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[外科手术中的基于模型的治疗]

[Model-based treatment in surgery].

作者信息

Vogel T, Kohn N, Ostler D, Marahrens N, Samm N, Jell A, Kranzfelder M, Wilhelm D, Friess H, Feußner H

机构信息

Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Deutschland.

出版信息

Chirurg. 2019 Jun;90(6):470-477. doi: 10.1007/s00104-019-0815-6.

Abstract

BACKGROUND

The "magic triangle" in surgery and other disciplines consists of the demand for increasingly gentler forms of treatment, simultaneous cost reduction and the fundamental primacy of improving the quality of results. The digitalization of medicine offers a promising opportunity to do justice to this, also in the sense of "Surgery 4.0". The aim is to create a cognitive, collaborative diagnostics and treatment environment to support the surgeon.

METHODS

In the sense of a "theory building" for analysis and planning, process modeling is the cornerstone for modern treatment planning. The main distinction is made between the patient model and the treatment model. The course of the actual surgical treatment can also be modeled: in principle it is possible to describe the course of an operation in such fine detail that the surgical procedure can be mapped and reproduced down to each single step, such as a single implementation of forceps. Basically, this has already been achieved. So-called neural networks also open up completely new forms of knowledge acquisition, machine learning and flexible reaction to nearly all conceivable possibilities in highly complex processes.

CONCLUSION

"Digitalization" is a necessary development in surgery. It offers not only countless possibilities to support the surgeon in the field of activity but also the chance of more precise data acquisition with respect to academic surgery. Modeling is an indispensable part of this and must be rigorously implemented and further developed.

摘要

背景

外科手术及其他学科中的“魔法三角”包括对愈发温和治疗方式的需求、同步降低成本以及改善治疗效果质量的根本首要性。医学数字化提供了一个有望实现这一点的机会,从“外科手术4.0”的意义上来说也是如此。目标是创建一个认知、协作的诊断和治疗环境以支持外科医生。

方法

从用于分析和规划的“理论构建”意义上讲,过程建模是现代治疗规划的基石。主要区分在于患者模型和治疗模型。实际外科治疗过程也可以建模:原则上,可以非常详细地描述手术过程,以至于手术程序可以精确到每一个步骤进行映射和再现,比如镊子的一次操作。基本上,这已经实现了。所谓的神经网络还为在高度复杂过程中获取全新形式的知识、机器学习以及对几乎所有可想象可能性的灵活反应开辟了道路。

结论

“数字化”是外科手术中一项必要的发展。它不仅为支持外科医生的活动领域提供了无数可能性,还为学术外科手术提供了更精确数据采集的机会。建模是其中不可或缺的一部分,必须严格实施并进一步发展。

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