Surgical navigation system and navigation method

Abstract

The present disclosure relates to a surgical navigation system (1) for guiding in surgery on a patient (P) by means of a surgical map (L), having: a first detection mode (2) adapted to detect at least one predefined region of tissue of the patient (P) as a first shot (8) with shot position data; a second detection mode (10) different from the first detection mode, the second detection mode being adapted to detect a predefined region of the tissue of the patient (P) as a second shot (16) with shot position data; a storage unit (18) in which a two-dimensional or three-dimensional surgical map (L) with respect to the patient (P) is stored, a first digital lesion value and a second digital function value of the tissue being stored for each position of the surgical map (L); a control unit (20) which is adapted to analyze and determine the first image (8) for the first detection mode (2) in such a way that at least one partial region of the tissue of the first image (8) is assigned a lesion value and / or a function value and is supplemented with the lesion value or the function value in an associated position of the surgical map (L); for the second detection mode (10), the second image is evaluated and determined in such a way that at least one partial region of the tissue of the second image is assigned a lesion value and / or a function value and the lesion value or the function value is supplemented in an associated position of the surgical map (L); and visualizing a view of the output surgical map (L) by means of the presentation device (22) for navigation assistance. The present disclosure also relates to a navigation method according to the parallel claims as well as a computer-readable storage medium and a computer program.

Description

Technical Field

[0001] The present disclosure relates to a surgical navigation system for intraoperative guidance of a surgical instrument, such as during tumor removal surgery on a patient with the aid of a surgical map. For this purpose, the navigation system has a first detection mode, in particular a CT imaging device and / or an MRT imaging device, which is adapted to detect and computer-readable provide at least one predefined region of the tissue of the patient as a first image with imaging position data before and / or during the surgery based on the first detection mode. This means that for the first image, there is also data on the position of the image relative to the patient, so that the image can also be spatially assigned to the patient. For example, in MRT imaging, the position of the tissue is also provided together as imaging position data. Furthermore, the present disclosure relates to a navigation method for intraoperative guidance, a computer-readable storage medium, and a computer program according to the preamble of the dependent claims. Background Art

[0002] In brain surgery, neurosurgery often faces the decision of determining the boundaries of diseased tissue, such as tumor tissue in particular, in order to remove as much of the tumor as possible and at the same time preserve as much healthy tissue (functional tissue) as possible and minimize functional impairment.

[0003] For this purpose, different modes during the surgery are used to identify diseased tissue or key structures (functional tissue) to be protected.

[0004] With the aid of magnetic resonance tomography imaging or computed tomography imaging (MRT / CT data), for example, diseased structures and key structures to be preserved during the surgery can be identified. This also applies to intraoperative microscopy imaging / images. This identification can be carried out automatically, for example, by a trained AI system, or also manually by a doctor.

[0005] Fluorescence (imaging), such as 5-ALA, is used to identify tumor tissue, i.e., diseased tissue.

[0006] On the other hand, intraoperative electrophysiological signals are used to identify important functional tissue to be preserved, such as important nerves.

[0007] Intraoperative histological data regarding sample acquisition is used to identify diseased tissue and healthy tissue based on the analysis results (point by point or region by region).

[0008] Unfortunately, the above-mentioned imaging methods, such as MRI / CT, microscopy or fluorescence, have the disadvantage that they are not always precise in differentiating between diseased tissue and healthy tissue. In addition, these methods have the drawback that they are generally not spatially assigned or associated, that is to say, they cannot be provided in a schematic map. Electrophysiological data and histological data are more precise and more discriminatory, but can only be used for individual regions of the anatomical structure. These limitations result in the surgeon not obtaining a uniform image of the surgical area in order to be able to reliably differentiate between diseased tissue and healthy tissue.

[0009] Although the surgeon uses different modalities, there remains uncertainty as to where exactly the boundaries of the diseased tissue can be defined. Summary of the Invention

[0010] Accordingly, the object and aim of the present disclosure is to avoid or at least mitigate the disadvantages of the prior art and in particular to provide a navigation system, a navigation method, a computer-readable storage medium and a computer program which provide visual assistance during the removal of diseased tissue, in particular tumour removal, in order to safely and intuitively show the surgeon the area to be excised and with particular care the areas of, for example, functional tissue, such as nerves, so as to thereby enable safe navigation and excision. A further sub-object may be to visually display the excision boundary line in a user-personalized manner directly in the view in order to visually show the possible cutting line and thereby support the surgeon.

[0011] These objects are achieved according to the invention with respect to a navigation system of this type by the features of claim 1, with respect to a navigation method of this type by the features of claim 10, with respect to a computer-readable storage medium by the features of claim 11 and with respect to a computer program by the features of claim 12.

[0012] Accordingly, the basic concept of the present disclosure provides a navigation system which uses various modalities, such as microscopy, MRI imaging, CT imaging, electrophysiology and / or histology (or histological examination), to create a centralized and uniform surgical map which has zones / regions / areas with diseased tissue to be removed and tissue to be retained (functional tissue; anatomical structures to be retained) and which, together with these, defines and in particular, together with the calculated boundary lines, provides the user with a visual view of the surgical map to assist the user during the operation.

[0013] While each individual modality is known per se, the corresponding disadvantage of the inexact delimitation of these regions as described above is now addressed by providing a solution to combine all available modalities and fuse them into a single centralized surgical map that can determine and visually present to the surgeon the boundaries of the diseased tissue to be removed and the healthy (functional) tissue to be preserved. By centrally fusing the data and converting the information into a unified and homogeneous "metric" of the surgical map in terms of lesion functionality with the aid of two location-related numerical values, such a centralized map can be provided that visually presents to the surgeon, e.g., by overlaying the surgical map with other acquisitions, such as MRT acquisitions, a view with the presented diseased tissue regions and functional tissue regions.

[0014] The term "acquisition" should be understood quite broadly and denotes, for example, a point-by-point or small region-by-region acquisition of whether diseased tissue or functional tissue is present by means of a biopsy and the corresponding histological evaluation at a location (acquisition location), or also a relatively large acquisition, such as an MRT acquisition of the patient, where, for an MRT acquisition, the corresponding (three-dimensional) acquisition location data are naturally also presented. In other words, for each acquisition, the location of the acquisition (or the acquired tissue) relative to the patient is also detected and provided, so that different detection modalities can be correctly positioned in the (unique) centralized surgical map by correspondingly determining the functional and lesion values.

[0015] The analysis and determination of the presence of functional or diseased tissue can be carried out differently. In particular, such analysis and determination can be carried out automatically and computer-aided. For example, a trained AI system trained on tumors can be adapted to recognize tumors in an acquisition such as a CT acquisition and identify the three-dimensional region as diseased tissue and assign a lesion value to the diseased tissue. For example, the lesion value can be set in the range from 0 to 10 and the functional value can be set in the range from -10 to 0. In this way, the intensity of the diseased tissue can also be determined.

[0016] What is important here is to convert, by means of the navigation system of the present disclosure, many different detection modalities into a unified "system" with lesion or functional values at each location (relative to the patient) in order to generate a homogeneous database for the diseased and functional tissue. With the aid of this unified database, other calculations and presentations can then be carried out, such as the (standardized) calculation of the resection line, in order to assist the surgeon during the resection.

[0017] In other words, the present disclosure relates to a navigation system that integrates various surgical modalities with a centralized computer-aided system. These modalities particularly include MRT / CT (navigation), microscopy, endoscopy, fluorescence, electrophysiological probing, and / or intraoperative histology (e.g., by means of Raman spectroscopy). The navigation system can also have a tracking system (e.g., an optical tracking system or a (robotic) kinematic tracking system) in order to determine the corresponding modality data / modality recordings of the precise position in or relative to the (anatomical structure) of the patient. Thereby, in addition to the shot itself, the spatial shot position can also be provided. If the shots or data of the modality used are detected and integrated into the navigation system, a surgical map can be created. The map contains an intensity map that defines the intensity (first digital lesion value, second digital function value) for each pixel (2D) in a 2D image / 2D view, particularly, or for each voxel (3D) in a 3D space, particularly. Thus, there are two opposite / contrasting values or signal types. On the one hand, there is the lesion intensity and on the other hand, there is the function intensity. The more a particular pixel or voxel (especially a tumor) is lesioned, the higher the lesion intensity. The more important the tissue is for preservation (e.g., important nerves), the higher the function intensity.

[0018] In particular, a (computer-aided) system can be provided that has a presentation device and interfaces for various modalities, wherein the tracking system of the navigation system provides position information for each modality in order to be able to provide the (spatial) shot position in addition to the shot, wherein a surgical map is created in a two-dimensional shape (2D) or a three-dimensional shape (3D), and particularly a color map is used to visualize, for example, how much tissue is lesioned or functional in order to determine the resection boundary.

[0019] In other words, there is provided a surgical navigation system for intraoperative guidance of a surgical instrument during tumor removal surgery on a patient with the aid of a surgical map, having: a first detection mode, in particular a CT imaging device or an MRT imaging device, which first detection mode is adapted to detect and computer-readable provide at least one predefined region of the tissue of the patient as a first image with imaging position data before and / or during the surgery based on the first (detection) mode; a second detection mode different from the first detection mode, in particular fluorescence imaging or electrophysiological imaging, which second detection mode is adapted to detect and computer-readable provide a predefined region of the tissue of the patient as a second image with imaging position data before and / or during the surgery based on the second (detection) mode; a storage unit in which a two-dimensional or three-dimensional surgical map of the patient is stored, wherein for each (2D or 3D) position (pixel or voxel) of the surgical map, at least a first digital lesion value and a second digital function value of the tissue are stored in the predefined region of the tissue; a control unit which is adapted to: - process the provided first image with imaging position data and the provided second image with imaging position data, - analyze and determine the first image for the first detection mode such that at least one partial region of the tissue of the first image is assigned a lesion value and / or at least one partial region of the tissue of the first image is assigned a function value, and the lesion value or the function value is supplemented in the corresponding position of the surgical map; - analyze and determine the second image for the second detection mode such that at least one partial region of the tissue of the second image is assigned a lesion value and / or at least one partial region of the tissue of the second image is assigned a function value, and the lesion value or the function value is supplemented in the corresponding position of the surgical map. And - visually output a view of the surgical map via a presentation device, in particular a surgical monitor, for navigation assistance.

[0020] Advantageous embodiments are claimed in the dependent claims and are explained in particular below.

[0021] In particular, the navigation system can be adapted to register the first image (of the first detection mode) in the form of a CT image and / or an MRT image and / or DTI data with the patient by tracking via a tracking system of the navigation system; and

[0022] - spatially track the position of a surgical microscope (as a visualization system and as a further detection mode with a corresponding second (microscope) image) and / or an endoscope (as a visualization system and as a further detection mode with a corresponding second (endoscope) image) by the navigation system; and / or

[0023] - Detecting and localizing electrophysiological recordings or signals via a navigation system using a tracked probe; and / or

[0024] - Detecting and spatially localizing histological recordings or data using the tracked (biopsy) probe with the aid of a navigation system. Different recordings with the associated recording position data can thereby be provided, which recording position data can be transferred into a surgical map.

[0025] In particular, the navigation system can have a robot or a robotic system (in combination with a robotic system), wherein a robotic arm of the robotic system is used to move and position a visualization system (in particular an operating microscope and / or an endoscope) and / or a probe. In particular, the robotic kinematics can be used as a tracking system to determine the position of the visualization system or the probe.

[0026] According to one embodiment, the control unit can be adapted to assign a first color to a first digital lesion value and a different, in particular complementary, second color to a second digital function value of the tissue, wherein the color intensity is proportional to the numerical value, such that a colored stored surgical map is output when the view is output via the presentation device. Thus, colors can be used to distinguish between lesion intensity and function intensity. The lesion intensity can in particular be presented in red and the function intensity can be presented in blue. In particular, the color of the lesion value is a color complementary to the function value. As a result, a colored map is created as a surgical map, wherein a higher intensity of red means more resection is recommended and blue means less resection is recommended. Since for non-image-based modalities there is no data (such as electrophysiological signals or histological data) for each pixel or voxel, the color coding enables the marking of the lesion area and the functional area to be inferred based on the 3D point / position signals. Through this presentation, the surgeon can better determine where in the operation the surgeon has to resect tissue. Thus, the view can also be set individually based on the data of the centralized surgical map. In particular, based on the point-by-point (position-dependent) values, such a view can be created in which an inference takes place between the individual values to represent a continuously differentiable surface.

[0027] According to a further embodiment, the control unit can be adapted to determine the gradient between the lesion value and the function value and to display a boundary line in the view based on this gradient in order to show the user the boundary for resection. In particular, the navigation system can thus be adapted to use the image gradient to generate a specific boundary line (in the case of 2D) or a boundary (table) surface (in the case of 3D). The position with the highest gradient is used, for example, between the red lesion area of the tissue and the blue functional area of the tissue to define the boundary. As a result, not only can a colored map indicating the lesion tissue and the functional tissue be defined and displayed, but also the boundary for resection can be defined and displayed. The navigation system can thus also use the image gradient to calculate and visualize a distinct boundary.

[0028] Preferably, the navigation system may have an input unit, in particular the presentation device may be configured as a touch display for detecting an input made by the user, wherein the control unit is adapted to adapt the gradient setting based on the input in order to change the boundary of the resection in the view of the surgical map. In particular, a regulator for setting the gradient (such as a slider regulator) may be displayed on the touch display and the user changes the setting by touching the regulator. Thus, the gradient can be adapted according to the aggressiveness of the lesion (such as glioblastoma for which aggressive resection is recommended) to meet the preferences of the surgeon and the needs of the patient. The adjustable gradient allows for a more or less aggressive resection depending on the type of lesion. The navigation system can in particular also use the adjustable gradient to define the aggressiveness of the resection area. In particular, the user can move or set the boundary starting from the maximum value of the gradient or in the "positive direction" (i.e., more of the lesion) by means of an input in order to protect more functional tissue, or move or set the boundary in the "negative direction" (i.e., more of the function) starting from the maximum value of the gradient in order to remove aggressive lesion tissue. Thus, in particular, the aggressiveness of tissue removal can be set by the "displacement" of the boundary starting from the maximum value of the gradient along the "positive direction" (i.e., around or relative to an additional / larger boundary of the functional tissue) or the "negative direction" (i.e., around or relative to a smaller boundary of the functional tissue). The gradient has a maximum value at the maximum difference between the lesion tissue and the functional tissue. Thus, for example, when drawing the initial boundary at the maximum value of the gradient, the boundary can be set for an aggressive removal in the direction of the functional tissue or for a less aggressive removal in the direction of the lesion tissue.

[0029] Preferably, the navigation system may have an input unit, in particular the presentation device may be configured as a touch display for detecting an input made by the user, wherein the control unit is adapted to manually define, based on the input, an area of tissue to which a first digital lesion value and / or a second digital function value of the tissue are assigned by means of the input, in order to also manually identify the area. In addition to at least two different detection modes, the surgeon can thus also manually define areas with important functions or lesions, which areas can be added to the surgical map or additional areas can be added by means of image segmentation.

[0030] In particular, as at least the first or second detection mode, the following can be used:

[0031] - MRT imaging and / or CT imaging and / or DTI imaging;

[0032] - Surgical microscope;

[0033] - Endoscope;

[0034] - Electrophysiology;

[0035] - Histology; and / or

[0036] - Fluorescence imaging device.

[0037] That is to say, the modes can especially include: CT / MRT / DTI with navigation, microscope, endoscope, electrophysiology, histology, fluorescence imaging. These different detection modes each have the advantage of precisely determining diseased tissue or functional tissue and can be used in a targeted manner so as to connect and integrate all these advantages.

[0038] In particular, the first detection mode and / or the second detection mode can be connected to the robot as an end effector, especially a surgical microscope and / or an endoscope and / or a fluorescence imaging device is mounted on the robot arm as an end effector. In other words, a microscope, an endoscope and / or a fluorescence imaging device (imager) can be mounted on the robot arm and actuated, moved or positioned by the robot arm.

[0039] Preferably, a probe for measuring data, such as a biopsy probe, can be fastened to the robot arm.

[0040] According to one embodiment, the navigation system can have a navigation camera as an optical camera and be adapted to track a fiducial tracker, or the navigation system can have a navigation camera as an optical camera and use a machine learning image processing system to spatially track an object. In particular, the navigation system can use an optical (navigation) camera with a fiducial tracker or a (machine) image processing system.

[0041] Regarding a navigation method for intraoperative guidance of a surgical instrument during tumor removal surgery on a patient with the aid of a surgical map, the object is achieved by the following steps: - Detecting at least one predefined region of the tissue of the patient before and / or during the surgery as a first capture with capture position data by means of a first detection mode, in particular a CT imaging device or an MRT imaging device; - Detecting a predefined region of the tissue of the patient before and / or during the surgery as a second capture with capture position data by means of a second detection mode different from the first detection mode, in particular fluorescence imaging or electrophysiological imaging; - Analyzing and determining the first capture for the first detection mode such that at least one partial region of the tissue of the first capture is assigned a lesion value and / or at least one local region of the tissue of the first capture is assigned a function value, and supplementing the lesion value or function value at the respective position in the surgical map, in which a first digital lesion value of the tissue and a second digital function value are stored for each (2D or 3D) position (pixel or voxel) at least in the predefined region of the tissue; - Analyzing and determining the second capture for the second detection mode such that at least one partial region of the tissue of the second capture is assigned a lesion value and / or at least one partial region of the tissue of the second capture is assigned a function value, and supplementing the lesion value or function value at the respective position in the surgical map L; and - Outputting a view of the surgical map by means of a presentation device, in particular a surgical monitor, for navigation assistance.

[0042] Regarding a computer-readable storage medium and a computer program, the object is achieved in such a way that the computer-readable storage medium and the computer program comprise instructions which, when executed by a computer, cause the computer to carry out the method steps of the navigation method according to the present disclosure.

[0043] Of course, the applications in brain surgery described herein can also be used for other indications, where different intraoperative modalities are used to distinguish the boundaries between lesional and functional tissue. BRIEF DESCRIPTION OF THE DRAWINGS

[0044] The present disclosure will be explained in more detail below with reference to the accompanying drawings by means of preferred embodiments. Shown are:

[0045] Figure 1 A schematic diagram of a navigation system according to a first embodiment of the present disclosure with different detection modes;

[0046] Figure 2 A schematic diagram showing a combination of lesion values and function values for defining a color map and for calculating an excision boundary;

[0047] Figure 3 An exemplary surgical map with adjustable boundaries or boundary lines;

[0048] Figure 4 An exemplary surgical map is shown as a color map with red and blue intensity maps, where red is used for diseased tissue and blue is used for important functional tissue;

[0049] Figure 5 Shows Figure 5 a two-dimensional top view of the surgical map; and

[0050] Figure 6 a schematic flow chart showing a navigation method according to a preferred embodiment.

[0051] The drawings are schematic in nature and are only intended for understanding the present disclosure. The same elements are provided with the same reference numerals. The features of different embodiments may be replaced with each other. Detailed Description

[0052] Figure 1 A surgical navigation system 1 (hereinafter only referred to as the system) for intraoperative guidance of a surgical cutting instrument during a surgical operation for tumor removal at a patient P with the aid of a surgical map L is shown schematically.

[0053] The system 1 has a first detection mode 2 in the form of a CT imaging device 4 and also an MRT imaging device 6 and is adapted to detect and provide computer-readable at least one predefined region of the tissue of the patient P as a first image 8 with the associated image position data (i.e., information about the spatial orientation of the image relative to the patient P) based on this first detection mode before the operation.

[0054] In addition, the system 1 also has a further second detection mode 10 different from the first detection mode 2 in the form of an operating microscope 11 and is adapted to detect and provide computer-readable a predefined region of the tissue of the patient P as a second image 16 with image position data before and / or during the operation based on the second (detection) mode.

[0055] In addition, the system 1 also has a further third detection mode in the form of fluorescence imaging 12. In this detection mode, imaging is also carried out again similar to the first and second detection modes 2, 10.

[0056] Additionally, the system also has a fourth detection mode in the form of an electrophysiological imaging system 14 and a fifth detection mode in the form of intraoperative histology, i.e., intraoperative sampling with a probe.

[0057] All five different detection modes are centrally combined and processed. To this end, the system has a storage unit 18 in which a two-dimensional or three-dimensional surgical map L of the patient P is stored, wherein for each (2D or 3D) position (pixel or voxel) of the surgical map (L), at least a first digital lesion value and a second digital functional value of the tissue are stored or storable in a predefined region of the tissue; in this embodiment, a three-dimensional surgical map L is stored, wherein for each position (X, Y, Z), a lesion value (P value) and a functional value (F value) (set to 0 before imaging here) are stored. Thus, the system 1 can read the intensities of the diseased tissue and the functional tissue after imaging and correspondingly supplementing the respective lesion values or functional values for a specific position (x1, y1, z1).

[0058] Furthermore, the system 1 has a central control unit 20, which is adapted to: process the provided first shot 8 with shot position data and the provided second shot 16 with shot position data. Similarly, the control unit 20 is also adapted to process the third shot of the third detection mode, the fourth shot of the fourth detection mode, and the fifth shot of the detection mode using the respective shot position data. The position of the detection mode and thus the position of the shot itself can also be determined (e.g., by transformation) by the tracking system 23.

[0059] The control unit 20 is further adapted to analyze and determine the first shot 8 for the first detection mode 2 such that at least one partial region of the tissue of the first shot 8 is assigned a lesion value and / or at least one partial region of the tissue of the first shot is assigned a functional value, and the lesion value or the functional value is supplemented in the corresponding position of the surgical map L. In this embodiment, the detected lesion value (positive here) is added to the lesion value of the surgical map according to the position, and similarly the detected functional value (negative here) is added to the surgical map. The analysis of the MRT shot can in particular be carried out by an artificial intelligence system (AI system) trained on tumors, which determines the region of the diseased tissue in the MRT shot and evaluates it accordingly using the lesion value. In particular, the control unit 20 performs the analysis and determination and is correspondingly adapted.

[0060] Similarly, the second shot is analyzed and determined for the second detection mode 10 such that at least one partial region of the tissue of the second shot is assigned a lesion value and / or at least one partial region of the tissue of the second shot is assigned a functional value, and the lesion value or the functional value is supplemented in the corresponding position of the surgical map L.

[0061] Similarly, for the third, fourth, and fifth detection modes at different respective spatial positions (when analyzed and determined), lesion values and / or functional values are respectively assigned and supplemented in the centralized (unique) surgical map L.

[0062] A centralized surgical map L is thereby obtained in which the different modalities are merged and integrated in order to provide a unified, homogeneous, centralized map L (see for example Figure 2 ), which can be integrated into different output modes. The surgical map L can be presented, for example, in a superimposed manner with a three-dimensional MRT image to display areas and / or boundaries and visually output to the surgeon.

[0063] The control unit 20 of the present embodiment is adapted to visually output a view of the surgical map L for navigation assistance via a presentation device 22 in the form of a surgical monitor, for example a virtual stereoscopic view of a tissue at a certain position with a predetermined viewing direction, the tissue having delineated areas of diseased tissue and functional tissue and presented boundary lines 24 (see also Figure 2 ).

[0064] Unlike the prior art, therefore, instead of observing individual detection modalities separately and individually, many different detection modalities are all used and centrally merged, unified and stored in a centralized surgical map L.

[0065] In particular, an extrapolation may also be performed in order to estimate the surrounding area also from point-by-point values, for example lesion values ​​determined by means of a biopsy.

[0066] Figure 2 A combination of a lesion value and a function value and a standardized map L including these two values ​​is shown schematically for the purpose of understanding the present disclosure to assist navigation.

[0067] exist Figure 2 The upper left of the diagram shows, by way of example, the so-called antagonist muscle of the cold zone, which is a risk structure and therefore has a high functional value. The risk structure can be determined in particular by the first detection mode 2, in particular by segmentation of DTI / fibers, for example MRT recordings or CT recordings, and by neuron monitoring. This provides the system 1 with a functional map of the risk structure (i.e. the anatomical structure to be preserved) to a certain extent.

[0068] On the other hand, Figure 2 The lower left of the hot zone shows by way of example the so-called main figure, which represents the target structure for removal. This data can be obtained by means of a further second detection modality 10, for example an MRI recording with demarcation of the tumor or a biopsy / histology result or fluorescence imaging, in order to visualize and detect the tumor structure. Thus, a lesion map of the structure to be removed is provided to the system 1.

[0069] Two maps, namely a functional map and a lesion map, are merged and fused in a centralized surgical map L. Thereby, functional structures and lesion structures are integrated and centrally present in this surgical map. If an additional detection mode is to be added, this new detection mode can very simply supplement the centralized surgical map with information about functional or lesion tissue, more precisely in the correct position relative to the patient (the shot ultimately has shot position data). Thus, a dynamically growing surgical map L can be created, which centrally and uniformly merges and fuses all information.

[0070] To ultimately assist the surgeon in the operation, a so-called gradient volume as shown in the right part of Figure 2 can be output, where the gradient between the functional area and the lesion area is output in the view, for example, via a surgical monitor. Boundary lines 24 are already given here, and these boundary lines represent resection boundaries calculated in a standardized manner.

[0071] The setting of the gradient can be changed by means of a slider regulator, which is presented and operable, for example, in a touch display, as the input unit 26, so as to set the aggressiveness of the resection accordingly as the resection boundary or the boundary line 24 changes.

[0072] That is, a threshold can be set to the gradient-defined contour (level set). This can be used especially for the orientation of the surgeon. Because especially steep or high gradients may be difficult to distinguish, for example, because the lesion area and the functional area are closely adjacent to each other.

[0073] In Figure 3 this setting of the gradient is shown exemplarily for understanding. In Figure 3 region A of, the gradient between the functional area and the lesion area is schematically shown, and two different boundaries can be seen here. The first boundary or boundary line 24 indicating a less aggressive resection of the tumor tissue (lesion tissue) and the second boundary for an aggressive resection are for detecting and removing the area around the lesion tissue. By setting the gradient, it is thus possible to move between these two boundary lines 24 with different aggressiveness. In Figure 3 region B of, the boundary of a very conservative resection is shown exemplarily.

[0074] For explanation, Figure 4 an exemplary illustration of the surgical map L as a color map with red and blue intensity maps is shown, where red is used for lesion tissue and blue is used for important functional tissue (shown here with different shades for the color). The amplitude correspondingly represents the area. A positive amplitude represents a lesion area with a lesion value, while a negative amplitude represents the functional area to be protected. A continuous surface is shown exemplarily between these areas. Here, the gradient can be considered for setting the boundary.

[0075] Figure 5 is Figure 4 an exemplary top view and shows the area to be removed (red) in two-dimensional form.

[0076] Figure 6 shows a navigation method according to a preferred embodiment. The navigation method is used for intraoperative guidance of a surgical instrument during tumor removal surgery on a patient with the aid of a surgical map, and in particular for the navigation system 1 of the present disclosure.

[0077] In step S1, at least one predefined area of the tissue of the patient P is detected before and / or during the surgery by means of a first detection mode, in particular a CT imaging device or an MRI imaging device, as a first capture with capture position data;

[0078] Then in step S2, a predefined area of the tissue of the patient is detected before and / or during the surgery by means of a second detection mode different from the first detection mode, in particular fluorescence imaging or electrophysiological imaging, as a second capture with capture position data;

[0079] In step S3, the first capture is analyzed and determined as follows for the first detection mode, such that at least one partial area of the tissue of the first capture is assigned a lesion value and / or at least one local area of the tissue of the first capture is assigned a function value, and the lesion value or function value is supplemented at the corresponding position in the surgical map, in which at least a first digital lesion value of the tissue and a second digital function value are stored for each position at least in the predefined area of the tissue.

[0080] In step S4, the second capture is analyzed and determined as follows for the second detection mode, such that at least one partial area of the tissue of the second capture is assigned a lesion value and / or at least one partial area of the tissue of the second capture is assigned a function value, and the lesion value or function value is supplemented at the corresponding position in the surgical map L.

[0081] Finally, in step S5, a view of the surgical map is output by a presentation device, in particular a surgical monitor, for navigation assistance.

[0082] List of Reference Signs

[0083] 1 Surgical navigation system

[0084] 2 First detection mode

[0085] 4 CT imaging device

[0086] 6 MRI imaging device

[0087] 8 First capture

[0088] 10 Second Detection Mode

[0089] 11 Surgical Microscope

[0090] 12 Fluorescence Imaging

[0091] 14 Electrophysiological Imaging

[0092] 16 Second Imaging

[0093] 18 Storage Unit

[0094] 20 Control Unit

[0095] 22 Presentation Device

[0096] 23 Tracking System

[0097] 24 Boundary Line

[0098] 26 Input Unit

[0099] 100 Robot

[0100] P Patient

[0101] L Surgical Map

[0102] S1 Steps of Detecting Using the First Detection Mode

[0103] S2 Steps of Detecting Using the Second Detection Mode

[0104] S3 Steps of Analyzing and Determining the Lesion Value and / or Function Value of the First Imaging

[0105] S4 Steps of Analyzing and Determining the Lesion Value and / or Function Value of the Second Imaging

[0106] S5 Steps of Outputting the View of the Surgical Map via the Presentation Device

Claims

1. A surgical navigation system (1) for intraoperative guidance, such as a surgical instrument, during tumor removal surgery on a patient (P) with the aid of a surgical map (L), the surgical navigation system having: A first detection mode (2), in particular a CT imaging device (4) or an MRT imaging device (6), the first detection mode being adapted to detect and computer - readably provide at least one predefined region of the tissue of the patient (P) as a first image (8) with imaging position data before and / or during the surgery based on the first detection mode; Characterized in that A second detection mode (10) different from the first detection mode (2), in particular fluorescence imaging (12) or electrophysiological imaging (14), the second detection mode being adapted to detect and computer - readably provide a predefined region of the tissue of the patient (P) as a second image (16) with imaging position data before and / or during the surgery based on the second detection mode; A storage unit (18) in which a centralized two - dimensional or three - dimensional surgical map (L) of the patient (P) is stored, wherein for each position of the surgical map (L), at least a first digital lesion value and a second digital functional value of the tissue are stored or storable in the predefined region of the tissue; A control unit (20), the control unit being adapted to: - Process the provided first image (8) with imaging position data and the provided second image (16) with imaging position data; - For the first detection mode (2), analyze and determine the first image (8) such that a lesion value and / or a functional value is assigned to at least one partial region of the tissue of the first image (8) and the lesion value or the functional value is supplemented at the corresponding position in the surgical map (L); - For the second detection mode (10), analyze and determine the second image such that a lesion value and / or a functional value is assigned to at least one partial region of the tissue of the second image and the lesion value or the functional value is supplemented at the corresponding position in the surgical map (L); and - Visually output a view of the surgical map (L) via a presentation device (22), in particular a surgical monitor, for navigation assistance in order to reliably distinguish between lesion tissue and functional tissue.

2. The surgical navigation system (1) according to claim 1, characterized in that, The control unit (20) is adapted to assign a first color to the first digital lesion value and a different second color to the second digital functional value of the tissue, wherein the color intensity is proportional to the corresponding numerical value, such that a color - stored surgical map is output when the view is output via the presentation device.

3. The surgical navigation system (1) according to any one of the preceding claims, characterized in that, The control unit (20) is adapted to determine a gradient between the lesion value and the functional value of the surgical map (L) and display a boundary line (24) in the view based on the gradient in order to show the boundary for resection to the user.

4. The surgical navigation system (1) according to claim 3, characterized in that, The navigation system (1) has an input unit (26). In particular, the presentation device (22) is configured as a touch display in order to detect an input made by the user. The control unit (20) is adapted to adapt the gradient setting based on the input in order to change the resection boundary line (24) in the view of the surgical map.

5. The surgical navigation system (1) according to any one of the preceding claims, characterized in that, The navigation system (1) has an input unit (26). In particular, the presentation device (22) is configured as a touch display in order to detect an input made by the user. The control unit (20) is adapted to manually define, based on the input, a region of tissue to which a first digital lesion value and / or a second digital functional value of the tissue has been assigned by means of the input, in order to also manually identify the region.

6. The surgical navigation system (1) according to any one of the preceding claims, characterized in that, As the at least first or second detection mode, the following are used: - an MRT imaging device and / or a CT imaging device and / or a DTI imaging device; - a surgical microscope; - an endoscope; - electrophysiology; - histology; and / or - a fluorescence imaging device.

7. The surgical navigation system (1) according to any one of the preceding claims, characterized in that, The first detection mode (2) and / or the second detection mode (10) are connected to the robot (100) as end effectors. In particular, a surgical microscope and / or an endoscope and / or a fluorescence imaging device are mounted on a robot arm as end effectors.

8. The surgical navigation system (1) according to any one of the preceding claims, characterized in that, A probe for measuring data is fastened to the robot arm of the robot (100).

9. The surgical navigation system (1) according to any one of the preceding claims, characterized in that the navigation system (1) has a navigation camera as an optical camera and is adapted to track a reference tracker, or the navigation system (1) has a navigation camera as an optical camera and uses a machine image processing system to spatially track an object.

10. A navigation method for intraoperative guidance of a surgical instrument during tumor removal surgery on a patient (P) with the aid of a surgical map (L), said navigation method being particularly for the navigation system (1) according to the foregoing claims, It is characterized by the following steps: - detecting (S1) at least one predefined region of the tissue of the patient (P) as a first shot (8) with shot position data before and / or during the operation by means of a first detection mode (2), in particular a CT imaging device or an MRT imaging device; - detecting (S2) a predefined region of the tissue of the patient (P) as a second shot (16) with shot position data before and / or during the operation by means of a second detection mode (10) different from the first detection mode (2), in particular fluorescence imaging or electrophysiology imaging; - analyzing and determining (S3) the first detection mode (2) of the first shot (8) such that at least one partial region of the tissue of the first shot (8) is assigned a lesion value and / or a functional value, and supplementing the lesion value or the functional value at the corresponding position in the surgical map (L), in which a first digital lesion value of the tissue and a second digital functional value of the tissue are stored or storable for each position at least in the predefined region of the tissue; - Analyze and determine (S4) the second detection mode (10) for the second shot (16) such that at least one partial area of the tissue of the second shot (16) is assigned a lesion value and / or a function value, and supplement the lesion value or the function value at the corresponding position in the surgical map (L); and - Output (S5) a view of the surgical map via a presentation device (22), in particular a surgical monitor, for navigation assistance so that it is possible to reliably distinguish between lesioned tissue and functional tissue.

11. A computer-readable storage medium comprising instructions which, when executed by a computer, cause the computer to perform the method steps of the navigation method according to claim 10.

12. A computer program comprising instructions which, when executed by a computer, cause the computer to perform the method steps of the navigation method according to claim 10.

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