07/18/2019 | Press

Live-streamed surgery with heavy metal and AI

The workshop series "Incisions and insights - medtech engineers and medical practitioners in dialogue" continued in July 2019 with "Intelligent permanent implants". During live surgery at the University of Tübingen's Institute of Clinical Anatomy and Cell Analysis, medtech engineers had the opportunity to talk to medical specialists in great detail about new ideas for instruments and methods. The proceedings also highlighted that intelligent permanent implants are an exciting field for artificial intelligence (AI).

The "Intelligent permanent implants" workshop saw participation by, among others, Prof. Hubert Löwenheim, Medical Director of the Department of Otolaryngology, Head and Neck Surgery, Dr. Tobias Krüger, Head of Electrosurgery in Thoracic and Cardiovascular Surgery, and Prof. Alireza Gharabaghi, Head of Functional and Restorative Neurosurgery, all from the University Hospital of Tübingen, and Dr. Rene von Metzen, Head of Biomedicine and Material Sciences at the Natural and Medical Sciences Institute of the University of Tübingen (NMI). Prof. Bernhard Hirt, Medical Director of the Institute of Clinical Anatomy and Cell Analysis, once again hosted the event and chaired the in-depth discussion.

Straight to work
The participants sat directly in the operating theatre as the surgeons carried out procedures such as inserting a cochlea implant and then, during - simulated - acute heart failure, connected a heart-lung machine. As deep brain stimulation can only be  demonstrated on patients who are awake, an exception was made and a video showing an operation on a patient with  Parkinson's disease was played to the participants. As expected, the medical experts once again got straight to work in this  workshop and showed what problems can occur in everyday surgery.

Bringing worlds together
Implanting a cochlea implant requires, for example, instruments that surgeons can use to carry out precise preliminary work in the minute structures of the inner ear. This also applies to deep brain stimulation, where a "pacemaker" in the form of electrodes is inserted up to 10 centimetres into the brain. Here, too, the challenge for surgeons is to position the device accurately without damaging the surrounding tissue. This therefore calls for instruments that are simultaneously stable and flexible and can  penetrate tissue while at the same time gently negotiating bends, as well as transmitting data during and after surgery. These  procedures showed once again that "heavy metal" is still used in medical technology, such as stereotactic metal frames that fix the skull in place. However, this equipment - which has been used for decades - is also combined with numerous high-tech applications in the operating theatre, such as sensors. Clinicians need to bring these worlds together. And sometimes they can  only do this by using pen and paper - for instance, when they "listen" to neural signals and evaluate them.

Power supplies
Supplying power is a perennial issue for implants that in some cases stay in the body for many years, including hearing aids and pacemakers. Whether it's induction, as for cochlea implants, or batteries for pacemakers, perfect solutions have yet to be found,  although scientists are working intensively in this area, as Dr. Rene von Metzen from the NMI emphasised. In contrast, cannulae and tubes that need to be inserted in the event of acute heart failure so that artificial cardio-respiratory support can be started  remain in the body for only a short period - a maximum of 30 days. Under extreme time pressure, the emergency team inserts an intravenous line on an anatomical specimen and installs a complex tube system that, among other things, diverts the blood and returns it oxygenated to the body. In this instance, surgeons are looking for implants with intelligent sensor technology that  continuously measure the pressure in the arteries, and aspiration needles that monitor the patient's pulse. Ultimately, it is a matter of a few, crucial minutes. The easier and more reliable the technology is, the faster it can be used and lives saved.

Artificial and human intelligence
Surgeons are thus constantly looking for implants that monitor functions independently and if necessary also control them. This calls for artificial intelligence (AI), which was represented at the event by Frank Trautwein, consortium leader of the KIKS  development project of the German Federal Ministry for Economic Affairs and Energy (BMWi). KIKS (Künstliche Intelligenz für Klinische Studien - German for "Artificial Intelligence for Clinical Studies") aims to develop a digital ecosystem that uses artificial intelligence to integrate the scientific analysis of courses of treatment into everyday clinical practice. The idea is for AI to aid the  surgeon's human intelligence where the human brain reaches its limits - i.e. in particular when it comes to processing and  analysing data or images in large volumes or from various areas.

Facts and funding
"Surgeons often don't talk about the problems," said one participant. "But as an engineer, you need to know about all the conditions of an operating theatre before you can develop appropriate instruments." It is exactly these facts that are provided by the "Incisions and insights" workshop series, which has been organised since 2016 by BioRegio STERN Management GmbH 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). And co-organiser Dr. Klaus Eichenberg, Managing Director of BioRegio STERN Management GmbH, was immediately able to counter the objection that new ideas cannot be implemented at companies because they do not fit into portfolios or no funding is available for this: "Through the "biohymed" project, we offer companies financial support to develop their innovative products and processes." The Central Innovation Programme for SMEs (ZIM) of the German Federal Ministry for Economic Affairs and Energy (BMWi) supports biohymed as a ZIM cooperation network. Together with universities, clinics and scientific institutions in the region and SMEs as project partners, this sets out to drive forward the biologisation of medical technology. More companies are therefore being given targeted support as part of the project so they can also, where necessary, submit equally promising applications for research and development to ZIM.