Following a pandemic-related hiatus, the workshop on “endoscopy and robotics in diagnostics and surgery” was finally able to return to the operating theatre of the Institute of Clinical Anatomy, where it provided exciting new insights and a glimpse into the future of surgery. The medtech engineers from numerous small and medium-sized medtech companies in the region watched live operations and practical exercises on the operating table. They also got a chance to discuss challenges – and solutions – with the medical directors and senior consultants directly. This time, the experts leading the workshop included Prof. Bernhard Krämer, Deputy Medical Director of Gynaecology, Prof. Hubert Löwenheim, Medical Director of the University Hospital Department of Otolaryngology, Prof. Arnulf Stenzl, Medical Director of the University Hospital Department of Urology and Director of the Stuttgart and Tübingen Inter-University Centre for Medical Technology (IZST), and Prof. Jürgen Honegger, Deputy Medical Director of the University Hospital Department of Neurosurgery. Prof. Tina Histing, Medical Director of the Clinic for Trauma and Reconstructive Surgery at BG Hospital in Tübingen, and Prof. Katja Schenke-Layland, Director of the NMI Natural and Medical Sciences Institute in Reutlingen, were also in attendance.

Cholangioscopy – single-use equipment versus cleaning

The first operation went deep into the abdominal cavity. It was a laparoscopy combined with a cholangioscopy, which makes it possible to perform endoscopic examination on the smallest passages in the gastrointestinal tract, such as the bile duct. This procedure sparked an initial discussion about the advantages and disadvantages of single-use endoscopes. In urology, where very long channels are required, cleaning endoscopes is often a difficult task. “Cleaning is no trivial matter,” says Prof. Stenzl. Roughly one in every eight devices is rendered defective after cleaning. This is a common problem with the fibre optics, for example. That is why the clinic is currently investigating the true environmental impact of opting for single-use devices, compared to cleaning reusable devices. The imaging provided by single-use endoscopes is considered to be inferior, and their size makes them more awkward to handle. That said, some argue that endoscopes should not be expected to do everything, for instance take care of diagnostics and treatment at the same time. Often, the doctor wants to “just take a look at things first”. To the astonishment of the medtech engineers, some users do not want one device with numerous functions, but rather highly specialised devices tailored to specific applications. It is believed that, if they were equipped with appropriate single-use elements, these devices would not be as expensive either. The doctors explained that performing an endoscopy with high-end equipment in tandem with a biopsy, for example, can be just as complex as open surgery. During the live operation, it became clear just how sensitive these devices are. The surgeons discovered a hole in the flexible part of the wafer-thin cholangioscopic endoscope and had to replace the wire. “It is precisely this level of authenticity that makes Incisions and Insights so extraordinary,” explains Prof. Hirt. “We don’t show perfection – we show what actually happens and what could be done better.”