ZusammenfassungZiel dieser Leitlinie ist es, den Einsatz von Lasern und optischen Strahlquellen mit ähnlichen Wirkungen (insbesondere IPL) an der Haut sicherer, effizienter und nebenwirkungsärmer zu gestalten. Die Lasertherapie von vermehrt melanozytenhaltigen Hautveränderungen sollte stets mit besonderer Vorsicht erfolgen. Die Laserung eines pigmentierten melanozytären Naevus wird nicht empfohlen. Für die Indikationen Lentigines und Café‐au‐Lait‐Fleck, nichtpigmentierter dermaler Naevus, Becker‐Naevus, Naevus Ota – Naevus Hori – Naevus Ito und Melasma sind in der Leitlinie spezifische Empfehlungen enthalten. Es wurden Empfehlungen verabschiedet zu nicht‐vermehrt melanozytenhaltigen Hautveränderungen (Epheliden, postinflammatorische Hyperpigmentierungen einschließlich Berloque‐Dermatitis, seborrhoische Keratosen, Schmutz‐ und Schmucktätowierungen sowie Metallablagerungen), Hypopigmentierungen (Vitiligo), benignen nichtpigmentierten Neoplasien (fibröse Nasenpapel, Naevus sebaceus, epidermaler Naevus, Neurofibrome, seboglanduläre Hyperplasien, Syringome, Xanthelasmata palpebrarum), entzündlichen Dermatosen (Akne papulopustulosa/conglobata, Akne inversa, Granuloma faciale, Lichen sclerosus, Lupus erythematodes, Psoriasis vulgaris, Rosazea und Rhinophym), Falten/Dermatochalasis/Striae, Hypertrichose, Narben (atroph, hypertroph; Keloide, Verbrennungs‐ und Verbrühungsnarben), laser‐assisted skin healing, Onychomykosen, Präkanzerosen und malignen Tumoren (aktinische Keratosen/Feldkanzerisierung, Cheilitis actinica, Basalzellkarzinom), vaskulären Hautveränderungen (Angiokeratom, Angiom, Hämangiom, Malformation, Besenreiser, Granuloma teleangiekaticum (pyogenicum), Rubeosis (Erythrosis interfollicularis colli, Ulerythema ophryogenes), Naevus flammeus, Teleangiektasien und Morbus Osler (Hereditäre Hämorrhagische Teleangiektasie) sowie viralen Hautveränderungen (Condylomata acuminata, Mollusca contagiosa, Verrucae planae juveniles, Verrucae vulgares und Verrucae palmares et plantares).

This guideline aims to improve the efficiency and safety of lasers and optical radiation sources with similar effects (especially IPL). Laser therapy of skin lesions with an increased amount of melanocytes should be performed with caution. Laser treatment of pigmented melanocytic nevi is not recommended. The guideline contains recommendations regarding the treatment of lentigines and café-au-lait spots, non-pigmented dermal nevi, Becker nevus, nevus of Ota/Hori/Ito and melasma. Further recommendations focus on the treatment of skin lesions without an increased amount of melanocytes (ephelides, postinflammatory hyperpigmentation including berloque dermatitis, seborrheic keratoses, traumatic/decorative tattoos and metallic deposits), hypopigmentation (vitiligo), benign non-pigmented neoplasms (fibrous papule of the nose, nevus sebaceus, epidermal nevus, neurofibroma, sebaceous gland hyperplasia, syringoma, xanthelasma palpebrarum), inflammatory dermatoses (acne papulopustulosa/conglobata, acne inversa, granuloma faciale, lichen sclerosus, lupus erythematosus, psoriasis vulgaris, rosacea, rhinophyma), wrinkles/dermatochalasis/striae, hypertrichosis, scars (atrophic, hypertrophic; keloids, burn/scald scars), laser-assisted skin healing, onychomycosis, precancerous lesions and malignant tumors (actinic keratoses/field cancerization, cheilitis actinica, basal cell carcinoma), vascular skin lesions (angiokeratoma, angioma, hemangioma, malformation, spider veins, granuloma telangiectaticum (pyogenic granuloma), rubeosis (erythrosis interfollicularis colli, ulerythema ophryogenes), nevus flammeus, telangiectasias and Osler's disease (hereditary hemorrhagic telangiectasia) and viral skin lesions (condylomata acuminata, mollusca contagiosa, verrucae planae juveniles/vulgares/ verrucae palmares et plantares).

Modern surgical devices are full of innovations and provide plenty of functionalities. However, they only perform to their full potential if they are properly configured. Only a small subset of surgical device functionalities is used due to the high complexity of today's device systems and the omnipresent situation that only the circulating nurses can (re-)configure non-sterile devices. Hence, there is a huge need for safe and effective assistance supporting the operating room (OR) staff to continuously work with the potentially best device setting to increase patient's safety and clinical outcome. Therefore, we propose a concept for situation-aware parameter recommendations and automatic (re-)configuration. Free access to adequate data is a prerequisite to extract knowledge for assistive systems and to provide situation awareness during execution. Thus, manufacturer-independent medical device interoperability is a basic requirement. Consequently, we use the new IEEE 11073 Service-oriented Device Connectivity (SDC) standards family, including Device Specializations. As part of the developing committee we introduce the idea and concept behind Device Specializations and highlight their use for assistive systems in the domain of minimal invasive surgery. To ensure safety and effectiveness of the assistive functionalities, our concept enforces deterministic rules providing a predictable and approvable behavior. We demonstrate our concept by the use case of a smart surgical double roller pump using an interpreter-based Rule Execution Engine.

Due to its advantages like minimal trauma and a low risk of infections, the minimally invasive surgery (MIS) has become the standard operation technique for many surgical procedures. During this type of intervention, one of the main tasks from a technical point of view is the control of the pressure in the operation area in order to give the surgeon sufficient space to perform his actions. Because no invasive measurements are available, an extended Kalman filter incorporating the peristaltic behavior of the used medical device was developed to estimate the pressure in the operation area. This contribution focuses on the observer design while a separately designed PI controller using loop shaping was employed for validation. The proposed observer-based control structure was tested with a simulator deploying the principle of physical equivalence.

The interconnection of therapy devices and the associated intelligent usage of available information is a key element for future improvements of medical therapies. Today, the success of an operation is determined by the quality of the therapy devices in connection with the individual knowledge and skills of the surgeon. A novel approach for the automatic, data based enhancement of a modern surgical technique is developed by a research association of clinical, academic and industrial partners. The concept of the project AFluCoMIS is applied to the minimally invasive surgery. The basic idea can be summarized as an increased usage of available data during an intervention. This information can be used to build an assistance system for the clinical staff which supports the surgeon with automatic device configuration, reference value settings and provides monitoring and safety features. A second innovation in the concept is derived from a postoperative correlation analysis between the course of the intervention and the clinical result. Knowledge can be gained from statistical data and improve following interventions. As a result, experience from past interventions is automatically made available to all surgeons by applying the derived parameters to the device. The combination of the surgeon's individual experience and automatically accumulated knowledge improves continuously the conditions for a successful intervention.