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R2Innovations / OncoVision : Sentinella - your new eyes

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A new important technical advance in radio-guided-surgery is the introduction of a new generation of portable mini gamma camera: Sentinella - your new eyes in intra-operative imaging. A revolutionary & integrated equipment for
real time intra-operative imaging of tumors and superficial OR deep lymph nodes , in open and/or laparoscopic surgery.

Gamma probes cannot give spatial or visual information and often cannot discriminate between sentinel nodes and secondary lymph nodes.

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R2Innovations / OncoVision : Sentinella - your new eyes

  1. 2. What is Sentinella : A truly global opportunity A revolutionary & integrated equipment for : Real time intra-operative imaging of tumors and superficial OR deep lymph nodes , in open and/or laparoscopic surgery. A peace of mind warranty for surgeons and referring physicians!
  2. 3. Radioguided Surgery: Present Situation Fantastic results, BUT technological limitations: Long learning curve, technical limitation of probes; subjective assessment of sound, limitation of amplitude and depth of detection, low sensibility in nodes near by the tumor / small / deep. Innovation is the vital spark of all human change v.s
  3. 4. Radioguided Surgery: Present Situation Limited depth of detection with conventional Gamma probes Problem ~2 or 3 cm
  4. 7. Dificulty of localization 3 6 Distance (cm)
  5. 8. Dificulty of localization 3 6 9 4x4 8x8 12x12 Distance (cm) FOV(cm)
  6. 9. Innovation is the vital spark of all human change Radioguided Surgery: wanted Situation NO technological limitations: A complete system for radioguided surgery. Revolutionary integrated cancer detection equipment for ease use in / out the OR. GAMMACAMERA + POINTERS + PROBE + VERIFICATION SOFTWARE Real time vision in OR of tumours and related drainage + lymph nodes, with high sensibility and sensitivity (>75% than probes 1 ): variable FOV and collimator, acquisition time, comparative images IN VIVO / EX VIVO + node verification software . EVIDENCE BASED MEDICINE: Wide range of international publications
  7. 10. What can Sentinella improve? Part 1 <ul><li>Optimized skin marking in NM department ( image A ) </li></ul><ul><li>Deep draining tumors: better localization of the SLN </li></ul><ul><li>Enhanced verification between first SLN and other nodes </li></ul><ul><li>Real time imaging of drainage and SLN </li></ul><ul><li>In-vivo and ex-vivo comparison ( image B ) </li></ul><ul><li>Peace of mind warranty for surgeons, i.e ROLL ( image C ) </li></ul>A B C Innovation is the vital spark of all human change accurate localisation ex vivo verification: roll technique – tumor margin
  8. 11. What can Sentinella improve? Part 2 <ul><li>Detecting SNL in a more accurate manner </li></ul><ul><li>Better marking of the SLN to plan surgical extirpation route </li></ul><ul><li>Real time vision of tumors and SLN during surgery </li></ul><ul><li>Better sensitivity and specificity </li></ul><ul><li>Conclusion: </li></ul>A B C Innovation is the vital spark of all human change
  9. 12. Sentinella specifications : A B C Innovation is the vital spark of all human change
  10. 13. Sentinella procedures : A B C Innovation is the vital spark of all human change
  11. 14. Practical example I: Sentinella in ROLL technique Images from H. Clinic Barcelona Dr. Sergi Vidal-Sicart (nm), Dra.P.Paredes (nm), Dr. G. Zanon (s) Innovation is the vital spark of all human change Centered lesion No Centered lesion <ul><li>ROLL technique (Radioguide Occult Lession Localization): </li></ul><ul><ul><li>Eliminating harpoon- allows for breast tumour margin verification inside OR. </li></ul></ul><ul><ul><li>It is made injecting the radiotracer inside the tumor </li></ul></ul><ul><ul><li>Once the tumor has been excised, the objective is to make sure that it has the convenient free borders and, according to this, there is no tumor inside the patient </li></ul></ul><ul><li>SNOLL technique (Sentinel Node and Occult Lession Localization) </li></ul><ul><ul><li>SN biopsy + ROLL </li></ul></ul>
  12. 15. Practical example 2: Sentinella in H&N cancer Images from NKI-AvL / Dr. Renato Valdes Olmos Innovation is the vital spark of all human change <ul><li>Head & Neck /Oral Cavity </li></ul><ul><ul><li>+/- 80MBq of 99mTecnetium-nanocolloid (0.4ml) injected from 4 to 24h before surgery </li></ul></ul><ul><ul><li>Dynamic lymohoscintigraphy & static images at 15 minutes and 2 hours. </li></ul></ul><ul><ul><li>SLNB performed in: </li></ul></ul><ul><ul><ul><li>breslow thickness>1mm or Clark invasion lefel 4 </li></ul></ul></ul><ul><ul><ul><li>T1 T2 oral cavity carcinoma patients-experimental-multicenter study. </li></ul></ul></ul>
  13. 16. Practical example 3: Sentinella in Prostate cancer Images from NKI-AvL / Dr. Renato Valdes Olmos Innovation is the vital spark of all human change
  14. 17. Absence of perfusion: confirmation of death Normal encephallic blood perfusion Confirmation of possible donors for transplants, encephalic death <ul><li>70.000 transplants per year wordwide </li></ul><ul><li>Mandatory absolute confirmation of death, and organ viability (biological perfusion vs simple blood flow) </li></ul><ul><li>After transplant, easy and secure assessment of implant viability </li></ul><ul><li>Sentinella is a safe, portable and user-friendly alternative / new standard </li></ul>Practical example 4: Hospital Univ.Virgen Macarena Innovation is the vital spark of all human change Anterior Left Lateral Anterior Left Lateral
  15. 18. Succesful experience in 4000 patients!

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