1. COMPUTER-AIDED SURGICAL PLANNING AND PROCEDURES A.Schaeffer; PolyDimensions GmbH, Bickenbach

2. Technical fundamentals Examples State-of-the-Art Problems Results Future developments Overview:

3. Technical fundamentals : Which components are used: Computer system (mostly PC-Hardware) Specialized software (mainly CAD-software, optimized for anatomy Tracking devices (optical, electromagnetical, …) Visualization systems (2D-/3D-Displays, Head-mounted-displays) User Interaction (mouse, joystick, voice-control, gesture recognition) Interaction with patient (microinstruments, robots…)

4. Examples: Planning of procedures from digital medical imaging data: Image recognition and segmentation Triangulation Visualization

5. Generation of CAD models: © PolyDimensions GmbH, Bickenbach © Simbionix Ltd., Israel

6. Results: 3D models of patient anatomy for planning of surgical approach © MeVis GmbH, Bremen

7. Benefits: Access to computerized calculations Estimation of size and localization Calculation of blood supply and resection lines 3D/Stereo-Visualization Use for Augmented Reality

8. Problems and Challenges: Automated image recognition not yet advanced enough Time-consuming preprocessing Computer-user-interface has to be improved for use in the OR Skilled users are mandatory for interpretation and use of digital data

9. Navigation in the OR: Already in clinical use in for special procedures Electromagnetical Optical Ultrasound Others… © BrainLAB AG, Heimstetten

10. Benefits of navigation in the OR: Exact localization of anatomical structures like tumors e.g. Positioning of instruments Use for robotic surgery Tracking and navigation needed for Augmented Reality

11. Problems: Special Precautions necessary for reliable use Expensive Still not usable for procedures on soft-tissue anatomy

12. Real-time simulation for planning and education: Already standard in aviation industry:

13. Real-time simulation in medicine: Medical education Quality assurance © Simbionix Ltd., Israel

14. Visualization: 2D-Displays Stereo 3D-Displays Head-Mounted-Displays © PolyDimensions GmbH, Bickenbach

15. Benefits and Problems: Faster overview Better orientation in difficult anatomy Real-time-interaction with computer Not yet commonly used technique Space-consuming in the OR

16. Robots in the OR: Growing number of clinical use Heart surgery Orthopedics, Traumatology (Implantology) Gynecology Others… © Intuitive Surgical Inc., Sunnyvale, CA

17. Benefits of robots in the OR: Precise interventions Can perform minimal invasive surgery Use for robotic surgery Tracking and navigation needed for Augmented Reality

18. Problems: Expensive devices Suitable procedures must be found and surgical approach has to be optimized for robots Force-Feedback may be helpful in robotic surgery Extensive training and experience mandatory for use

19. Future developments: Faster overview Autonomous image recognition Faster processing of medical data Better navigation Skilled and trained users

20. Thank you for your attention!