Presentation ORL / CMF 2008

ORL & Maxilo Facial

MAG 2008

· Une resection plus complète des tissus malades (ex: Polype) Le chirurgien peut

etre plus “agressif” avec une navigation

· Un taux de 2nd operation diminué

Pourquoi utiliser la navigation en ORL?

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· Un taux de 2nd operation diminué

· Evite les complications chirurgicales

· Augmenter la sécurité et l´efficacité dans le geste

· Extrement utile si un repère anatomique a été enlevé lors d´une chirurgie

précédente

A propos de BrainLAB

Technologie et plateform

Logiciel de plannnification pre-opératoire

Logiciel de navigation per-opératoire

Sommaire

MAG 2008

BrainLAB

• 3,000 hopitaux utilisant des logiciels

BrainLAB

• Clients dans plus de 75 pays

• 1000 employés dans 16 bureau de par

le monde

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New BrainLAB headquarters in Feldkirchen near Munich

• 230 ingénieurs R&D

• 200 Ingénieurs services

• 3,300 Logiciels installés

• Plus de 350 installations en ORL et CMF

• Nouveau developpement pour la

plannification Maxilo facial depuis 2005

2005

2006

Laser-based surface registration

FiberTracking

2008

2007

Novalis® Tx

Integrated Neuroscience Center

Etapes de developpement

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1990

1993

1997

1998

2003Integrated radiosurgery system

Cranial planning & navigation

BrainSUITE® iMRI

BrainSUITE® iCT

3D visualization software

2001

Stereotactic radiosurgery hardware

Centre de Neuroscience integré

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Debloquer les possibilités pour les patients et le staff

Oncologie

Neurochirurgie

Salle op integré

Rachis & Trauma

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Orthopédie

Radiologie

Pharmaceutique

ORL

Imagerie Intra-operatoire– 1.5T iMRIBrainSUITE® iMRI sallle d´opération integré

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• Enregistrement automatisé du patient et transfert des scans inter-opératoires.

• Integration de la gestion des données et visualisation permettant d´améliorer le processus

de decision

• Opérations en dehors de la ligne de 5 Gauss utilisant des instruments chirurgicaux

normaux.

Negatoscope numérique – Digital Lightbox

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Sommaire

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Technologie a marqueurs passifs

Technique

• Camera envoie des signaux infrarouge

• Les spheres reflechissantes reflechis le signal

• La camera recoit le signal en retour

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Votre bénéfice

• Localisation précise de tous les instruments sans erreur

• Pas de d´emmetteur ou recepteur supplémentaire

Tous les systèmes utilisent

• Techonolgie avec marqueur passif

• Les memes fonctionalités logicielle

Platformes

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Sommaire

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• Landmark based definition of Frankfort

Horizontal and Midsagital Plane in 2D

and 3D.

• Dataset is aligned to defined Planes

• Planes and Alignment necessary to be

Logiciel de plannification pre-opératoire iPlan1st step: Frankfort Horizontal

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• Planes and Alignment necessary to be

able to mirror the segmented objects

from healthy to defect side

Benefit: Fast and easy definition of planes for mirroring and alignment of the dataset

• Several methods of Segmentation:

•Semiautomatic Segmentation

•Segmentation Slice by Slice with

Brush

•Using of Seed Brush (segments

2nd step: Segmentation of objects

Logiciel de plannification pre-opératoire iPlan

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•Using of Seed Brush (segments

areas with same Houndfield units)

• Semi-automatic segmentation as

fastest option to segment bony

structures.

Benefit: Several options of segmentation depending on preferences and indication.

• Segmentation by definition of region of

interest in each view

• Only the red highlighted structures will

be segmented

• Changing of Houndsfield Units until

2nd step: Semiautomatic Segmentation


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• Changing of Houndsfield Units until

structures of interested are highlighted

red

Benefit: Most time saving and easiest option of Object Segmentation which is superior over time consuming standard segmentation slice by slice

• Healthy side is used as template for

defect side.

• Object is mirrored at the prior defined

Midsagital plane

3rd step: Mirroring of segmented objects


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Benefit: Time saving creation of templates for reconstruction of defect side

• The copied object can be moved in any

direction

• The movement is done in the 2D views

Indication: Movement of fragmentsMovement of copied objects

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• Semiautomatic Image Fusion – also for

postoperative control

Résumé de la plannification pre-operatoire

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• Definition of Midsagital

• Semiautomatic Segmentation

• Advanced Object Planning (Mirroring)

Particularité BrainLAB: La plannif maxilo faciale

• Frankfort Horizontal alignment brings the patient’s head in a natural position.

• In most cases only one part of the face is affected -so we can use the remaining as a contour template. => Use of miroring function

• If both sides are affected, the Software can be used as planning tool for

repositioning of big fragments or to plan a model of an implant which can be

exported with a STL –Export (next Version).

• Another major field is implanting of dental. It is possible to plan them with trajectories

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• Another major field is implanting of dental. It is possible to plan them with trajectories

and dental implants can be imported and planned via STL-Import (next version)

• With iPlan CMFsurgeons can plan the intervention safe different states and come

back later for refinements.

• Now they can virtually plan the treatment or try out new reconstructive techniques

without touching the patient.

• With the support of an atlas they don‘t need to outline typical structures, iPlan makes

it as easy and fast as possible to generate a treatment template• With the support of our navigation systems the reconstructions are more precise and more accurate than before. Now the surgeon can operate in areas where that he

wouldn‘t have touched without the support of BrainLAB‘s advanced technology.

Workflow – 4 étapes pour la navigation per-opératoire

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Navigation per-opératoire

Sommaire

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Navigation per-operatoire

• Utilization of preoperative scans –

no navigation scan necessary

• No fiducials necessary

1st step: Preoperative Scan

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Benefit: Reduction of radiation dose for patient

Non-invasive referencing with

headband - generally used for

sinus surgery in ENT

2nd step: Intraoperative preparation – Patient reference star


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Minimal invasive referencing in

bone structure - generally used

for skull base surgery, lateral

indications or CMF cases

Benefit: Referencing according to needs and indication.

• Surface scanning with a laser

• No given registration points or registration routes

• Registration accomplished in one minute

• Registration possible in a sterile environment

3rd step: intraoperative registration


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Benefit: Touchless registration saves sterile environment.

4th step: Navigation


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Benefit: Time saving setup and workflow as well as advanced functionalities

• Simple integration of all instruments

• Different geometries of stars and

adapter clamps fit on every

instrument

4th step: Instrument integration


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Benefit: Fast integration of every rigid instrument available in the OR

Image integration


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Benefit: Video integration endoscope and micorscope as well as image injection in microscopes

Eraser

• Virtual anatomical update of structures

• Tip of instrument is tracked

• Removed tissue can be visualized

Advanced features

Intraoperative Imaging

• Ultrasound integration

• IGSonic as fully integrated ultrasound

device


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virtually

• First step to real intraoperative imaging

Benefit: From essential navigation to unlimited functionalities

• Other imaging devices like C-arms

• Platforms according to needs

• Data acquisition

Résumé de la navigation per-opératoire

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• Data acquisition

• Referencing

• Registration

• Navigation and Integration

Conclusion

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Conclusion

BrainLAB offre une solution pour la navigation et la plannification ORL

La plannification CMF est une option de la partie ORL

BrainLAB est le seul vendeur majeur proposant une véritable

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BrainLAB est le seul vendeur majeur proposant une véritableplannification CMF, prenant en compte les implants

La plannification et la plateforme de navigation sont concuespour recevoir d´autres spécialités (Neuro, ortho, Etc.)

…merci!

MAG 2008

Presentation ORL / CMF 2008

Health & Medicine

Transcript of Presentation ORL / CMF 2008