title: Toward increased autonomy in the surgical OR: needs, requests, and expectations.
abstract: BACKGROUND
  The current trend in surgery toward further trauma reduction inevitably leads to increased technological complexity. It must be assumed that this situation will not stay under the sole control of surgeons; mechanical systems will assist them. Certain segments of the work flow will likely have to be taken over by a machine in an automatized or autonomous mode.
  
  
  METHODS
  In addition to the analysis of our own surgical practice, a literature search of the Medline database was performed to identify important aspects, methods, and technologies for increased operating room (OR) autonomy.
  
  
  RESULTS
  Robotic surgical systems can help to increase OR autonomy by camera control, application of intelligent instruments, and even accomplishment of automated surgical procedures. However, the important step from simple task execution to autonomous decision making is difficult to realize. Another important aspect is the adaption of the general technical OR environment. This includes adaptive OR setting and context-adaptive interfaces, automated tool arrangement, and optimal visualization. Finally, integration of peri- and intraoperative data consisting of electronic patient record, OR documentation and logistics, medical imaging, and patient surveillance data could increase autonomy.
  
  
  CONCLUSIONS
  To gain autonomy in the OR, a variety of assistance systems and methodologies need to be incorporated that endorse the surgeon autonomously as a first step toward the vision of cognitive surgery. Thus, we require establishment of model-based surgery and integration of procedural tasks. Structured knowledge is therefore indispensable.
authors.affiliation: Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, 81675 München, Germany. michael.kranzfelder@tum.de
authors.forename: Michael
authors.initials: M
authors.lastname: Kranzfelder
authors.forename: Christoph
authors.initials: C
authors.lastname: Staub
authors.forename: Adam
authors.initials: A
authors.lastname: Fiolka
authors.forename: Armin
authors.initials: A
authors.lastname: Schneider
authors.forename: Sonja
authors.initials: S
authors.lastname: Gillen
authors.forename: Dirk
authors.initials: D
authors.lastname: Wilhelm
authors.forename: Helmut
authors.initials: H
authors.lastname: Friess
authors.forename: Alois
authors.initials: A
authors.lastname: Knoll
authors.forename: Hubertus
authors.initials: H
authors.lastname: Feussner
mesh_terms: D001331:Automation; D002983:Clinical Competence; D003362:Cost-Benefit Analysis; D003952:Diagnostic Imaging / Q000191:economics / Q000379:methods; D057286:Electronic Health Records; D004867:Equipment Design; D006801:Humans; D062069:Inventions; D010535:Laparoscopy / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D008328:Man-Machine Systems; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods; D009873:Operating Rooms; D061214:Patient Safety; D010820:Physicians / Q000523:psychology*; D017009:Professional Autonomy; D012371:Robotics / Q000191:economics / Q000295:instrumentation / Q000379:methods / Q000639:trends; D025321:Surgery, Computer-Assisted / Q000191:economics / Q000295:instrumentation / Q000379:methods; D013525:Surgical Instruments / Q000191:economics / Q000639:trends*; D013536:Suture Techniques; D013675:Technology, High-Cost; D016526:Workload