NAVIPHY, surgical navigation for greater surgery precision

GMV, the Research Institute of the Hospital Universitario La Paz (IdiPAZ), the Virtual Reality and Modelling Group (Grupo de Modelado y Realidad Virtual: GMRV) of the Universidad Rey Juan Carlos and the Canary Island Healthcare Research Foundation (Fundación Canaria de Investigación Sanitaria: FUNCANIS) make up the consortium formed for the research project “Navigation, physical simulation and imaging in intraoperative procedures”, NAVIPHY. Its purpose is to achieve greater precision in brain, breast and maxillofacial surgery, “developing surgical simulation algorithms and exploring the use of intraoperative imaging to upgrade the surgical simulator we have developed”, explains Carlos Illana, GMV’s Head of Product.

GMV, in collaboration with the specialists Pedro Lara and David Macías, has developed a surgical-navigation module in the intraoperative radiotherapy device radiance^TM in order to guide breast cancer surgery and application of intraoperative radiotherapy, in use now for two years. In the NAVIPHY project GMV is tackling the challenge of creating adaptations for other complex surgical procedures such as maxillofacial and brain in which precision is a sine qua non of success.

Information technologies and precision imaging now enable surgery procedures to be planned and simulated beforehand and can also guide specialists during the actual surgery, in both cases helping to improve results. Nonetheless, when dealing with soft tissues like the brain, there remains some work to be done in order to be able to help surgeons operate with greater precision. Collaboration between healthcare and technological personnel, as is the case in NAVIPHY, is key here. After all, one of the biggest challenges of image-guided surgery is precise modeling of any changes to the patient’s anatomy during the operation. To achieve this it is necessary not only to develop surgical-simulation algorithms, in order to ensure greater control of the surgical procedure and result, but also clinical expertise and interpretation skills to guide and advise the research while also assessing and vetting the applicability of all developments.

To this end the consortium’s multidisciplinary team is now working on evaluation of the use of intraoperative images when radiotherapy is being administered to the cancer site after tumor removal within the operating theater. It is likewise exploring the use of multimodal imaging techniques (CT, ultrasound, etc) for a better anatomical representation of patients as well as surgical navigation tools to facilitate up-to-date and individualized information, thus progressing towards personalization of the treatment.

NAVIPHY is a one-million-euro, 45-month project falling within the Ministry of Science, Research and Universities’ research challenges R&D call and subsidized by the European Union (EU) through funds of the European Regional Development Fund (ERDF).

Multidisciplinary Team

The technological leaders of the project are Carlos Illana, GMV’s Head of Product, and Miguel Ángel Otaduy, research professor of the Universidad Rey Juan Carlos. Clinical leadership falls to Doctor Jose Luis Cebrián, for maxillofacial surgery research; Doctor Marisa Gandía and Doctor Carlos Pérez, for neurosurgery, and Doctor Luis Alberto Glaría, for radiotherapy. The Hospital Universitario de Gran Canaria Doctor Negrín, for its part, which has been working for two years now with the GMV-developed breast tumor treatment navigation system, is providing a team made up by Beatriz Pinar (Radiotherapy), Magali García (Radio-diagnosis) and Jezabel Fernández (general surgery).

As Carlos Illana explains, in this first phase of the project work is concentrating on “gaining a better knowledge of protocols, work flows and technological equipment to hand within the various specialties involved in the project in order to decide on the most suitable tools for carrying the project through successfully”. Miguel Ángel Otaduy takes up the argument: “a detailed knowledge of clinical procedures will enable us to pinpoint the needs and challenges of the simulation algorithms and models and begin to design groundbreaking solutions for same”.

In the words of Luis Alberto Glaría, Assistant Radiation Oncologist of the Hospital Universitario La Paz, the overriding objectives laid down in this first stage of the project are “standardization of a data-culling model for each type of surgery and exploring the way of validating the technology to be applied; informing the ethical committee in order to obtain its authorization for extra information gathering over and beyond habitual surgery and the technological assessment developed in the project”.

Marisa Gandía points out that “one of the main problems faced by neurosurgeons” is the limited quality of the currently available intraoperative imaging equipment for working with a surgical navigator in internal brain structures (such as brain parenchyma, posterior fossa and ventricles). As for maxillofacial surgery, José Luis Cebrián argues that current planning systems focus on bony structures without forecasting the surgery’s impact on soft structures. As regards brachytherapy and intraoperative radiotherapy, Luis Alberto Glaria stresses that predicting behavior of the organ being operated on would be highly useful. Up to now, he explains, “placement of the radiation applicators after tumor removal is carried out on a surgery-modified anatomy”.

GMV-developed products like radiance^TM and insightArthroVR, successfully taken up by specialists, vouch for the company’s ability to fulfill the project goals.

Funded by: ERDF/Ministerio de Ciencia, Innovación y Universidades – Agencia Estatal de Investigación/ _Project (RTC-2017-5878-1)