35 2 Mobile applications in gastrointestinal surgery: a systematic review INTRODUCTION The use of smartphones and mobile application software (apps) is deeply integrated into society and their potential is being increasingly recognized in healthcare. In the past decade, the development of healthcare apps has rapidly increased, with the intention of providing medical solutions to some extent. At present, over 400.000 healthcare apps are available for download in mobile app stores worldwide.1 To date, the number of apps used in gastrointestinal surgical care is limited compared with that in other surgical disciplines.2 This may change rapidly. Apps are believed to offer great possibilities to support or improve gastrointestinal surgical care, and overall healthcare is on the lookout of the smart use of digital solutions in times of limited resources. Apps may facilitate patients, healthcare providers (HCP), or both. Apps have the potential to improve information provision, communication between patients and HCP, clinical decision-making, perioperative guidance and monitoring, and education/training. In addition, apps may be used to register clinically relevant variables as apps can be developed to connect with sensors or other measurement devices such as a camera, an activity tracker, a biosensor, or a blood pressure monitoring device.3,4,5. The use of apps in healthcare is not without controversy or debate.6,7 As apps may influence patient-reported or clinical outcomes, they must be properly developed and validated. Apps or software in general to be used as a medical device must comply with standards as described by the European Medical Device Regulation (MDR) or the American Food and Drug Administration (FDA), safeguarding the quality and safety of the app.8,9 However, the distribution of apps is limitedly regulated by the app stores, with minimum supervision on whether these specific legislations are indeed met. Even if they are met, it is not guaranteed that the use of the app will lead to valid and reliable results across situations and user settings.7,10 For that, scientific research validating apps with welldesigned research protocols is required. To date, a clear overview of properly validated gastrointestinal surgical apps is lacking. Therefore, this systematic review focuses on the following research questions: (1) Which apps that are used in gastrointestinal surgical care have been described in literature? (2) Are these apps clinically evaluated on objective outcomes and able to improve gastrointestinal surgical care?
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