Towards real-time simulation of clinical thinking in surgery Stéphane Avril
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1 Towards real-time simulation of clinical thinking in surgery Stéphane Avril Un Open Lab pour la co création en santé
2 Centre Ingénierie et Santé Un Open Lab pour la co création en santé 2
3 Centre Ingénierie et Santé Un Open Lab pour la co création en santé 3
4 Vascular surgery - AAA AAA occur in 5% of male people aged 65 years or older Mostly asymptomatic Rupture of aneurysms : deaths / year in the USA Has to be treated before rupture Open aortic surgery Endovascular repair ( / year) Un Open Lab pour la co création en santé 4
5 Clinical outcomes of EVAR Strong influence of stent-graft design Better outcomes with 3rd generation stent-grafts Strong influence of surgeon experience Patient selection Stent-graft positioning Catheterization Un Open Lab pour la co création en santé 5
6 More and more complex procedures Un Open Lab pour la co création en santé 6
7 EVAR workflow Choice of the type of repair (Open surgery vs Endo) Patient age, comorbidities and preferences, Aorto-iliac morphology Anticipation of intra and post-operative complications Choice and sizing of the stent-graft to be implanted 21.2 mm Planning software Stent-graft sizing chart Un Open Lab pour la co création en santé 7
8 Clinical objectives Secure EVAR interventions using numerical finite-element simulations Easier /faster preoperative planning Predict EVAR outcome Avoid complications COMPLEX CASES Aorto-iliac tortuosities Supra-renal and thoracoabdominal aneurysms (fenestrated and branched stent-grafts) Un Open Lab pour la co création en santé 8
9 Simulation in vascular applications New insights on aneurysm rupture mechanisms Arterial wall mechanics How does it rupture? When? New patient-specific decision making tool Patient-specific From medical images Un Open Lab pour la co création en santé 9
10 Validated model of stent-grafts Approach of stent-graft deployment [Demanget et al., 2012, Ann Biomed Eng] Mechanical equilibrium Stent-graft mechanics Stent-graft and aorta mechanics FE models Stent-graft in preoperative geometry Equilibrium post-deployment Un Open Lab pour la co création en santé 10
11 First clinical validations in 2014 Comparison Red: simulation Grey: CT-scan Un Open Lab pour la co création en santé 11
12 Extensions to all types of EVAR devices in 2015 [Perrin et al., 2016, JMBBM] Simulation Comparison Red: simulation Grey: CT scan Cohort of highly complex cases in collaboration with stent-graft companies on going Un Open Lab pour la co création en santé 12
13 Fenestrated stent grafts in 2016 European patent Un Open Lab pour la co création en santé 13
14 Creation of the start-up Predisurge in 2017 >50 cas simulés avec succès Études cliniques en cours Un Open Lab pour la co création en santé 14
15 Soon in the operating theater? Un Open Lab pour la co création en santé 15
16 HPC challenges Complex physics with soft solids, fluid structure interactions, contact nonlinearities and biology Precision requires enough resolution in time and space Clinicians wants real time simulations Un Open Lab pour la co création en santé 16
17 Towards numerical assistance during surgery Un Open Lab pour la co création en santé 17
18 Models including biology Clinical application Application to mice models of aortic aneurysms Identification of regional variations of material properties in aortas Development of mechanobiological models Un Open Lab pour la co création en santé 18
19 Hospital demonstrator Un Open Lab pour la co création en santé 19
20 Hospital demonstrator Cluster de calcul haute performance Casques de réalité virtuelle Tablettes, équipements de visualisation Licences de logiciels de simulation/ optimisation - Visualisation en temps réel des activités de l hôpital - Occupation des lits - Demande en soins - Evaluation de performances - Virtualisation de scenarios de simulation - Immerger les praticiens dans une nouvelle organisation - Faire tester de nouvelles technologies - Apprentissage personnalisé - Mise à disposition des applications à distance - Lien avec l open lab pour la continuité Un Open Lab pour la co création en santé 20
21 Hospital demonstrator Problème + Données Modélisation en collaboration Prototypage rapide Co création Plateforme de modélisation générique Indicateurs de Un Open Lab pour la co création en santé performance 21
22 Acknwledgements David Perin Pierre Badel Victor Acosta Francesca Condemi Ambroise Duprey Jean-Pierre Favre Jean-Noël Albertini Salvatore Campisi Funding: ERC-2014-CoG BIOLOCHANICS Un Open Lab pour la co création en santé 22
23 Merci de votre attention Un Open Lab pour la co création en santé
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