Proceedings of the conference Terminology and Artificial Intelligence 2015 (Granada, Spain) 17 Ontologies for terminological purposes: the EndoTerm project Sara Carvalho Christophe Roche Rute Costa NOVA CLUNL Condillac Research Group NOVA CLUNL Department of Linguistics LISTIC Department of Linguistics Faculty of Social Sciences and Université de Savoie Faculty of Social Sciences and Humanities Mont Blanc Humanities Universidade NOVA de Lisboa Campus Scientifique Universidade NOVA de Lisboa Avenida de Berna, 26-C 73376 Le Bourget du Lac Avenida de Berna, 26-C 1069-061 Lisboa Portugal France 1069-061 Lisboa Portugal and christophe.roche@univ-savoie.fr rute.costa@fcsh.unl.pt School of Technology and Management University of Aveiro R. Com. Pinho e Freitas, 28 3750-127 Águeda Portugal sara.carvalho@ua.pt operationalization of terminologies, i.e. a compu- Abstract tational representation of their concept system, has become increasingly important. In this re- In today’s digital society, characterized by the Semantic Web and by Linked Data, ontologies, spect, ontologies, in the sense of Knowledge En- in the sense of Knowledge Engineering, have gineering (KE) – “a formal, explicit specification paved the way for new perspectives for Termi- of a shared conceptualization”3 –, constitute, ac- nology, namely in what concerns the operation- cording to Roche (2015: 129), “one of the most alization of terminological products. The promising paths towards operationalizing termi- collaborative work involving Terminology and nologies”. Granting a key status to ontology in ontologies has led to the emergence of new the- terminology work implies, nevertheless, rethink- oretical perspectives, one of which being Onto- ing Terminology’s theoretical and methodologi- terminology. This approach aims to reconcile cal principles and acknowledging the existence Terminology’s linguistic and conceptual dimen- of a double dimension – linguistic and conceptu- sions whilst maintaining their fundamental dif- ferences and, in addition, enables the al – that may enhance Terminology’s role as a construction of a computer-readable representa- scientific discipline in its own right. tion of a given conceptualization. Bearing this In the recent years, this joint work involving in mind, this paper presents the EndoTerm pro- Terminology and ontology has led to the devel- ject, a multilingual resource within the medical opment of numerous resources in various areas domain – with as the core of knowledge, one of them being Medicine. The concept – that comprises both verbal and non- current challenges concerning the way medical verbal representations and that can be computa- information and knowledge are produced, used, tionally represented and manipulated. The stored and shared require efficient and reliable presentation of micro-concept systems based on these verbal and non-verbal representations will support a reflection upon the role of the latter in 3 terminology work. Even though Gruber’s definition – “explicit specification of a conceptualization” (1993: 199) – prevails in the litera- ture as the most widely quoted, for the purpose of this pa- per, ontology in the sense of KE will be regarded bearing in 1 Introduction mind Studer et al.’s proposal (1998) quoted above, as it introduces three critical features: the fact that this specifica- Today’s digital society has paved the way for tion should be explicit, i.e. the type of concepts used and the new perspectives and opportunities for Termi- constraints on their use are explicitly defined, and formal, nology. In a context characterized by the Seman- i.e. machine-readable; and that the conceptualization should be shared, i.e. an ontology should capture knowledge that is tic Web1 and by Linked Data2, the need for the consensual among a given community. These authors have merged Gruber’s definition and the one put forward by 1 Berners-Lee et al. (2001); Shadbolt et al. (2006). Borst (1997) – “a formal specification of a shared conceptu- 2 Berners-Lee (2006); Bizer et al. (2009) alization”. For further information, see Guarino et al. (2009) Proceedings of the conference Terminology and Artificial Intelligence 2015 (Granada, Spain) 18 solutions, in a society that demands immediate non-verbal representation, as well as on the input and multi-platform access to all digital content. of subject field experts, a set of conceptual maps eHealth, defined by the World Health Organi- will be put forward. The final section will consist zation (WHO) as “the cost-effective and secure of some concluding remarks. use of information and communications technol- ogies in support of health and health-related fields, including health-care services, health sur- 2 Terminology and ontology veillance, health literature, and health education, knowledge and research”4, has been considered a 2.1 Terminology’s double dimension top priority by national and international institu- tions worldwide, with several action plans and This approach, which encompasses both a lin- programs focusing on expert collaboration, pa- guistic and conceptual dimension that are interre- tient empowerment and interoperability5. lated, has been more recently described by In order to be achieved, these and other goals Roche (2012, 2015), Costa (2013) and Santos & may greatly benefit from the input provided by Costa (2015). According to Roche (2015: 136), an approach combining the operationalization Terminology is “both a science of objects and a potential of ontologies with Terminology’s vital science of terms”. For Costa (2013), it is precise- contribution to specialized knowledge as regards ly this double dimension, and the study of the its representation, organization and dissemina- relationship between one and the other that tion. makes Terminology assume its role as an auton- In short, this paper aims to reflect on the role omous scientific subject. of ontologies in supporting the creation of con- This double dimension approach implies, cept systems for terminological purposes, partic- therefore, that both the experts’ conceptualiza- ularly in the subject field of Medicine. Within tion of a given subject field and the discourses Medicine, special attention will be given to Ob- produced by them must be taken into account. stetrics and Gynecology, namely to the concept The cornerstone of this approach lies in the com- of 6 , a chronic, inflammatory plementarity of these two fundamentally differ- disease of gynecological nature that is yet rela- ent dimensions. Understanding the relationship tively unknown, even among the expert commu- between the two dimensions is crucial in termi- nity. nology work, as it will contribute to define a This paper will be structured as follows: sec- methodology that will not compromise the main tion 2 will focus on the theoretical background, goal of a terminological project as it is under- specifically in what concerns Terminology’s stood in this paper, which is to represent, organ- double dimension perspective and the notion of ize and share the knowledge from a domain, Ontoterminology. Section 3 will be dedicated to based on the way it is conceptualized by a com- the role of ontologies and/or terminological sys- munity of experts. tems in the biomedical domain. Section 4 will Consequently, it is believed that experts are provide a brief overview of the EndoTerm pro- indispensable to terminology work, working col- ject, presenting a case study around the concept laboratively with the terminologist in the differ- of , a ent steps of the project, in order to identify the type of surgery currently being used within the key concepts of the subject field, as well as the context of endometriosis. Based on verbal and way they relate to each other and how they are represented (cf. Costa et al., 2012) 4 Nonetheless, and bearing in mind what was http://www.who.int/healthacademy/media/WHA58-28- en.pdf (30.07.2015) described in the introductory section, it is of par- 5 As an example, the successful implementation of interop- amount importance that the terminological prod- erable Electronic Health Records (EHR) and ePrescription ucts may, at some point, be operationalized, i.e. systems is one of the pivotal elements of the eHealth Action have a computational representation, and thus a Plan 2012-2020, developed by the European Commission and available at: https://ec.europa.eu/digital- more effective impact on the everyday life of the agenda/en/news/ehealth-action-plan-2012-2020-innovative- different target groups within the various subject healthcare-21st-century (30.07.2015) fields. 6 Throughout this paper, concepts will be capitalized and The rising interest in the aforementioned con- written between single chevrons, whereas terms will be ceptual and linguistic dimension, as well as in presented in lower case and between double quotation marks (Cf. Roche, 2015) the subsequent synergies involving Terminology Proceedings of the conference Terminology and Artificial Intelligence 2015 (Granada, Spain) 19 and ontologies has led to the emergence of new domain, and the experts can – and should – play theoretical perspectives7, one of which being On- a critical role in advising the terminologist as to toterminology. the texts that are deemed representative and/or mandatory in a given area. Access to both linguistic and extra-linguistic 2.2 Ontoterminology: a new approach to knowledge is essential to any terminological pro- Terminology? ject, provided the text selection is supported by Proposed by Roche et al. (2009), Ontoterminol- rigorous criteria and the methodology/-ies used ogy aims to reconcile Terminology’s linguistic are consistent with the type of resource being and conceptual dimensions while maintaining created, its purpose(s), target group(s) and re- their fundamental differences. Defined as a “ter- spective needs9. minology whose conceptual system is a formal Instead of making them incompatible, the On- ontology” (Roche et al., 2009: 325), this ap- toterminology approach aims to integrate the proach considers the conceptualization of a given linguistic and the conceptual dimensions whilst subject field as the starting point of any termino- preserving their core identities. This is visible in logical project, thus corroborating ISO 704’s Roche’s (2012) extension of the classical seman- view that “producing a terminology requires an tic triangle by Ogden and Richards (1923), called understanding of the conceptualization that un- the “double semiotic triangle” (Figure 1). derpins human knowledge in a subject area” (2009: 3). As mentioned in 2.1, the expert plays an es- sential role throughout the process. However, Roche (2007) believes there may be risks inher- ent to the extraction of ontologies directly from texts, since very often, and due to inconsisten- cies, ellipses, metaphors and other phenomena, the lexical networks extracted from texts may not Figure 1: Double semiotic triangle (Roche, 2012) match the conceptual systems created with the In this diagram, it becomes clear that even help of the experts – hence, the discourse about though both dimensions are present in on- knowledge should not be confused with toterminological projects, they rely on two dis- knowledge itself: “Saying is not Modelling” tinct semiotic systems and should therefore not (2007). be confused. By separating signified (meaning) This is not to say, though, that natural lan- and signifier (term) – related to Linguistics and guage should be excluded from terminology natural language – from the concept and its name work. In fact, “to conceptualize one must verbal- (identifier) – part of a formal system, Ontotermi- ize” (Roche, 2015: 149). Resorting to specialized nology acknowledges a distinction between the texts is indeed relevant8, although it must be tak- definition of the term, written in natural lan- en into account that texts do not contain concepts guage, and the definition of the concept, written per se, but the linguistic usages of the terms that in a formal language10. designate them. All in all, specialized texts con- This distinction can be particularly important stitute an invaluable resource to the terminolo- in subject fields where concepts can be both rep- gist, especially in their first contact with a given resented and defined in a non-verbal way11. Med- 7 9 “Termontography” has been developed by the CVC in Santos & Costa (2015) advocate a mixed methodology in Brussels within the scope of the FF Poirot European Project terminological work (onomasiological and semasiological), and seeks to integrate ontologies in terminology work by although they argue that the order “is not arbitrary” (p. 176). combining Ontology Engineering, Terminography and Cor- For knowledge representation purposes, a concept-based pus Linguistics (Kerremans et al. (2004); Kerremans & approach may constitute a more adequate starting point. 10 Temmerman (2004); Temmerman & Kerremans (2003)). The formal language supporting concept definitions Despite the fact they do not share the same goals and are should allow these to be objective (not depending on an based on a different theoretical and methodological frame- individual interpretation), consistent and constructive (al- work, comparing these approaches is not the purpose of this lowing the conceptualization to be computationally manipu- paper. lated) (Roche, 2015). 8 11 And, in some cases, even indispensable, especially in the A more thorough analysis on the role of the non-verbal in legal field, where texts are the pillar of expert knowledge terminology and knowledge representation may be found, and communication (see Costa et al. 2011, 2013). for instance, in Galinski & Picht (1997); Picht (1999, 2011); Proceedings of the conference Terminology and Artificial Intelligence 2015 (Granada, Spain) 20 icine is one of such domains: Figure 2 depicts the 3 Terminological resources in Medicine female reproductive system of a woman suffer- ing from endometriosis, and it includes the ex- As mentioned above, Medicine is currently un- tent and location of the disease in terms of dergoing significant changes in what concerns lesions and adhesions. the production, use, storage and dissemination of medical information and, subsequently, medical knowledge. Nowadays, it is somewhat difficult to conceive – at least in some parts of the world – the practice of medicine without computerized medical records, prescriptions, examinations or even procedures, especially with the advent of robotic surgery. Due to the increasing needs and challenges that have characterized this area over the last few decades, a new discipline has emerged, in the confluence of Information Science, Computer Science and Healthcare: Health Informatics has been defined as “the interdisciplinary study of the design, development, adoption and applica- Figure 2: Stage-IV endometriosis (Classification of Endometriosis by the American Society for tion of IT-based innovations in healthcare ser- Reproductive Medicine, 1997) vices delivery, management and planning14.” In order to facilitate the computer-based pro- Far from seeing a mere illustration, a subject cessing and exchange of medical or clinical in- field expert would immediately recognize a case formation among all the stakeholders, that of Stage-IV (severe) endometriosis. Rather than information is represented and organized via a being regarded as signs from a Saussurean per- number of terminological products, often spective, the terms that can be identified here grouped under the notion of “terminological sys- (“peritoneum”, “culdesac”, “deep endo”, “com- tem”, with several typologies having been pro- plete obliteration”, “dense adhesions”, etc.) posed throughout the years (see Table 1). should be perceived as signs in the sense of Wil- ISO EN liam of Ockham, for whom a sign is “tout ce qui, Keizer et 17115 12264 Duclos et al. (2000) al. (2014) étant appréhendé, fait connaître quelque chose (2007) (2005) d’autre” (cf. 1988: 7)12. classification ✓ ✓ ✓ ✓ coding The potential of the ontoterminological ap- system ✗ ✓ ✗ ✓ proach, supported by the acknowledgement of coding ✗ ✓ ✓ ✗ Terminology’s double dimension, provides an scheme nomenclature ✓ ✗ ✓ ✓ opportunity to make a contribution to the subject ontology ✓ ✗ ✗ ✓ field of Medicine, in particular to , allowing the creation of EndoTerm, a multi- terminology ✓ ✓ ✓ ✓ thesaurus ✓ ✗ ✓ ✓ lingual resource that comprises both verbal and vocabulary ✓ ✗ ✓ ✓ non-verbal representation and that can be com- putationally represented and manipulated13. Table 1: Typologies of terminological systems. Used by the ISO/TC215 “Health Informat- ics”, this umbrella term is characterized as a “set Madsen (forthcoming); Roche (forthcoming); Prieto- of designations within the domain of health care Velasco (forthcoming). with, when appropriate, any associated rules, 12 It is clear that, on the one hand, we do find terms in dis- relationships and definitions” (ISO 1828: 2012). course that give rise to the construction of meaning – a sig- Albeit relevant, this definition does not fit the nifié in the Saussurean sense, i.e. they acquire value in discourse. On the other hand, and as signs, terms also have purposes of this paper and the project it aims to the capacity to exist outside of discourse (Ockham’s per- present, as it does not address the conceptual di- spective), pointing towards the concept and thus providing 14 access into the specialized domain. U.S. National Library of Medicine. Available in: 13 A first glimpse of which can be see in Section 4. https://www.nlm.nih.gov/hsrinfo/informatics.html Proceedings of the conference Terminology and Artificial Intelligence 2015 (Granada, Spain) 21 mension of terminological resources and, hence, 3.1 Endometriosis: facts and figures their ongoing evolution from “simple code- Endometriosis is defined as “the presence of en- name-hierarchy arrangements, into rich, dometrial-like tissue outside the uterus, which knowledge-based ontologies of medical con- induces a chronic, inflammatory reaction” cepts”, as noted by Cimino (2001)15. (Kennedy et al., 2005). The exact prevalence of Concept orientation has been presented in the the disease is unknown, but it is believed to af- literature as one of the key principles underlying fect an estimated 176 million women of repro- the creation of today’s (bio)medical terminologi- ductive age worldwide (Adamson et al., 2010). cal resources (see, for example, Chute et al. While its etiology is uncertain, it is likely to be (1996); Coiera (2003); Duclos et al. (2014); multifactorial, including genetic, immunological, etc.), and was, in fact, one of the twelve require- endocrinological and environmental influences. ments, also known as desiderata, that Cimino Women with endometriosis typically have a (1998) believed should support all terminological range of pain-related symptoms, such as dys- systems within the medical context in the 21st menorrhea, dyspareunia, dyschezia, dysuria, century16. non-cyclical pelvic pain, as well as chronic fa- In recent years, many (bio)medical termino- tigue (Dunselman et al., 2014). A recent study logical resources have been designed or rede- conducted in 10 countries throughout the world signed, in order to incorporate ontology-based has reported an overall diagnostic delay of 6.7 elements, such as formal concept definitions, years (Nnoaham et al., 2011). Moreover, the which, in turn, will enable both the operationali- World Endometriosis Research Foundation zation and the aspired interoperability in this (WERF) EndoCost study (Simoens et al. (2012) field. Yet each resource serves a specific pur- has shown that the costs arising from women pose, which, in turn, determines their epistemo- with endometriosis treated in referral centers are logical principles, core structure, the substantial (an average annual total cost per organization of the various concepts, as well as woman of €9579), an economic burden that is at the language(s) of expression. least comparable to the costs of other chronic One of the initial stages of the EndoTerm pro- diseases, such as diabetes, Crohn’s disease, or ject included extensive research of a set of repre- rheumatoid arthritis. sentative (bio)medical resources (e.g. Surgical procedures play a key role in the di- International Classification of Diseases (ICD), agnosis and treatment of the disease and are of- Medical Subject Headings (MeSH), Human Dis- ten depicted in the form of videos, which is why ease Ontology (DOID), Unified Medical Lan- they were chosen as the focus of the case study guage System (UMLS)), to be used as a starting to be presented in Section 417. point in the creation of a thorough concept map of the domain in question. One of the following subsections will contain an example of one of 3.2 Endometriosis in SNOMED-CT these resources and its respective results con- cerning , namely the Systema- The Systematized Nomenclature of Medicine – tized Nomenclature of Medicine – Clinical Clinical Terms (SNOMED-CT) is a comprehen- Terms (SNOMED-CT). Firstly, however, it is sive, multilingual healthcare terminology, result- important to contextualize the concept of depar- ing from the merge of the Systematized ture within our research project. Nomenclature of Pathology (SNOP), published by the College of American Pathologists, and the Clinical Terms Version 3 (former Read Codes), designed by the UK’s National Health Service18. When implemented in an application, and due to the Description Logic foundation of this tool, 15 It should be mentioned, though, that the boundaries SNOMED-CT enables the representation of clin- among these different types of resources have become more and more blurred, in such a way that the term “ontology” is 17 often being used indistinctly to refer to all of them. Grabar Laparoscopy plus histology of resected endometriosis is, et al. (2012: 376-377) list several examples from the in fact, considered the “gold standard” in the diagnosis of (bio)medical domain that illustrate “the lack of precise dis- this condition (Dunselman et al., 2014). 18 tinction among semantic resources in the literature”. It is currently owned and distributed by the International 16 Check Cimino (1998, 2006) for further information on the Health Terminology Standards Development Organisation Desiderata. (IHTSDO). Proceedings of the conference Terminology and Artificial Intelligence 2015 (Granada, Spain) 22 ical content in electronic health formats (e.g. EHR) in a consistent, reliable and computer- readable way19. The building blocks of this resource are the: i) concepts, representing clinical meanings and organized into hierarchies, ranging from general to specific (with 19 top-level concepts); ii) de- scriptions, which link appropriate human- readable terms to concepts; and iii) relation- ships, connecting concepts to other related con- cepts20. Each one of these three components has Figure 3: in SNOMED-CT (adapted their own unique numeric identifier. Figure 3 from http://browser.ihtsdotools.org) illustrates the results obtained for in SNOMED-CT. It should be noted that the subtype concepts In the blue box on the top left corner, it can are mainly related to the different organs or body be seen that is the parts where the disease can be located (e.g. blad- concept name, and it coincides with the so-called der, intestine, etc.). There are further subdivi- Fully Specified Name (FSN), whereas “Endome- sions in some of the Children that have not been triosis (clinical)” is the preferred synonym and included due to space constraints. “Endometriosis” the acceptable synonym. The The final diagram represents the two types of Parents and Children elements refer to the “su- concept relationships associated to , distinguished by colours and question, linked via |Is a| relationships. types of arrows. The purple concept is an upper- level SNOMED-CT concept, linked to the initial concept by a |Is a| relationship. The yellow bub- bles display an attribute relationship [has Asso- ciated morphology] and [has definitional manifestation] between the initial concept and and , respectively. 4 Terminology and Knowledge Organi- zation 4.1 The EndoTerm Project As previously mentioned, the EndoTerm project aims at the creation of a multilingual21 termino- logical resource based around the concept of . This will be destined to future experts and to experts of other, related domains, mainly for training purposes. One of the objec- tives is to integrate the resource in an e-learning platform. Since there are very few specialized texts about this disease in European Portuguese (EP), as most experts publish in English, it is believed 19 a contribution could also be made to enrich the For more information, see: http://www.ihtsdo.org/snomed- domain terminology in EP and, simultaneously, ct; https://elearning.ihtsdotools.org 20 The relationships in SNOMED-CT express defining char- to improve linguistic quality criteria, which, in acteristics of a concept and they can be divided into: a) subtype hierarchy relationships (Is a); or b) attribute rela- tionships, which have a particular value provided by another 21 concept, i.e. procedure concepts are linked, for instance, to In English, European Portuguese and French. German certain sites. might be included at a later stage of the project. Proceedings of the conference Terminology and Artificial Intelligence 2015 (Granada, Spain) 23 the future, might be applied to other projects in- Based on information provided by textual volving information retrieval. sources, some of which cited below, by the Although the inclusion of both verbal and aforementioned video article and others on the non-verbal elements had already been foreseen same topic, as well as by the feedback from two in the project, due to the importance of the latter senior expert gynecologists who are also sur- in this particular subject field, the group of ex- geons, a concept modeling proposal based on perts that have been collaborating in this endeav- was created using a software our suggested the analysis of a type of resource environment for concept system building called that is becoming more and more important with- OTe (Ontoterminology engine) Soft, supported in the medical community: the video article22. by ontoterminological principles (see Section By combining verbal (narration from the ex- 2.2.). pert(s), slides with text, etc.) and non-verbal el- Designed by the Condillac research team26, ements (2D or 3D images, animations, surgery this tool has a clear concept orientation, even footage), video articles constitute a noteworthy though the user can also incorporate terms and, resource to take into account in the light of Ter- thus, the linguistic dimension. OTe Soft is struc- minology’s double dimension. As a new type of tured around concepts, perceived as knowledge scholarly communication that seems to be here to of a plurality of things that “help organize reality stay, its inclusion in a specialized corpus in a by grouping similar objects through what they medical terminology project may become inevi- have in common (Roche, 2015) (e.g. ). One or more terms may be assigned to retical and methodological challenges. each concept, in various languages: i) natural (e.g. “laparoscope” (EN); “laparoscope” (FR); etc.; or ii) formal (e.g. programming language). 4.2 : the case study In addition, a concept may be qualified by attrib- The case study presented in this paper is based utes, which have a given value, and be assigned on a video article entitled “Single port laparos- one or more instances, also called “things”, i.e. copy”23, which portrays a gynecological proce- representations of elements in reality (Check dure – in this case, a hysterectomy, commonly Figure 6). seen as a last resort in cases of severe endometri- Concepts are linked to each other via concept osis – using a relatively recent type of surgery relations: subsumption (is_a) (generic) and com- called single port laparoscopy. position (part_of) (partitive) are presented by The further study of the concept pointed towards a lack of termino- ate new concept relations, as long as the logical logical consensus among the expert community. principles are maintained (e.g. two concepts can- In fact, more than 20 acronyms used to designate not be linked by the instance of relation)27. These this concept have been identified in the litera- relations are represented by different colours, in ture24. order to facilitate the graph’s visual readability. In order to solve this problem, a multidisci- The final “product” is called model, or semantic plinary medical consortium 25 gathered in 2008 network, which can be exported in various for- and decided that the term “laparoendoscopic sin- mats (json, RDFS or OWL). gle-site surgery” (also known as LESS surgery) The following figures (4, 5 and 6) present ex- most accurately depicted the surgical procedure amples of micro-concept maps built around the in question. concept of : due to possible vis- ual constraints, only partial views are shown here. The first micro-map (Figure 4) aims to po- 22 For a more detailed description of this new type of re- source, see Carvalho et al. (forthcoming). 23 Available at: http://www.fertstert.org/article/S0015- 26 0282%2812%2900387-1/fulltext www.condillac.org 24 27 See Box et al. (2008), Gill et al. (2010), Autorino et al. One of the challenges of creating a concept-modeling (2011), Rao et al. (2011), Sarkissian & Irwin (2013), Mori proposal lies, in fact, in defining other types of concept (2014), Naitoh (2014). relations that do not fall under the generic or partitive cate- 25 Called the Laparoendoscopic Single-Site Surgery Consor- gories. The ISO standards (1087-1:2000 and 704: 2009) tium for Assessment and Research (LESSCAR), that pub- lack diversity and systematisation, by classifying all the lished a consensus statement with the main conclusions of remaining relations as “non-hierarchical” (cf. Nuopponen that meeting (Gill et al., 2010). 2011, 2014). Proceedings of the conference Terminology and Artificial Intelligence 2015 (Granada, Spain) 24 sition within the broader con- not yet allow the user to upload external re- cept of . sources (e.g. images, videos, diagrams, etc.)29. Figure 5 explores the types of umbilical inci- sions that may occur in a LESS surgery, being that the single incision in the umbilicus (navel) is regarded by the expert community as the essen- tial characteristic of the concept, i.e. the charac- teristic which makes the concept what it is and constitutes its essence (cf. ISO 1087-1: 2000). In this figure, the metaphoric use attributed to the should also be emphasized. Figure 4: The concept of Figure 5: Types of There is a first subdivision presenting and as Figure 6 contains a more detailed insight on subordinate concepts of . In the latter the types of laparoscopes that exist, one of which subtype, the subsequent hierarchy-based model- - - is currently be- ing was constructed through specific differentia- ing used to perform LESS surgeries. In this case, tion, bearing in mind the Aristotelian definition the EndoEYE is presented as an instance of this of genus + differentia28: i) with/without external concept. incision; ii) with one incision/with more than one incision. Besides other advantages, such as the operationalization potential mentioned before, this concept modeling strategy constitutes a val- uable starting point for the terminologist in the construction of natural language definitions. On the upper left side, the linguistic dimen- sion is also visible, and it includes the terms as- sociated to the concept. In this case, it was decided to list some of the synonyms of the concept identified in the literature: Single- Incision Laparoscopic Surgery – SILS; Single- Site Laparoscopy (SSL); Single-Port Access (SPA); Single-Port Laparoscopy (SPL). Alt- hough the image does not show that, the user has the possibility of navigating through the concept network via concepts, terms, or relations. The three images in Figure 4 were added afterwards, as the current version of the OTe Soft tool does Figure 6: Types of 28 These, along with other Aristotelian categories, are ex- 29 plored in Porphyry’s Isagoge (2003). This also applies to the images in the remaining figures. Proceedings of the conference Terminology and Artificial Intelligence 2015 (Granada, Spain) 25 There is also a basic distinction within the Berners-Lee, T. (2006). Linked Data. Retrieved April 20, expert community between flexible and rigid 2014, from http://www.w3.org/DesignIssues/LinkedData.html laparoscopes, as depicted by the map. Berners-Lee, T. et al. (2001). The Semantic Web. Retrieved 5 Concluding remarks March 14, 2014, from http://www.cs.umd.edu/~golbeck/LBSC690/SemanticWe As a scientific discipline in the confluence of b.html several others (e.g. logic, information science, Bizer, C. et al. (2009). Linked Data - The Story So Far. cognitive sciences, linguistics, etc.), Terminolo- International Journal on Semantic Web and Information gy brings an unquestionable added value not on- Systems (IJSWIS), (Special Issue on Linked Data). ly to the study of specialized language in various subject fields but, ultimately, also to the study of Box, G. et al. (2008). Nomenclature of natural orifice how knowledge is represented, organized and translumenal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS) procedures shared among a community of practice. in urology. Journal of Endourology, 22(11), 2575–2581. Nowadays, though, that contribution can only be further enhanced if the results of terminologi- Carvalho, S. et al. Why read when you can watch? Video cal work can be operationalized, i.e. represented articles and knowledge representation within the medical domain. In Proceedings of the 2015 TOTh Conference in a computational format. 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