Multisegmental gastrointestinal dysmotilities: a surgical scenario for future implementation of theranostic devices

<b>Aim:</b> Multisegmental gastrointestinal (GI) dysmotilities, such as chronic intestinal pseudo-obstruction, may lead to life-threatening events. The interdisciplinary INTAKT project is developing wirelessly communicating GI devices for intelligent sensor technology and electrostimulation-based motility modulation. However, a concrete vision of clinical implementation has not been previously described. <b>Methods:</b> An interdisciplinary team of surgeons, gastroenterologists, biologists, engineers, veterinarians and product designers developed a clinical scenario based on pre-clinical experiments, contextual analysis and usage scenarios. <b>Results:</b> The surgical experiences of our previous studies with conventional open, laparoscopic and robotic setups were analyzed. Patient selection, a surgical strategy and perioperative management are described in detail. <b>Conclusion:</b> Further technological solutions may enable first-in-human trials according to our protocol. The INTAKT study group developed a future clinical scenario for multisegmental theranostic devices in treating therapy-refractory multisegmental motility disorders of the GI tract. Electrophysiological feasibility and safety of surgical approaches were analyzed, including open, laparoscopic and robotic methods. Minimally invasive procedures demonstrated potential in reducing tissue trauma and offering advantages in intraoperative GI electrical recordings. Robotic surgical systems deemed most suitable for the proposed strategy, but the laparoscopic approach was considered more cost-effective for broader clinical application. Patient selection criteria for multisegmental GI motility disorders were outlined. A surgical strategy involves multisegmental implantation of theranostic devices after electrophysiological analysis to delay or avoid extensive GI resection or organ transplantation. Decision-making for device implantation or surgical resection is based on intraoperative electrophysiological statistics rather than symptom scores. Postoperative risks and limitations of future theranostic devices were acknowledged.