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30 Life Sciences Report – Therapy & Devices Wireless microengine made from a twisted fibre Researchers from the Helmholtz-Zentrum Geesthacht (HZG), Institute of Biomaterial Science in Teltow (Brandenburg) and the University of Bordeaux developed highly efficient, micro-sized motor-cum-energy storage system. The ‘microengine’ is made from polymeric micro-fibres, which are stiff at room temperature. When heated, the fibres become elastic and can be twisted – like a model aeroplane powered by a rubber band. Unlike the elastic band, however, when the fibres are cooled, they remain twisted until the microengine is re-heated. The energy stored when the fibres were twisted is released, the movable end begins to turn and the ‘microfiber motor’ can propel objects. Source: HZG / Oliver Gould With their easy-to-build motor, the two research teams in Bordeaux and Teltow fill a gap in the market, as for many applications, an electric motor is too weak, too large, insufficiently robust, and requires electricity and control cables. In the micro-fibre motor, the energy density is 60 times greater than in natural skeletal muscles. to imitate in vivo situations using 3D biomaterials combined with the cultivation of primary cells in bioreactors. Optimise medical procedures with AI, VR/AR, robotics and 3D imaging Digital technologies have a disruptive impact on medical and surgical care. Artificial intelligence, robotics, and augmented reality will play significant roles in conjunction with clinical applications. The German capital region offers a high concentration of research expertise in life sciences, photonics and informatic sciences as well as a strong and high innovative startup and AI ecosystem. This is a crucial precondition for developing highly innovative products and procedures such as robotics in surgery. large wounds and to enable fast patient recovery and mobilisation. Since then, minimal invasive surgery has become the gold standard for many surgical fields, most importantly laparoscopy and otorhinolaryngology. W.O.M. WORLD OF MEDICINE is a Berlin-based global leader in those particular applications of minimal-invasive medicine. Before artificial intelligence can be introduced into operating rooms (OR) at scale, operating rooms need to be digitised. Health IT specialists need to collect, warehouse and dashboard data and insights in a machine-learning-ready form. This is exactly where the Berlin-based company caresyntax started its journey in 2013, having introduced end-to-end IoT solutions to nearly 2000 hospitals worldwide touching all types of data streams from electronic medical records to radiology and laparoscopic videos, among others. Minimal-invasive surgery, the technology of small incisions, was first developed in the 1980s with the aim to avoid Caresyntax is convinced that artificial intelligence will have a very special role in operating rooms as a sounding board “Berlin offers access to world-class medical institutions, leading technical universities, and a vibrant start-up ecosystem. It is this three-pronged combination that makes Berlin the ideal hub for supporting caresyntax on its mission to transform the more than 300 million surgeries each year.” © Peter Rigaut Björn von Siemens Co-founder, caresyntax

Life Sciences Report – Therapy & Devices 31 for surgical teams all the way up to the C-suite to promote safety, quality and efficiency in surgery. Specifically, they are bringing peri-operative clinical decision support solutions online for all operating room stakeholders who benefit from how, for example, certain techniques or drugs can lead to a variety of clinical outcomes for a given patient profile, and plan, control and execute across the surgical continuum accordingly leveraging big data and deep learning. Digitization in the operating room, however, presents some challenges that need to be addressed. According to Marc Kraft, professor of medical technology at the TU Berlin, the “high demands on data security and data protection are good examples. In the context of artificial intelligence applications, it is necessary to discuss the possible loss of knowhow among users with their natural intelligence, which is then used less frequently. If methods of machine learning are used, the traceability of results must be guaranteed and process validation is mandatory. If an optimization is carried out with digitally supported operating room process documentation, this can also be perceived as patronizing and leading to further consolidation of work processes. Digital manufacturing processes can fundamentally change the value chains and the role distributions of actors”. As illustrated above, minimally invasive surgery with endoscopes has become the medical standard. It promises a fast and complication-free healing. However, the limited field of view, also called keyhole surgery, and the navigation and orientation outside of it pose great challenges to technology and surgeon. Several groups of researchers in the capital region are developing solutions for mixed or virtual reality. The growing number of projects in virtual surgery is facilitated by the strong presence of clinicians, software specialists, gaming industry and designers. In 2019, the former excellence cluster Image Knowledge Gestaltung hosted by Humboldt-Universität zu Berlin, transformed into the new excellence cluster Matters of Activity. Image Space Material by the Berlin University Alliance. Prof. Igor M. Sauer is one of the Principal Investigators at Matters of Activity – Image Space Material. Together with his team at the Charité – Universitätsmedizin Berlin and the Humboldt-Universität zu Berlin, he is working on extended reality (XR) solutions for preoperative surgical planning in visceral surgery as well as for the analysis and design in tissue engineering. In his work, Prof. Sauer has investigated the impact of mixed reality in the operation room (OR). His group showed transparent displays which can fundamentally change the concept of intra-operative imaging and interaction in the OR. While standard computer monitors generally relegate viewers to a static and passive position, mixed reality applications display patientrelated information directly in the surgeon’s field of view. Seen through a transparent head-mounted display, medical data overlays and annotates the surgeon’s vision with anatomical information by synchronising with the scale and position of the patient in real time. As this eliminates the offset between image and patient, surgeons do not need to continuously switch back and forth between screen and surgical site in order to view information, resulting in improved hand-eye coordination and spatial awareness. Furthermore, the research group investigates the impact of the transformation of human anatomy and physiology into computable material. As a result of converting e.g. soft tissue into geometric shapes, the manipulation of anatomy can be translated into algorithmic problems. Cutting tissue is then not only based on virtual datasets but can be executed by robotic systems that anticipate decisions, restrict actions and augment the surgeon’s point of view. Within the cluster Matters of Activity the group evaluates new practices of robotassisted cutting including new human-computer interfaces that can improve the limitation of access to physical space. The Fraunhofer Institute for Telecommunications, Heinrich Hertz Institute (HHI), is also currently running several projects funded by the Federal Ministry of Education and Research (BMBF) in the field of digital surgery. The project COMPASS, which has launched in September 2018, aims to develop a cooperative immersive assistance system for minimally invasive surgery, which improves intraoperative surgical navigation and optimizes the surgical workflow. The COMPASS system is intended to recognize the navigation process of the surgeon through comprehensible, immersive visualization and interaction, to navigate the surgeon in an anticipatory manner and to accompany him through the surgical procedure. Images of a 3D endoscope are used to create an anatomical map of the patient. On this, distinctive anatomical regions, risk structures, directional guidelines and information on the surgical steps are entered and adjusted according to the endoscope position. The surgeon navigates through the patient‘s body and interacts with the surgical navigation system to receive information. The procedures are being developed with clinical research partners in Leipzig (Innovation Center Computer Assisted Surgery – ICCAS) and Munich (Research group MITI - Minimally invasive Interdisciplinary Therapeutical Intervention) for sinus surgery and laparoscopy. Overall, eight partners from the fields of research and industry contribute to the results. Another innovative project at HHI is the project MultiARC. The focus of MultiARC combines multispectral imaging, 3D-measurement and true-to-scale augmentation of clinical images in the field of surgical microscopy. The hybrid

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