gms | German Medical Science

The importance and clinical use of computer aided assistance systems are increasing and reaching new application areas. This progression is reflected in young, but growing interdisciplinary societies like ISCAS (International Society of Computer Assisted Surgery), CAOS (Computer Assisted Orthopedic Surgery), MICCAI (Medical Image Computing and Computer-Assisted Interventions), JSCAS (Japan Society for Computer Aided Surgery) and CURAC (German Society for Computer and Robot-Assisted Surgery). The contributions of this issue are based on work presented on the annual meeting of the CURAC society 2005 in Berlin.

Computer Assisted Surgery is characterized by its essential need for interdisciplinary exchange between different surgical disciplines and between physicians, engineers, computer scientists, physicists, medical technicians and developers. On the CURAC annual meeting, but also on other conferences it is obvious that those interdisciplinary communities are significantly growing together. Physicists and “technicians” are developing a common language and the comprehension of both groups for the problems and solutions of each other is increasing. This is important for the development of innovative systems and therapies, which are practically applicable and clinically relevant.

The number of commercial navigation systems used in clinical routine is significantly increasing. The application areas are mainly neurosurgery and orthopedics, but also Ear, Nose, and Throat (ENT) and trauma surgery. For several surgical procedures there is an ongoing clinical research on advantages and possible disadvantages of navigation systems. Further investigations focus on the application of existing navigation systems to other surgical procedures, but also innovative research work is done, for example by integrating intraoperative imaging modalities or sophisticated visualization techniques like intuitive Augmented Reality approaches.

The transfer of established computer assisted approaches from neurosurgery or orthopedics to other surgical disciplines like visceral surgery is still at the beginning. Soft tissue deformation is a major challenge induced by the patients respiration and/or heart movement or the surgical intervention itself. In neurosurgery the latter problem is called brain shift. Two contributions deal with this problem using intraoperative imaging or movement tracking.

Advances of medical robotics are conceivable with improved, light-weighted and better adapted systems. The vision of autonomous systems is not aspired at present. At this time there is a tendency towards interactive and partially autonomous systems, for suitable indications, where really a clinical or financial benefit can be expected. Such systems support the surgeon and not replace him.

The journal starts with new extensions of the established field of neuronavigation by incorporating other imaging modalities, application to other treatment methods and sophisticated visualization techniques. The potential of PET imaging for the determination of malignancy grade in navigated cerebral glioma surgery is investigated by Thomale et al. (GMS CURAC 2006;1:Doc02). The minimization of the aforementioned brain-shift problem by intraoperative 3D ultrasound navigation is presented by Lindner et al. (GMS CURAC 2006;1:Doc03). The application of commercial neuronavigation systems to special indications (Mirchev et al., GMS CURAC 2006;1:Doc04) and small but practical extension of those systems are discussed (Thomale et al., GMS CURAC 2006;1:Doc05). Neuronavigation is also extended to other neurosurgical treatment methods, like Transcranial Magnetic Stimulation (TMS) (Matthaeus et al., GMS CURAC 2006;1:Doc06). A further development in neuronavigation is the integration of diffusion tensor imaging (DTI) data. Such innovative techniques are needed to visualize for example the pyramidal tract (Enders et al., GMS CURAC 2006;1:Doc07),

The next contributions deal with more general visualization techniques. A good visualization often depends on a proper choice of parameters. Augmented Reality might be an innovative and intuitive approach to set these parameters (Del Rio, GMS CURAC 2006;1:Doc08). Salah et al. (GMS CURAC 2006;1:Doc09) use expressive illustrations to visualize multiple anatomical structures.

The last part of the issue presents work in the field of medical robotics. The development of a medical robot is very expensive. Modular systems, which can be used for different applications would decrease those costs. Peters et al. (GMS CURAC 2006;1:Doc10) suggest a modular concept and give one example implementation. Besides this conceptual issue, also the practical integration of a robotic system into the OR is an important issue, which is reported by Engelhardt et al. (GMS CURAC 2006;1:Doc11) for craniotomies. If haptic feedback can improve telemanipulation systems significantly is still an open question and investigated by Schirmbeck et al. (GMS CURAC 2006;1:Doc12).

Interactive robotic systems aim at a further improvement of the accuracy of interventions compared to passive navigation. Interactive mechatronic support systems can reduce inaccuracy induced by tremor or slipping off by the surgeon. Lenze et al. (GMS CURAC 2006;1:Doc13) present such a system for bone milling in ENT surgery.

A further application area of medical robotics is radiosurgery. The commercial CyberKnife system enables a higher treatment flexibility and the possibility to compensate patient motion caused by respiration. The contribution of Schlaefer et al. (GMS CURAC 2006;1:Doc14) deals with more complex planning procedures due to this higher flexibility. But the most precise planning is worthless, if the accuracy is decreased by patient motion and deformation. Sauer et al. (GMS CURAC 2006;1:Doc15) suggest a method for target motion tracking by monitoring the respiration status. Not only the compensation of respiratory motion by a robot system is necessary, but also the incorporation of the motion into the planning process (Schlaefer et al., GMS CURAC 2006;1:Doc16).

We hope you enjoy this first issue of the GMS CURAC Journal as an inspiration. There is an ongoing discussion on open access for scientific publications. We think that an open access online journal is an adequate form of publication for this interdisciplinary and fast developing community.

We would like to thank the authors for their contributions, and the reviewers for their support in preparing this issue.