3d et applications chirurgicales pour une médecine innovante et personnalisée
TRANSCRIPT
Khanh TRAN DUY, Co-CEO, 3D Side
Jeudi 10 décembre
3D et applications chirurgicales pour une médecine innovante et personnalisée.
Liege Creative, en partenariat avec :
BONE TUMOR SURGERY
Advanced planning &
Patient Specific Instruments
3D et applications chirurgicales pour une médecine innovante et personnalisée
• Introduction
• Technical workflow at 3D-Side
• General workflow for a surgery
• Cases examples
• Feasability of 3D technology in the biomedical field
• Conclusion !!
3D-SIDE SA is a spin off (Université catholique de Louvain – Belgium)
! 3 Years of activity in Belgium, France and Spain
! Focused on 3D technologies utilization for
complex surgery
! Dedicated software infrastructures
! Dedicated manufacturing capabilities
! ISO 13485 in preparation (in 2015)
!!!
Simula(on!
3D!Models!
Surgical!guides!
Dedicated!implants!
Implant(design((Per0opera2ve(mold(for(PMMA(bone(cement((
3D(Planning(Mul2modal(Registra2on(
((((
(
Skull(Curvature(Mold(crea2on(in(3D((
Pa2ent(bone((Allogra@((Resec2on(
(Pa2ent(Skull(
Resec2on((guide(
Allogra@(guide(implant(guide(
The way it works
Pre-operative assistance Intra-operative assistance
Tumor Location
Resection Planning
Patient Specific Instruments MRI / CTscan
Segmentation Registration
Volume creation Simulation 3D Printing
Techniques : Imaging !
Segmentation Overlap Volume creation
Techniques : Imaging !
CTScan CT Scan + MRI Registration
The way it works
Pre-operative assistance Intra-operative assistance
Tumor Location
Resection Planning
Patient Specific Instruments MRI / CTscan
Segmentation Registration
Volume creation Simulation 3D Printing
Techniques : Simulation !
3D-Manipulation/ Planning
The way it works
Pre-operative assistance Intra-operative assistance
Tumor Location
Resection Planning
Patient Specific Instruments MRI / CTscan
Segmentation Registration
Volume creation Simulation 3D Printing
Techniques : 3D-Printing !
3D Object Slicer Layered object
+! =!1!
Laser draws a 2D layer
New layer of powder is sprayed
2!
Cleanning and sandblasting
3!
Powder cake including objects
Biomedical 3D Technologies Key points
" Multi techniques
Basic example !
Volume Creation Simulation 3D-Printing
Biomedical 3D Technologies Key points
" Multi techniques " Flexibility
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Clinical!complica(ons!!!&!!!Func(onal!issues!!!!!!!!!!!!!!!!!!!!!!!!28%!to!35%!of!local!recurrence#!!!!!!!!!$Inaccurate!reconstruc(on!!
!!!
Tumor Location !!!
Resection Path !!!
Transfer on Patient
!!!
Cuttings
Pre-operative errors Intra-operative errors
GLOBAL!RESECTION!INACCURACY!
Bone Tumor Surgery: Issues & Challenges
Tumor Application !
Workflow
!!
Visit our secured website www.3Dside.eu/demand
!!
Upload CT scans & MRI
Step 1 Images Transfer
✓ 3
Planning Tumor Instruments
2 1
Workflow !
2
Delineate the tumor
Step 2 Pre-operative planning Supervision/validation
SURGEONS
✓ 3 2
Planning Tumor Instruments
Workflow !
2
Define all your needs through the application or website
Step 2 Pre-operative planning Supervision/validation
SURGEONS
✓ 3
Planning Tumor Instruments !!✓✓
Workflow !
2
Step 2 Pre-operative planning Supervision/validation
SURGEONS
Worflow !
Step 3 Surgery
Biomedical 3D Technologies Key points
" Multi techniques " Flexibility " Custom made communication " Learning curve from surgeons
Performances
Manual Instruments Times!(min.) 52 8*
Intralesional!resec(on 4 (17%)
0* (0%)
Loca(on!(mm)!(CI!95%)
11.2 (9.8 ; 12.6)
1.7* (1.5 ; 2.1)
*significantly different at p<0.05
Gouin!F!et!al.!ComputerQAssisted!Planning!and!Pa(entQSpecific!Instruments!for!Bone!Tumor!Resec(on!within!the!Pelvis:!A!Series!of!11!Pa(ents.!Sarcoma.!014;2014:842709!
Biomedical 3D Technologies Key points
" Multi techniques " Flexibility " Custom made communication " Learning curve from surgeons " Precision
Case examples : Pelvis with implant
✓ 3
Planning Tumor Instruments
2 1
Case examples : Pelvis with implant
✓ 3 2
Planning Tumor Instruments
Case examples : Pelvis with implant
✓ 3 2
Planning Tumor Instruments
Biomedical 3D Technologies Key points
" Multi techniques " Flexibility " Custom made communication " Learning curve from surgeons " Precision " Standard collaboration
Case examples : Pelvis with implant
✓ 3
Planning Tumor Instruments !!✓✓
Case examples : Pelvis with allograft
✓ 3
Planning Tumor Instruments
2 1
Case examples : Pelvis with allograft
✓ 3 2
Planning Tumor Instruments
✓ 3 2
Planning Tumor Instruments
Case examples : Pelvis with allograft
✓ 3
Planning Tumor Instruments !!✓✓
Case examples : Pelvis with allograft
Step 3 Surgery
Case examples : Pelvis with allograft
Step 3 Surgery
Case examples : Pelvis with allograft
Case examples : Femur 1
Case examples : Femur 2
Biomedical 3D Technologies Key points
" Multi techniques " Flexibility " Custom made communication " Learning curve from surgeons " Precision " Standard collaboration " Trans-disciplinary " Long process during design vs use in the or " Short delay if good communication " Insertion in surgeon workflow " Complex cases
Cranioplasty : Problems
!Gold standard :
cranioplasty with PMMA (hand made)
!!
!- Aesthetics
- Exothermicity of PMMA
- Time consuming
- Tricky in OR
- …
!!
Cranioplasty : Solutions
Company! Country! Website! Material!
Xilloc
The
Netherlands
www.xilloc.com
PEEK
De Puy-Synthes
USA
www.depuysynthes.com
PEEK
Codman
Custombone
Italy USA
https://www.depuysynthes.com/about/codman-neuro
HA
Cranioplasty : Problems
Problems
- Thickness (Codman)
- No opportunities for adjusting (milling,..)
- Cost (8keuro or more)
- Lead Time (few weeks – 6 for Codman)
- Strong interaction with the surgeon required :
osteosynthesis positions & number, central suspension, …
- …
!!!
Cranioplasty : Our Solution
Cranioplasty : Our Solution
Peroperative Injection of PMMA in a patient Specific Mold
Cranioplasty : Our Solution
• Fast in OR, no skills required, “funny” to perform
• Short Lead time (10 days or faster)
• Complex shape possible
• Full thickness implant
• Flexible in OR (osteosynthesis selection, milling, suspension,…)
• Cost reduction
• Less constraints on CT dose (due to adaptability in OR)
• Exothermicity in the mold permit a better polymerization of the PMMA
• The surgeon can freely select the osteosynthesis mean, as well as their number and location, as usual with the standard method
• A second implant can be manufactured if required (competitors send two implants).
• Less/no hands contact during shaping – better sterility
• The implant can adapt (size augmentation or reduction) in case of larger preoperative resection.
Cranioplasty : Our Solution
!!!
Standard manual method
CustomBone
J&J
Our PSI² - Mold PMMA
Complex shapes possible - + ++
Adaptability in OR – reduction + -- ++
A d a p t a b i l i t y i n O R – augmentation
+ - +
Central suspension + - +
Freedom for osteosynthesis material
++ - ++
Exothermicity on patient tissues -- ++ ++
Time in OR -- ++ +
Mechanical strength - -- +
Sterility - ++ +
Costs ++ - +
Thin structures possible + - ++
Radio opacity + + +
Osteo-integration possible - + -
Results - aesthetics -- ++ ++
Lead time +++ -- +
Case examples
Segmenta2on((
Op2misa2on(géométrique(
Reconstruc2on(3D(
Détermina2on(de(la(résec2on(&(Design(de(l’implant(
Valida2on((de(l’implant(maître(sur(modèles(3D(
Step 1 Design /simulation
Case examples
Step 2
Modèle(3D(en(salle(Stériles(et(biocompa2bles(
Visualisa2on(de(la(résec2on(à(effectuer(et((pose(des(guides(de(résec2on(
Modèle(de(résec2on(Guides(de(résec2on(
Per-op visualization
Case examples
Step 3 Pose(des(guides(et(marquage((monopolaire)(
Résec2on(obtenue(
Résec2on(
Guidage et résection
Case examples
Step 4
Prépara2on(et(fixa2on(
Implant(PMMA(fabriqué(en(salle(validé(sur(le(modèle(3D( Pose(finale(avec(adapta2on(de(la(
suspension(centrale(
Pose de l’implant
Case examples
Step 1 Design /simulation
Segmenta2on((Reconstruc2on(3D(
Détermina2on(de(la(résec2on(
Pre0design(de(l’implant(
Case examples
Step 2 Per-op visualization
Modèle(et(résec2on( Valida2on((de(l’implant(maître(sur(modèles(3D(
Modèle(réséqué(
Sinus(&(plafond(Vérifica2on(des(fixa2ons((
Case examples
Step 3 Implant fabrication
Valida2on((de(l’implant(maître(sur(modèles(3D(
Injec2on(en(salle(Durant(l’anesthésie(
Case examples
Step 4 Per-OP Resection and visualization
Modèle(3D(en(salle(Stériles(et(biocompa2bles(
Visualisa2on(de(la(résec2on(à(effectuer(et((pose(des(guides(de(résec2on(
Guides(de(résec2on( Modèle(de(résec2on(
Case examples
Step 5 PER-OP RESECTION
Adaptabilité( Prépara2on((
Case examples
Step 5 Pose de l’implant
Placement(0(copie( Suspension(et(fixa2on(
Tumor resection + cranioplasty
Implant(design(Segmenta2on( Resec2on((Superposi2on(((
Fabrica(on!selon!spécifica(ons!((tanium,!ceramic,!PMMA,…)!
Prototypage(
Guide(per0opératoire( Implant(en(place(
Other cases
Reconstruc2on((3D(
Transfert(–(fabrica2on(du(guide(de(forage((
Planning(0(choix(et(pliage(de(la(plaque((
Per0opératoire(((
Other cases
Planning!de!reconstruc(on! Planning!de!!mise!en!forme!
Planning!de!résec(on!
IRM CT
2D! 3D!
Biomedical 3D Technologies Key points
" Multi techniques " Flexibility " Custom made communication " Learning curve from surgeons " Precision " Standard collaboration " Trans-disciplinary " Long process during design vs use in the or " Short delay if good communication " Insertion in surgeon workflow " Complex cases " Costs " Reimbursment " Global gain " Certfication /quality " No CE labelling " Risks managment in OR " Do we need engineers?
Thank you for your attention