G Buess

University of Tuebingen, Tübingen, Baden-Württemberg, Germany

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Publications (212)300.41 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: The EURO-NOTES Clinical Registry (ECR) was established as a European database to allow the monitoring and safe introduction of Natural Orifice Transluminal Endoscopic Surgery (NOTES). The aim of this study was to analyze different techniques applied and relative results during the first 2 years of the ECR. METHODS: The ECR was designed as a voluntary database with online access. All members of the European Society for Gastrointestinal Endoscopy and the European Association for Endoscopic Surgery were requested to participate in the registry. Demographic and therapy data as well as data on the postoperative course are recorded in the ECR in an anonymous way. RESULTS: A total of 533 patients who underwent NOTES procedures were included in the study. Four different hybrid techniques for 435 cholecystectomies were described, registering postoperative complications in 2.8 % of patients, addition of a single trocar in 5.3 %, and conversions to laparoscopy in 0.5 %. Both flexible endoscopic and rigid laparoscopic cholecystectomy techniques proved to be safe and effective with minor differences. There was a shorter operative time in the rigid laparoscopic group. Thirty-three appendectomies were reported by transgastric and transvaginal techniques, with transvaginal techniques scoring shorter operative time and hospital stay, but with a frequent need to add more trocars. Overall complications occurred in 14.7 % of patients but they did not differ significantly among the different techniques. One transvaginal and 31 transanal sigmoidectomies were included for prolapse and diverticulitis, with four postoperative complications (12.5 %), but none needing further treatment. Twenty peroral esophageal myotomies were included with three postoperative complications (15.0 %), but none needing further treatment. CONCLUSIONS: Five years since the introduction of NOTES into clinical practice, hybrid techniques have gained considerable clinical application. Several NOTES hybrid cholecystectomy and appendectomy techniques are practicable and safe alternatives to laparoscopic procedures. Also, sigmoidectomies and peroral esophageal myotomies were described, proving feasibility and safety. Nevertheless, the real benefit of NOTES for patients still needs to be assessed.
    Surgical Endoscopy 03/2013; · 3.43 Impact Factor
  • P. van Bergen, W. Kunert, G. F. Buess
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    ABSTRACT: BackgroundIn 1995, when we first used a high-definition television (HDTV) video system during a laparoscopic cholecystectomy in Tuebingen, we were surprised by the excellence of the spatial impression achieved by an image with improved resolution. Although any improvement in vision systems entails a trade-off among cost, quality, and complexity, high-definition imaging may well become an essential part of 3-D video systems. The aim of this experimental study was to assess the impact of high definition on surgical task efficiency in minimally invasive surgery and to determine whether it is preferable to use a 3-D system or a 2-D system with perfect resolution and color—for instance, HDTV or the three-chip charge-coupled device (3CCD). MethodsWe compared a 3-D video system with the vision through a stereoscopic rectoscope for transanal endoscopic microsurgery (TEM). Because its stereoscopic direct vision is not restricted to either shutter technology or video resolution, TEM optics represents the state of the art. For objective comparison, inanimate phantom models with suturing tasks were set up. The setups allowed the approach of parallel instruments as in TEM operations or via a laparoscopic approach, with oblique instruments coming laterally. Both types of procedure were carried out by highly experienced laparoscopic surgeons as well as those inexperienced in endoscopic surgery. These volunteers worked under 3-D video vision and/or TEM vision. Altogether, the model tasks were performed by 54 different persons. ResultsThe evaluation did not show a significant (p >0.05) difference in performance time in all models, but there was a clear trend showing the benefit of a higher resolution. ConclusionWe found a tendency for both endoscopically inexperienced and experienced surgeons to benefit from the use of a system with improved resolution (direct vision) rather than a 3-D shutter video system.
    Surgical Endoscopy 04/2012; 14(1):71-74. · 3.43 Impact Factor
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    ABSTRACT: BackgroundRobotic aid in minimally invasive surgery (MIS) is becoming more and more common. We designed an experimental trial in a phantom model to verify the feasibility of solo surgery for MIS. By performing laparoscopic cholecystectomy on a phantom model, we compared combinations of different systems available in terms of safety, comfort, and time requirements. MethodsTwo surgeons skilled in endoscopic procedures tested the following systems as endoscope holders: the robotic system (AESOP), foot-controlled (AESOP 1000), and voice-controlled (AESOP 2000); the remote controlled FIPS Endoarm, electrically driven and controlled by a finger-ring joystic; the passive system TISKA Endoarm, a mechanical arm moved by hand and fixed by electromagnetical brakes. All of these systems combined with a second TISKA Endoarm as an instrument holder. A combination of two mechanical Martin arms, c, also was tested. The results were compared with those from a control group involving an assistant surgeon. A total of 70 experiments were performed. ResultsThe shortest dissection time was registered by the combination of two TISKA Endoarms, with a statistically significant difference as compared with the control group (p <0.05) and experiments using AESOP 1000 (p<0.05). The TISKA Endoarm also proved to be more comfortable when used as an instrument holder (p<0.001 vs Martin arm), and rated second only to AESOP 2000 as an endoscope holder. The rating of AESOP 2000 as endoscope holder was significantly higher than that of all other groups (p<0.001). The study proved the feasibility of solo surgery. The time needed for dissection was shortest when two TISKA Endoarms were used, demonstrating the possible advantages of solo surgery. The TISKA Endoarm received a subjective positive rating when used as both endoscope holder and instrument holder. The voice control of AESOP 2000 seemed to be a major improvement in the development of an optimal man-machine interface. Nevertheless, the system presents considerable space requirements and does not supply control of 30° optics. The principle of the finger-ring joystick adopted by the FIPS Endoarm seemed very intuitive but lacking in ergonomy. ConclusionLaparoscopic solo surgery can be considered a safe procedure, although further technologic developments should lead to improved ergonomy, intuitiveness of handling, and architecture of the systems, offering the surgeon better control, increased precision of action, and reduction in operation time.
    Surgical Endoscopy 04/2012; 14(10):955-959. · 3.43 Impact Factor
  • 41. Kongress der Deutsche Gesellschaft für Endoskopie und Bildgebende Verfahren (DGE-BV), München; 01/2011
  • 88. Jahrestagung der Vereiningung der Bayrischen Chirurgen e.V., München; 01/2011
  • XXII. Kongress der Südwestdeutschen Gesellschaft für Gastroenterologie, Tübingen; 01/2011
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    ABSTRACT: Aims Regarding basic laparoscopic operations, the missing depth information of a usual 2D monitor can be compensated to a high degree by experience and secondary spacial depth cues. Experiments in laparoscopic surgery are advancing towards more and more complex operations. In the course of that, manoeuvres become more difficult and instruments with additional functions and degrees of freedom emerge. Thus in future operations the flaw of a 2D system becomes more relevant and 3D systems might be necessary. In a standardised experiment using phantom models, the influence of 3D HD visualisation on task efficiency has been quantified. Methods The 3D HD system used consists of a dual channel laparoscope, a stereoscopic camera, a camera controller with two separate outputs and a wavelength multiplexing high definition stereoscopic monitor*. In the comparative study made, five standardised tasks had been perfomed by 20 students and 10 surgeons who were preselected by a stereo vision test. Each one performed the tasks both under 2D and 3D vision taking at least a 48 hour break between the two turns. An electronic error counting, as well as a time metering, was used for comparing the probands’ performances. Results Looking at the students' group, in 4 of 5 tasks the error count was significantly smaller when using 3D visualisation. Also the time needed was less in 4 of 5 tasks. Not only the beginners took advantage of the 3D system but also the surgeons. Conclusion The surgical Benefit of high definition is not in question because it has no negative implications. This study shows that 3D HD further improves task efficiency in the phantom model concerning precision, safety and performance time. This effect is at most when performing complex instrument manoeuvres which points out an importance of this new technology for ambitious operation techniques and future instruments.
    19th Int Congress of the EAES, Torino, Italy; 01/2011
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    ABSTRACT: Summary The insertion of trocars under visual guidance has been developed to a safe procedure. However, ‘blind’ primary puncture for insufflation with a Veress needle still carries a well-recognised risk of injuries. We have added specific optical features to the protective shield of a conventional Veress needle with the aim of minimising these risks. The resulting special Veress needle, with an optical protective shield, allows us to benefit from the advantages of optical trocars (Optiview trocars; Ethicon Endosurgery, Cincinnati, USA) during the primary puncture. Orientation within the tissue layers and visualisation of adhesions and intraperitoneal organs is therefore possible prior to the penetration of the peritoneum. This Veress needle consists of a conventional needle with an integrated spring mechanism. The spring-activated protective shield allows the integration of a fibre glass optic at the distal end of the protective shield. The tissue surrounding the transparent shield is thus visible. The protective shield and optic are not mechanically tied to each other. We have modified this needle to suit the non-trocar Dilatation System Step (Innerdyne, California, USA). This gives a system capable of performing primary punctures under the usual Veress needle conditions, but the area to be accessed can be viewed. At the same time, a sleeve (an expandable trocar bushing) is brought into the intra-abdominal area and dilated to an internal diameter of 7, 10 or 12 mm. After dilatation, high-flow insufflation takes place under optical monitoring, e.g. with a 10 mm optic. Diagnostic inspection is therefore possible while insufflation is still in progress; this is considerably less time-consuming than the conventional method. The area to be diagnosed can be accessed repeatedly using the same Veress needle and various sleeves. Such an approach makes it unnecessary to use classical trocar systems. A more effective utilisation of instrumentation is also more cost-effective. The dilatable sleeves are always brought in with the low penetration pressure of the Veress needle and under visual control. Dilatation trocars are used to spread the sleeves, thus risks can be reduced to a minimum.
    07/2009; 8(4):245-254.
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    ABSTRACT: Summary Laparoscopic surgeons will be familiar with the frustration generated by periodic interruptions to the operation caused by an impaired view through the laparoscope. If accidental bleeding occurs, a poor view of the operative field may threaten conversion to open surgery, or if severe, the patient's life. Maintenance of unimpeded visual clarity is therefore of prime importance during endoscopic surgery, but to date there has been little objective evidence documenting how this may be achieved. Investigations were conducted to identify conditions that hinder vision during endoscopic surgery, and some possible solutions were experimentally evaluated in inanimate and live animal models. It was concluded that to prevent the condensation of water vapour on the optical viewing surface an integrated, monitored electrical heating system is required. To maintain ideal visual conditions, insufflated gas should continuously flow directly over the front lens and be warmed and humidified. The optical system should also be capable of rinsing and drying the lens, and able to exsufflate smoke and particulate debris manufactured during electrocautery. This information was used in co-operation with an industry partner for the development of a multi-function optical system that provides continuously unencumbered acuity under all situations encountered in the laparoscopic environment.
    07/2009; 5(5):450-455.
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    ABSTRACT: Summary Minimally invasive interventions require a multitude of technical devices, like gas-insufflators, cameras, light-sources, high-frequency and others. The devices available today represent stand-alone ‘function-insulas’ from the view-point of systems technique. They have to be placed in the operating theatre and set up right before each specific intervention. From each single devices supplies, cables and hoses lead to the body of the patient. They have to be connected on both sides, within the sterile and the non-sterile field. One of the major drawbacks lies in the lack of direct control of the devices by the surgeon and the confusing display of parameters and the technical status. On this background the systematic revision of the current endo-surgical work-place appears to be a major requirement for further technical and surgical progress in endoscopic surgery. In close cooperation between surgeons and engineers a systems work-place for minimally invasive surgery, OREST, has been developed and clinically tested. It integrates all devices into a mobile cabinet. The single devices are connected to a central computer and can be remote-controlled directly by the surgeon from the table. A special display continuously informs about the system status. The lines and cables are guided into the sterile field by means of a swivel arm from one side of the patient. Four multi-plugs are used to connect all lines at a central terminal within the sterile area. Clinical application of the first prototype OREST I started in 1993.
    07/2009; 4(2):57-62.
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    ABSTRACT: The benefit of using retrieval systems in minimally-invasive surgery is to facilitate the removal of operative specimen, while minimising the contamination of the peritoneum and port-sites in the abdominal wall. We have developed an innovative retrieval system with a mechanism of action and design that differs widely from other devices. Its increased functionality is achieved by combining it with a laparoscopic instrument: the resected tissue is wrapped in plastic foil, rather than being entrapped in a bag. During delivery through the abdominal wall, permanent traction is exerted on the specimen and thus obstruction in the port-site is avoided. The retrieval system has been tested for impermeability and proven to be safe and able to avoid spillage of cells.
    07/2009; 9(5):361-365.
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    ABSTRACT: Summary Visual perception is the leading sensorial impression from the environment in most situations of daily life. It is almost the only sensorial impression from the operating field in image-guided surgery. In this regard the qualities of the imaging system have considerable impact on the course of the surgical intervention. The way to significant improvements of technical imaging systems is shown up by the sense of vision itself. Five aspects of the sense of vision can be identified as a model for endoscopic imaging tools: (1) Direction of the line of sight; (2) Maintenance of clear vision; (3) Spatial vision; (4) Differentiated visual field and panoramic view; (5) High resolution. The five aspects of the human visual sense introduced obviously represent only a part of the qualities of the human eye. Without doubt our simple analysis of the physiology cannot be understood as a technical plan to imitate the human eye. But it should demonstrate how we can abstract functional principles and define developmental guidelines for future tools according to these functional principles. In a series of developments technical solutions covering the above features have been set up and operatively tested. The experience gained thereof has been used to define the scenario of an integrative future endoscope system, currently realized within a collaborative project.
    07/2009; 5(5):410-418.
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    ABSTRACT: Summary Endoluminal therapy is widespread among different clinical specialities. Endoluminal therapy of gastrointestinal disease, endovascular therapy of stenoses, and transurethral resection of the prostate are only three examples from this diversified medical field. Notwithstanding the impressive technical possibilities offered by contemporary products, technological advances will have a considerable impact on the further development of endoluminal therapy. New technologies, such as microsystem technology, will bring about significant advances in both functionality and performance of endoluminal systems. Miniaturized robotic components and sensor systems for analysis of tissues in situ could form part of advanced devices applied, for example, to local tumour surgery. This article describes, in brief, a scenario of an endoluminal manipulator system and its technological platform.
    07/2009; 7(1):37-42.
  • G. F. Buess, A. Arezzo, M. O. Schurr
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    ABSTRACT: Summary Endoluminal surgery may be defined as procedures performed in a hollow organ using typical surgical techniques, such as dissection, suturing and stapling. By their nature, these procedures must be performed under endoscopic control. Applications of endoluminal surgery to the gastrointestinal tract should ideally be performed via natural orifices. Gastric endoluminal procedures, such as tissue resection by means of strip biopsy or polypectomy, are becoming increasingly common, especially in Japan. The laparoscopic transgastric approach has also been described recently. Endoluminal rectal surgery using retractors started many centuries ago. Complex surgical techniques under endoscopic vision can be performed by transanal endoscopic microsurgery (TEM). Today TEM is widely accepted, but not in every country. With the current impact of new technology, numerous potential endoluminal applications can be foreseen. Ongoing projects in endoluminal surgery include the treatment of bleeding ulcers of the gastrointestinal tract, antireflux techniques for gastro-oesophageal reflux disease (GERD) and the full-thickness resection of early gastrointestinal lesions. Compared with laparoscopic surgery, endoluminal surgery is a further important step in reducing the invasiveness of procedures. In combination with future endoscopic screening programmes for early tumours of the gastrointestinal tract, a revolution in the surgical treatment of these diseases can be foreseen.
    07/2009; 7(1):31-36.
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    ABSTRACT: Summary The increasing complexity of Minimally Invasive Therapy and surgery requires the transformation and application of classic systems theory. The basic tools of systems analysis and design are essential to realize technology that functions in a co-ordinated fashion to ensure a safe, smooth and precise execution of interventions or operations on a human being. The paper describes the basic classification of systems and outlines the speculative structure of an MIT Operating System (MITOS) from the medico-technical point of view. Future developments such as remote handled telepresence surgery and CT/MR image-guided surgery are included in the perspective.
    07/2009; 4(5-6):301-308.
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    ABSTRACT: Almost 2000 surgeons have taken part in training programmes for minimally-invasive surgery in our department since 1989. Different operations are simulated in training phantoms. Intensive development work has led to the production of human body forms in which animal tissue from the slaughterhouse is integrated, to mimic realistic human anatomy. Quality control and inquiries showed good learning curves and high acceptance of the training method among participants.
    07/2009; 9(5):311-314.
  • M. O. Schurr, G. F. Buess, S.-P. Heyn
    07/2009; 6(1):2-5.
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    ABSTRACT: Summary In laparoscopy the view is often hindered by soiling or condensation on the front lens of the endoscope. In this study the physical conditions of the endoscope in laparoscopic surgery were initially determined in an animal model. The intra-abdominal CO2 was found to rapidly equilibrate to body temperature and become nearly 100% saturated with water. These conditions were duplicated in a controlled inanimate model to investigate the physical principles of clear endoscopic vision. The temperature of the distal end of the laparoscope was observed to vary between 32°C and 40°C in the typical intra-abdominal environment. Vision is unimpeded by condensation on the front lens if it is maintained at temperatures greater than the body temperature of 37°C. The authors suggest implementation of a controlled heating device in laparoscope design to sustain clear vision in endoscopic surgery without the need for extracorporeal cleaning cycles. Because CO2 insufflation to the front lens and rinsing liquid cool the optic and favour reactive fogging, the whole optic has to be warmed up.
    07/2009; 5(5):440-444.
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    ABSTRACT: Summary Laparoscopic colorectal surgery represents a major field of research in centres of minimally invasive surgery. Mostly so-called laparoscopically assisted procedures are applied where the specimen is removed and the anastomosis performed via a minilaparotomy. For the resection of the left colon and the rectum two methods were developed in the University Hospital in Tübingen. A special stapling technique is presented for resection of the left colon and the proximal part of the rectum. The specimen is removed and the anastomosis performed transanally. For low anterior resection including colo-anal anastomosis the technique of TEM is applied in a combined laparoscopic transanal procedure.
    07/2009; 4(2):75-80.
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    ABSTRACT: A simple ex vivo model has been developed using porcine large bowel. Various endoluminal procedures can be simulated and trained in this easy-to-use model. The main advantages are realistic human-bowel configuration and use of biological tissue simulating some of the bowel-wall properties. X-ray transparent materials were used for radiological-assisted procedures and the simple set-up allows multiple use.
    07/2009; 11(1):3-5.

Publication Stats

2k Citations
300.41 Total Impact Points

Institutions

  • 1990–2013
    • University of Tuebingen
      • Department of General, Visceral and Transplant Surgery
      Tübingen, Baden-Württemberg, Germany
  • 2011
    • Technische Universität München
      München, Bavaria, Germany
  • 1992–2009
    • Universitätsklinikum Tübingen
      • Department of General, Visceral and Transplant Surgery
      Tübingen, Baden-Württemberg, Germany
  • 2008
    • Steinbeis Hochschule Berlin
      Berlín, Berlin, Germany
  • 1996–2008
    • Clinic for Minimally Invasive Surgery
      Berlín, Berlin, Germany
  • 2005
    • Ospedale Evangelico Internazionale
      Genova, Liguria, Italy
  • 2003
    • Assiut University
      • Department of General Surgery
      Asyūţ, Muhafazat Asyut, Egypt
  • 1999
    • Mercy Hospital St. Louis
      San Luis, Missouri, United States
  • 1995
    • Universität Witten/Herdecke
      Witten, North Rhine-Westphalia, Germany
  • 1994
    • Kanazawa University
      Kanazawa, Ishikawa, Japan
  • 1993
    • Rush University Medical Center
      • Department of General Surgery
      Chicago, IL, United States
    • Sapienza University of Rome
      Roma, Latium, Italy
  • 1987–1990
    • Johannes Gutenberg-Universität Mainz
      • Klinik und Poliklinik für Allgemein- und Abdominalchirurgie
      Mainz, Rhineland-Palatinate, Germany