Intraoperative judgments and actions based on diagnostic surgical devices

Surgeons continue attempts to improve treatment results with development of the individual skills and intraoperative techniques in a continuous life-long fashion. Nevertheless, a dramatic change in medical practice had happened with introduction of the novel medical technologies for advanced diagnostics and treatment, such as computed tomography, magnetic resonance imaging, stereotactic radiosurgery, endo-vascular coils, surgical microscope, intraoperative navigation systems, etc. The present article highlights the impact of the diagnostic surgical devices on the intraoperative judgements and actions. The main purpose of the diagnostic surgical devices is intraoperative visualization of the biological signals. The first step of this process, visualization itself, already contributes to clinical decision-making, but obtained information is qualitative, thus experience is required for its precise interpretation. The second step is regarded to transformation of the subjective qualitative information into objective quantitative digital data using various image analyzers and/or computer software. During the third step the quantitative digital data are converted into objective anatomical, functional, and histopathological information, which can be used for scientifically-based intraoperative decision-making, taking into consideration the thresholds of resection rate, stimulation current, malignancy index of the tissue specimen, etc. Since all these thresholds provide not absolute recommendations, but possible guidelines for surgical actions, the information used for intraoperative decision-making should consider the details of the individual case and include probabilistic statistical analysis based on the feedback from the multicenter databases. Development of such comprehensive support system for intraoperative decision-making carries significant potential to improve surgical results in the future.