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ORL & Maxilo Facial
MAG 2008 Page 1
· 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?
MAG 2008 Page 2
· 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 Page 3
BrainLAB
• 3,000 hopitaux utilisant des logiciels
BrainLAB
• Clients dans plus de 75 pays
• 1000 employés dans 16 bureau de par
le monde
MAG 2008 Page 4
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
MAG 2008 Page 5
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
MAG 2008 Page 6
Debloquer les possibilités pour les patients et le staff
Oncologie
Neurochirurgie
Salle op integré
Rachis & Trauma
MAG 2008 Page 7
Orthopédie
Radiologie
Pharmaceutique
ORL
Imagerie Intra-operatoire– 1.5T iMRIBrainSUITE® iMRI sallle d´opération integré
MAG 2008 Page 8
• 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
MAG 2008 Page 9
A propos de BrainLAB
Technologie et plateform
Logiciel de plannnification pre-opératoire
Logiciel de navigation per-opératoire
Sommaire
MAG 2008 Page 10
Technologie a marqueurs passifs
Technique
• Camera envoie des signaux infrarouge
• Les spheres reflechissantes reflechis le signal
• La camera recoit le signal en retour
MAG 2008 Page 11
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
MAG 2008 Page 12
A propos de BrainLAB
Technologie et plateform
Logiciel de plannnification pre-opératoire
Logiciel de navigation per-opératoire
Sommaire
MAG 2008 Page 13
• 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
MAG 2008 Page 14
• 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
MAG 2008 Page 15
•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
Logiciel de plannification pre-opératoire iPlan
MAG 2008 Page 16
• 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
Logiciel de plannification pre-opératoire iPlan
MAG 2008 Page 17
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
MAG 2008 Page 18
• Semiautomatic Image Fusion – also for
postoperative control
Résumé de la plannification pre-operatoire
MAG 2008 Page 19
• 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
MAG 2008 Page 20
• 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
MAG 2008 Page 21
A propos de BrainLAB
Technologie et plateform
Logiciel de plannnification pre-opératoire
Navigation per-opératoire
Sommaire
MAG 2008 Page 22
Navigation per-operatoire
• Utilization of preoperative scans –
no navigation scan necessary
• No fiducials necessary
1st step: Preoperative Scan
MAG 2008 Page 23
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
Navigation per-operatoire
MAG 2008 Page 24
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
Navigation per-operatoire
MAG 2008 Page 25
Benefit: Touchless registration saves sterile environment.
4th step: Navigation
Navigation per-operatoire
MAG 2008 Page 26
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
Navigation per-operatoire
MAG 2008 Page 27
Benefit: Fast integration of every rigid instrument available in the OR
Image integration
Navigation per-operatoire
MAG 2008 Page 28
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
Navigation per-operatoire
MAG 2008 Page 29
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
MAG 2008 Page 30
• Data acquisition
• Referencing
• Registration
• Navigation and Integration
Conclusion
MAG 2008 Page 31
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
MAG 2008 Page 32
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 Page 33