Navigation in surgery

Abstract

Introduction: "Navigation in surgery" spans a broad area, which, depending on the clinical challenge, can have different meanings. Over the past decade, navigation in surgery has evolved beyond imaging modalities and bulky systems into the rich networking of the cloud or devices that are pocket-sized.

Discussion: This article will review various aspects of navigation in the operating room and beyond. This includes a short history of navigation, the evolution of surgical navigation, as well as technical aspects and clinical benefits with examples from neurosurgery, spinal surgery, and orthopedics.

Conclusion: With improved computer technology and a trend towards advanced information processing within hospitals, navigation is quickly becoming an integral part in the surgical routine of clinicians.

Fig. 1

Spinal OR setup: The common OR setup involving surgical navigation consists of a stereotactic camera (upper right corner) and a computer screen (center)—both are mounted at the ceiling in the OR here. Further marker spheres are rigidly attached via a reference array to the patient and to surgical instruments

Fig. 2

Basic workflows of image-based and model-based navigation. Image-based navigation requires preoperative images which need to be registered to the patient setup, typically employed for cranial or spinal surgery. Model-based navigation requires no imaging data and the process of registration matches the patients anatomy to a virtual model, typically employed for orthopedic surgery

Fig. 3

The Brainlab platform family serves the needs of each discipline: Curve in two different configurations: a ceiling-mounted and b dual display; c Kick, more portable and with a smaller footprint; and d Dash, the smart mobile solution. Copyright: Brainlab AG

Fig. 4

Multimodal image fusion is an important preoperative planning step to combine various imaging information for optimal surgical route planning. Copyright: Brainlab AG

Fig. 5

Exemplary neuronavigation screenshot showing microscope-based navigation and the overlay of functional information, e.g., eloquent cortical areas (light blue outline), subcortical fibers (colorful fibers) in relation to the tumor (yellow outline) allowing to navigate to the tumor avoiding critical risk structures. Copyright: Brainlab AG

Fig. 6

Intraoperative imaging of the future with a portable, multi-slice CT scanner tightly integrated with navigation optimized for use in surgery. Copyright: Brainlab AG

Fig. 7

Knee navigation screenshot showing how navigation adds valuable information for orthopedic surgeons. It enables a gap optimization and delivers information on the laxity of the knee joint over the whole range-of-motion. This allows an analysis of the initial and final biomechanical situation during a knee replacement surgery (graph on bottom of image; purple: initial situation, yellow: final situation). Copyright: Brainlab AG

Fig. 8

Use of Brainlab® Dash navigation system during total knee replacement surgery: the surgeon can intuitively navigate the bone resection with the iPod screen alongside the surgical field

Fig. 9

Typical partitioning of needs in an integrated OR

Fig. 10

A clinical online network like Quentry™ enables uploading of medical images into the cloud to single user or defined departmental accounts, the so-called CareTeams. The uploaded medical data can then be accessed on mobile, desktop, and surgical navigation devices