The main objective of TLEMsafe project is to develop, validate and clinically implement an ICT-based patient-specific surgical navigation system. This system integrates modelling, simulation and visualization, it is based on realistic (near real-time accurate, 3-D, anatomical predictive) models of tissues and is capable of capturing the patient-specific and treatment-specific information.

In TLEMsafe project we utilize and further develop the Twente Lower Extremity Model (TLEM), a recently developed musculo-skeletal computer model, to represent the patient-specific situation. The next step is to allow the surgeon to virtually operate on the patient-specific model, after which the model can predict the functional effect of this intervention. In this way, the surgeon can test various surgical scenarios before actually operating. Once the optimal surgical plan is selected, the plan is fed into a computer assisted navigation system that allows the surgeon to reproduce the selected surgical plan for his patient during the actual surgery (Figure 1).

TLEMsafe system scheme

Figure 1: Schematic representation of the TLEMsafe system developed in the project.

The utilization of TLEMsafe system will greatly add to safety of patients that have to undergo severe surgery of their muscuslo-skeletal system. With TLEMsafe, the surgeon is able to pre-plan his surgery in a unique 3-D manner (currently 2-D images are generally used) which reduces surgical errors and/or intra-operative and post-operative complications. By coupling the pre-planning software to the patient-specific musculo-skeletal model, the functional effect of the surgical intervention can be predicted which highly facilitates the prognostic capabilities of the medical team.

The developed system can also be used to discuss (and visualize) the expected functional outcome with the patient prior to the surgery. For example, in a tumor case the surgeon can investigate what the functional result will be of a limb saving operation. If this functional result is very limited, an amputation may be advisable.

The ability to predict this outcome and discuss it with the patient is of great value. As the pre-planning tool is directly connected to the computer navigation system, the (optimal) pre-planned surgical scenario can very accurately be executed during the actual surgery. This will further increase patient safety, reduce complications and facilitate functional recovery of the patient.

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