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Navigation surgery (NESS) is the typical application area where virtual and real objects, must be merged into a single unified scene (augmented reality/AR), especially if this image guided system is connected with N-Osirix-LM-VE-VS technology

The ultimate goal of the N-Osirix-LM-VE-VS technology is to allow the presentation of virtual objects to all of the human senses in a way identical to their natural counterpart; in some applications real and virtual objects need to be integrated making it necessary to present and manipulate them simultaneously in a single scene, leading to the development of hybrid systems referred to as augmented reality systems

Simulated 3D-reconstruction of organs from MSCT-cross sections is an important diagnostic tool by providing clinicians with a more naturalistic view of a patient's anatomy; the interactivity reflects in the possibility of simulating the endoscope tip movements through an organ cavity, or empty spaces (virtual endoscopy or virtual surgery), and the real-time requirement means that the simulation must be able to follow the actions of the user that may be moving in the virtual environment

In navigation surgery, we have standard hardware equipment in OR, anel personal computer vith navigation device, stand with navigation CAM, rmask, navigation probe, and various smart instruments

The basic “ENT navigation equipment” conssists of the optical system technology, with NO cables, with NO geometric distortions, with easy universal adaptation, and with large field of view

I prefer the system with highly precise, extremely small navigation instruments which guides the surgeon through the software, which provides the most flexible OR setup, with automatic recognition of the surgeon’s intent during the procedure, and with no need to press a button

In some systems, we have a headband and patient tracker with reflectors for the determination of the patient’s position.; this system eliminates the need for rigid patient fixation for navigation procedures

The registration of the patient is provided by touching the anatomic landmarks with the navigated probe. The (tele)-N-Osirix-LM-VE-VS system provide a highly useful and informative visualization of the regions of interest, thus bringing advancement in defining the geometric information on anatomical contours of 3D-human head-models by the transfer of so-called “image pixels” to “contour pixels”, which will provide a new quality in proper training of future surgeons in CAS as well as tele-CAS activities.

With the Navigation CAM the surgeon can get the largest field of view, more flexibility in OR setup and patient positioning, and the two way communication between the CAM and the instruments. The (tele)-N-Osirix-LM-VE-VS system consists of the remote operative site and a surgical workstation, that includes 3-D vision, dexterous precision surgical instrument manipulation, and input of force feedback sensory information.

The navigation CAM is the eyepiece of the navigation system and the most critical component for navigation success: a stereo CAM determines the position and orientation of the patient and the instruments through markers or reflectors, all registration steps can be completed in under a minute, before the surgeon even enters the O.R. , also, the surgeon can check some following options if he want to use the mask as patient tracker only

Using this system, it is provided active tracking for maximum accuracy, two-way communication between the handpiece and the camera , which enables the surgeon to control the SW remotely from the handpiece, and no touch-screens or additional personnel required to run the system

Using VE-models supported by LM-“commands in the air” we simulated the endoscope tip penetration through the nose and paranasal sinuses which cannot be explored by the existing endoscopic methods,i.e. using only the “standard FESS endoscopic ” approach (we obtained relative relationships of the borderline areas that are important for the final diagnosis of pathologic conditions in the region)

Even the best preoperative planning is of limited use if its implementation in the OR is not guaranteed; whereas traditionally these plans are transformed mentally by the surgeon during the intervention, computer assistance and virtual reality technology can substantially contribute to the precise execution of preoperative plans

Virtual endoscopy (VE) is a new method of diagnosis using computer processing of 3D image datasets (such as 2D-multislice computed tomography (MSCT) and/or magnetic resonance imaging (MRI) scans) to provide simulated visualization of patient specific organs similar or equivalent to those produced by standard endoscopic procedures. Visualization avoids the risks associated with real endoscopy, and when used prior to performing an actual endoscopic examination, it can minimize procedural difficulties

In order to understand the idea of virtual reality (VR), it is necessary to recognize that the perception of the surrounding world created in our brain is based on the information coming from human senses and with the help of the knowledge that is stored in our brain

The real-time requirement means that the simulation must be able to follow the actions of the user that may be moving in the virtual environment8. The computer system must also store in its memory a 3D model of the virtual environment. In that case, a real-time virtual reality system will update the 3D graphic visualization as the user moves, so that up-to-date visualization is always shown on the computer screen

We need a new sinus surgery technique in a daily routine practice? Imagine that the perception system in humans could be deceived, creating an impression of another „external“ world where we can replace the „true reality“ with the „simulated reality“ that enables precise/safer&faster diagnosis/surgery. Of course, we tried to understand the new, visualized virtual world (VW) by creating an impression of virtual perception of the given position of all elements in the patient's head, which does not exist in t

Simulater reality was aimed at upgrading diagnostic work-up and endoscopic surgery by ensuring a faster and safer operative procedure, and represent a basis for realistic simulations, and can create an impression of immersion of a physician in a non-existing virtual environment

Every ENT specialist will be able to provide VR support in implementing surgical procedures, with additional correct control of all risks, without additional trauma, while having an impression of the presence in virtual world, navigating through it and manipulating with virtual objects (3DCA-navigation)

When the 3D-surface with tissues arranged by objects is obtained, it is possible to derive spatial cross-sections at selected cutting planes, thus providing additional insight into the internal regions observed (Osirix/Leap Motion&NES-3D-volume rendering models); A tele-presence system extends the operator’s sensory-motor facilities and problem solving abilities to a remote environment, providing the local operator with necessary sensory information to simulate operator’s presence at the remote location

The fly-through techniques, which combine the features of endoscopic viewing and cross-sectional volumetric imaging, provide more effective and safer endoscopic procedures (marker-based VR-simulation), and use the corresponding cross-sectional image or multiplanar reconstructions to evaluate anatomical structures during the operation (3D-navigation&augmented reality in the OR)

Internal medicine unit

Modern ENT unit/tele-ENT working place: 1. in our activities, 3D-CAS and Tele-3D-CAS also provide the transfer of computer data (images, 3D-models) in real time during the surgery and, in parallel, of the encoded live video signals

Dermatology unit

Contact

Ilica 191A, HR-10000 Zagreb
Tel: ++385 1 2222 736
Tel: ++385 1 2084 444
Fax: ++385 1 2222 737
E-mail: poliklinika@poliklinika-klapan.com

Poliklinika KMG

Patient guide

Preparation for medical procedures - adults

Polyclinic flyer

Preoperative findings

Instructions at discharge after the procedure

Informed consent for medical interventions

© 2019 KMG Poliklinika Klapan Medical Group