1. Digital OR: How UKE is realizing the operating room of the future

• From Vision to Standard Operation
• Security Through Isolation
• More Than Telemedicine: Efficiency and Flexibility at the Operating Table
• Modernization with Foresight: Construction, Hygiene, and Workflow Planning
• Financing and Economic Viability
• Data Integration and AI Potential

The University Medical Center Hamburg-Eppendorf (UKE) is a pioneer in Germany in establishing fully digitally networked operating rooms. What began as a conceptual project has long been productive everyday life: the “digital OR” is a reality – with highly secure video routing systems, AI-based assistance functions, and a special network architecture that makes the facility both innovative and resilient against cyberattacks.

From Vision to Standard Operation

As early as 2016, the hospital began to conceptually address the digitalization of OR infrastructure. With the new construction of the Martini-Klinik and the Heart Center, it was an opportunity to implement a new system. The heart of the digital OR is a modular video routing system from manufacturer Caresyntax, based on Barco’s AV network technology. This infrastructure allows any video source – such as endoscopes, robots, X-ray or monitoring devices – to be centrally managed, controlled, and distributed in real-time. Instead of a multitude of incompatible interfaces, there are now only uniform standard connectors and encoders. This creates order, interoperability, and hygienic safety.

Moderne Operation im UKE (15 Bilder)

Die leistungsstarke Kamera muss gekühlt werden, um eine Überhitzung zu vermeiden. Gleichzeitig muss aus hygienischen Gründen verhindert werden, dass die Abluft des Kühlsystems in den sterilen Operationssaal gelangt. Deshalb befindet sich die Kamera in einer Kuppel, die als Barriere dient. (Bild:

Marie-Claire Koch / heise medien

)

Transmission is uncompressed via 10-gigabit fiber optic networks to rule out image delays (“delays”) in live surgical applications. Every movement of the endoscope must be traceable on the monitor without any time lag – a must for precise interventions, especially in the robotic surgery of the Martini-Klinik, one of the largest centers worldwide.

Between 72 and 96 fiber optic cables were laid per operating room, leading to central technical rooms. The actual hardware is installed there – away from hygienically sensitive areas and efficiently cooled. From there, the transition to internal servers and – if necessary – to video conferencing systems also takes place.

Security Through Isolation

A key feature of the UKE system is its complete physical network separation. The video network (“high-security zone”) is isolated from the internet; no data packets can penetrate outwards. However, to enable teleconsultations, teaching, or live broadcasts, UKE uses hardware video conferencing systems from Cisco that exclusively transmit audio and video data – no network connections. Secure, controlled conferences can be conducted via standardized SIP dialing, for example, via internally operated Cisco Meeting Servers, without third-party cloud services.

This architecture has proven its worth: during the CrowdStrike outage in 2024, which paralyzed clinics and airlines worldwide, UKE remained unaffected. The IT infrastructure, operated consistently on-premise, protected the facility from system failures – an example that IT security and digitalization do not have to be mutually exclusive.

More Than Telemedicine: Efficiency and Flexibility at the Operating Table

The digital OR is not a step towards remotely controlled surgery – quite the opposite. Surgeons always remain in the room; liability reasons prohibit remote control of medical devices. Rather, it is about information integration and workflows: The system bundles all image, video, and metadata in a uniform user interface. This includes:

• Visualization of live cameras, endoscopes, robotics systems, and radiological images
• Overlay of relevant patient data and records
• Control of recordings, split screens, or live broadcasts for teaching and research

The interfaces to the hospital information system (KIS) are designed to function independently of the provider – crucial, as UKE is currently migrating from Soarian to CGM Clinical.

A practical benefit is particularly evident in emergency surgery: if a second opinion is needed during an operation, a specialist colleague can join via video conference without the patient having to remain under anesthesia for a long time. Decision-making processes are drastically shortened.

Modernization with Foresight: Construction, Hygiene, and Workflow Planning

The technical implementation was an enormous logistical achievement. In the existing operating rooms, the retrofits were organized minimally invasively: only two operating rooms per weekend could be converted to the new infrastructure to avoid operational interruptions.

Each measure required air barriers, hygienic approvals, and tests of the laminar airflow system, which generates sterile air above the operating table. The effort was considerable – but necessary to meet the requirements for cleanliness and continuity.

Financing and Economic Viability

The project was largely made possible by funds from the Hospital Future Act (KHZG), which provides funding for digitalization and IT security. These funds covered the investment costs, but not the ongoing operation.

UKE bears the operating expenses itself – comparable to previous systems, but usually without significant additional costs thanks to an efficient architecture and better maintainability. The choice of manufacturer was also economically shrewd: Care Syntax, interested in a reference partnership, offered particularly competitive conditions.

Data Integration and AI Potential

UKE is one of the first hospitals in Europe with a fully digitally managed patient record (since 2009). This has led to an enormous internal data repository – a treasure that is now used by the spun-off IDM gGmbH for AI projects.

One of the first products of this initiative is “Orpheus,” a medically trained language assistance system that reliably recognizes medical terminology and documents it contextually – a significant work relief compared to generic dictation systems.

These AI projects are still independent of the digital OR, but they show where the journey is heading: towards an ecosystem in which surgical data, documentation, and intelligent assistance interlock.

The concept of the digital OR is now being adopted by other university hospitals – including those in Freiburg, Erlangen, and Kiel. However, the fact that UKE was able to gain comprehensive practical experience early on gives it an advantage.

(mack)

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This article was originally published in German. It was translated with technical assistance and editorially reviewed before publication.