use an endoscope, I then only have one hand available. The endoscope also needs to be cleaned continuously, which is where a screen wiper system would be useful.“ A surgeon assisted by a robot and high-resolution video technology for the endoscope – 3D endoscopy is the current standard – could resolve this dilemma. Many surgeons already use a combination of microscope and endoscope to have the „best of both worlds“. The endoscope is replaced by the exoscope for a range of indications, particularly for surface tumours. The exoscope is not inserted into the body but can be placed at a distance to illuminate and visualise the operating area more effectively.

The time lag
The medical professionals definitely see room for improvement in the delay in transmitting the images to the monitor. The images lag behind significantly, particularly when surgeons are working quickly, which may lead to vascular trauma in some cases. Another problem with visualisation using the endoscope is that, although the surgeon can enter deeper areas and easily identify the images transmitted from those areas, he does not see any image of the end of the endoscope and its immediate surroundings. This lack of an overview, the thickness of the instrument and the limitations of the working channels constantly present challenges for surgeons in their everyday work.

Light and shade
Correctly illuminating operating areas for both endoscopic and open surgery was a topic that all the surgeons considered to be fundamentally important. This is because light plays a key role in medical technology and planning of operations. Well-lit areas without unnecessary heat generation simplify work, enhance reliability and reduce potential sources of error. Surgeons and medtech engineers thus focused their discussions in particular on the adaptability of LED lights, hygiene standards and the shadow effect of certain lamps. They commented that, although the microscope illuminates the surrounding area well, it becomes very hot in doing so. The endoscope also offers both advantages and disadvantages, according to one of the medical directors: „I can go in a long way, it lights up the site, but also produces shadows.“ Having several homogeneous light sources on the endoscope or new light sources on the sucker could be a possible solution.

So far, many surgeons have used headlamps, especially in ENT, plastic surgery and ophthalmology. Foerster glasses, developed over 50 years ago and also referred to by professionals as „Tübingen necklaces“, are a popular and robust diagnostic instrument inside and outside the operating theatre and are now equipped with LEDs.

The operating table
During the live operation in which a transplant made of resorbable material was inserted onto the root of a nose, the surgeons complained in particular about the tangled cables around the table. „They’re real tripping hazards,“ said one. „As a surgeon, it annoys me in the extreme. Here I’ve got cables, foot pedals and optical equipment, plus a full table. I think it’s awful the way I have to work here. It must be possible to find a remedy. This is where we need the product developers.“ He imagined a cable-free workplace and battery-operated instruments as a solution.

Extremely interesting and absolutely essential
Following the live operations, the representatives of the medtech companies came together with the surgeons in small groups and discussed solutions. For example, Blakesley nasal cutting forceps made of nitinol, a nickel-titanium alloy, with „shape memory“. The surgeon is able to adapt these forceps to the patient’s individual anatomy. They regain their original shape after heat sterilisation thanks to the thermal shape memory effect. These forceps are already a great success in China. In Germany, marketing is rather sluggish, as the product is four times the cost of standard nasal cutting forceps. The representative of an SME equipment manufacturer from the region explained that, for the medtech engineers, direct feedback from the surgeons is particularly important: „Nothing compares to personal communication with specialists. This is where I get ideas and already start working on the solution in my head. It’s only in practical situations that you can find out exactly what surgeons really need. This in itself makes this event something special.“ This view is shared by Dr. Klaus Eichenberg, co-organiser and Managing Director of BioRegio STERN Management GmbH: „An event like ‚Incisions and insights‘ doesn’t exist in this form anywhere else. Eight medical directors from a wide range of specialist fields talk in direct terms about medical needs in the operating theatre. We continually receive feedback saying that this format is not only extremely interesting but also absolutely essential.“

About BioRegio STERN Management GmbH:
BioRegio STERN Management GmbH promotes economic development in the life sciences industry, helping to strengthen the region as a business location by supporting innovations and start-up companies in the public interest. It is the main point of contact for company founders and entrepreneurs in the Stuttgart and Neckar-Alb regions, including the cities of Tübingen and Reutlingen.
The STERN BioRegion is one of the largest and most successful bioregions in Germany. Its unique selling points include a mix of biotech and medtech companies that is outstanding in Germany and regional clusters in the fields of automation technology and mechanical engineering.

Company-Contact
BioRegio STERN Management GmbH
Klaus Eichenberg
Friedrichstrasse 10
70174 Stuttgart
Phone: +49 (0)711-870354-0
E-Mail: info@bioregio-stern.de
Url: http://www.bioregio-stern.de/en

Press
Zeeb Kommunikation GmbH
Anja Pätzold
Hohenheimer Strasse 58a
70184 Stuttgart
Phone: +49 (0)711-6070719
E-Mail: info@zeeb.info
Url: http://www.zeeb-kommunikation.de

Science Research Technology

Surgeons only have two hands too

„Incisions and insights“ – medtech engineers and medical practitioners in dialogue at abdominal surgery workshop

Surgeons only have two hands too

„Incisions and insights“ workshop, which focused on abdominal surgery (Source: BioRegio STERN/Michael Latz)

(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 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.“

About BioRegio STERN Management GmbH:
BioRegio STERN Management GmbH is a skill-sharing network, providing a help and ad-vice centre for founders of new businesses, entrepreneurs and researchers in the life sciences sector in the cities of Stuttgart, Tübingen, Esslingen and Reutlingen and the Stuttgart and Neckar-Alb regions. BioRegio STERN Management GmbH represents the interests of these market players in dealings with political circles, the media and associations and provides advice on grant applications and corporate financing. Key focal points include regenerative medicine, medical technology and the automation of biotechnology. Managing Director Dr. Klaus Eichenberg is a molecular and cell biologist and investment analyst.

Company-Contact
BioRegio STERN Management GmbH
Klaus Eichenberg
Friedrichstrasse 10
70174 Stuttgart
Phone: +49 (0)711-870354-0
E-Mail: info@bioregio-stern.de
Url: http://www.bioregio-stern.de/en

Press
Zeeb Kommunikation GmbH
Anja Pätzold
Hohenheimer Straße 58a
70174 Stuttgart
Phone: +49 (0)711-6070719
E-Mail: info@zeeb.info
Url: http://www.zeeb.info