TGS - Target Guided Surgery

Scopis TGS is a next-generation solution for navigated Functional Endoscopic Sinus Surgery (FESS) that offers surgeons highly advanced image guidance and visualization capabilities in a single system.

TGS is based on Building Blocks planning software, developed with Professor Peter J. Wormald (Adelaide, Australia) and a worldwide network of leading key opinion leaders in ENT. This solution allows the analysis and identifcation of sinus cells in the complex patient anatomy and planning of the natural drainage pathways through the sinus cavity.

During surgery, the planned pathways are overlaid in real-time onto the endoscopic image providing the surgeon with Scopis Augmented Reality (AR) technology. A special instrument guidance and alarm system assists the surgeon to guide his endoscopic instruments on the pathways directly to the targets. Guidance of endoscopic instruments may help assist the surgeon to perform a more minimally invasive, accurate and selective surgery.

TGS* allows the surgeon to:

• Analyze the 3D anatomy using the Building Blocks® planning

• Plan sinus drainage pathways and target anatomy

• View surgical plans overlaid onto the endoscopic image with Augmented Reality (AR)

• Guide navigated instruments along planned pathways to targets

• Supports balloon sinuplasty by assisting balloon guidance along the natural drainage pathway

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Building Blocks

Building Blocks planning helps users understand the anatomy of the frontal recess and to transfer any radiological content - presented on a CT scan - into an understandable 3D picture. This allows the surgeon to do a stepwise sequential dissection of each cell in the frontal recess. 

The ability to draw the building blocks on paper and to work out the drainage pathway around these blocks helps the surgeon to fully understand exactly where the instruments need to be placed and how to perform the dissection properly

Building Blocks planning is much easier with the Scopis planning software. The surgeon is able to draw building blocks on the CT scan itself in all three dimensions, resize them and place them in and over the cells that normally would have to be manually drawn. Importantly, the frontal sinus drainage pathway can also be drawn directly on the CT scans, creating an accurate 3D representation on top of the patient image.

Taking the planning into the operating room allows the surgeon to perform the surgery with additional safety and orientation for a complete dissection and optimal results

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Augmented Reality

“Conclusion: Surgical navigation with AR was easily deployed in this cadaveric model of ESS. This technology builds upon the positive impact of surgical navigation during ESS, particularly during frontal recesssurgery. Instrument tracking with this technology facilitates identifying and cannulation of the frontal sinusoutflow pathway without dissection of the frontal recess anatomy. AR can also highlight “anti-targets”(ie, structures to be avoided), such as the optic nerve and internal carotid artery, and thus reduce surgicalcomplications and morbidity.“ [1]

3D planning

“Incorporation of virtual 3D planning surgical software may help augment trainees‘ understanding andspatial orientation of the frontal recess ans sinus anatomy.The potential increase in trainee profciency and comprehension theoretically my translate to improve surgical skill and patient outcomes and in reduced surgical time.“ [2]

“Most trainees (89%) believed that the virtual 3D planning software signifcantly improved their understanding of the spatial orientation of the frontal sinus drainage pathway“ [2]

[1] Citardi MJ, Agbetoba A, Bigcas JL, Luong A. Augmented reality for endoscopic sinus surgery with surgical navigation: a cadaver study. Int Forum AllergyRhinol. 2016;6:523–528.

[2] Agbetoba A, Luong A, Siow JK, et al. Educational utility of advanced three-dimensional virtual imaging in evaluating the anatomical confguration of thefrontal recess. Int Forum Allergy Rhinol. 2016;XX:1-6

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