Surgical process modeling

Abstract

Due to the rapidly evolving medical, technological, and technical possibilities, surgical procedures are becoming more and more complex. On the one hand, this offers an increasing number of advantages for patients, such as enhanced patient safety, minimal invasive interventions, and less medical malpractices. On the other hand, it also heightens pressure on surgeons and other clinical staff and has brought about a new policy in hospitals, which must rely on a great number of economic, social, psychological, qualitative, practical, and technological resources. As a result, medical disciplines, such as surgery, are slowly merging with technical disciplines. However, this synergy is not yet fully matured. The current information and communication technology in hospitals cannot manage the clinical and operational sequence adequately. The consequences are breaches in the surgical workflow, extensions in procedure times, and media disruptions. Furthermore, the data accrued in operating rooms (ORs) by surgeons and systems are not sufficiently implemented. A flood of information, "big data", is available from information systems. That might be deployed in the context of Medicine 4.0 to facilitate the surgical treatment. However, it is unused due to infrastructure breaches or communication errors. Surgical process models (SPMs) alleviate these problems. They can be defined as simplified, formal, or semiformal representations of a network of surgery-related activities, reflecting a predefined subset of interest. They can employ different means of generation, languages, and data acquisition strategies. They can represent surgical interventions with high resolution, offering qualifiable and quantifiable information on the course of the intervention on the level of single, minute, surgical work-steps. The basic idea is to gather information concerning the surgical intervention and its activities, such as performance time, surgical instrument used, trajectories, movements, or intervention phases. These data can be gathered by means of workflow recordings.These recordings are abstracted to represent an individual surgical process as a model and are an essential requirement to enable Medicine 4.0 in the OR. Further abstraction can be generated by merging individual process models to form generic SPMs to increase the validity for a larger number of patients. Furthermore, these models can be applied in a wide variety of use-cases. In this regard, the term "modeling" can be used to support either one or more of the following tasks: "to describe", "to understand", "to explain", to optimize", "to learn", "to teach", or "to automate". Possible use-cases are requirements analyses, evaluating surgical assist systems, generating surgeon-specific training-recommendation, creating workflow management systems for ORs, and comparing different surgical strategies. The presented chapter will give an introduction into this challenging topic, presenting different methods to generate SPMs from the workflow in the OR, as well as various...

Context-aware medical technologies - relief or burden for clinical users?

“…Methodological issues, such as best practices and common standards for the internal representation of clinical and surgical contexts or approaches for an effective integration of contextual information with medical systems' and applications' states, need to be studied. Yet, ontologies [18][19][20], process models [21,22], or hierarchical structuring [23] have been proposed to model aspects of contexts in surgery. Experiments with machine-learning methods [24,25] have been conducted, but the relevant data structures and the universal algorithms still need to be identified.…”

Surgery 4.0: the natural culmination of the industrial revolution?

“…It not only includes the normal course of an operation but considers potential modifications and deviations as well. He also explained how to create “surgical models” either by a bottom-up or top-down approach [3]. Modern SDS methodologies such as machine learning will become extremely helpful to establish “model-based surgery”.…”

Surgical process modelling strategies: which method to choose for determining workflow?

“…Two previous review papers [21,22] cover the relevant concepts of surgical process modelling. However, due to the complexity of the field, the dependencies between these concepts and the criteria for selection of the most suitable modelling strategy are not clear.…”