Real-time support system for performing at least one bone tunnel by arthroscopy

A system for assisting with a production of at least one bone tunnel by arthroscopy in a joint of a patient using a surgical piercing instrument, the system comprising an imaging device or a measuring device, a monitoring device, a visualization unit and a programmable device, said programmable device adapted to:

• obtain a preoperative three-dimensional anatomical model specific to the patient, said preoperative three-dimensional anatomical model comprising a representation of at least one portion of interest of the joint of the patient and a representation of anatomical structures of interest,
• acquire monitoring information of a current position and orientation of the surgical piercing instrument IP(t) during a manipulation of said surgical piercing instrument using the monitoring device;
• determine a peroperative partial three-dimensional anatomical model comprising a representation of the at least one portion of interest of the joint, by:
• acquiring, using the imaging device, a stream of peroperative two-dimensional images comprising said at least one portion of interest of the joint, and acquiring monitoring information of the current position and orientation DI(t) of the imaging device using the monitoring device;
• wherein said peroperative partial three-dimensional anatomical model is obtained from the stream of peroperative two-dimensional images and said monitoring information of the current position and orientation DI(t), or
• acquiring, using the measuring device, a cloud of points representative of the at least one portion of interest of the joint, and acquiring monitoring information of the current position and orientation of said measuring device;
• wherein said peroperative partial three-dimensional anatomical model is obtained from said cloud of points;
• register the preoperative three-dimensional anatomical model on the peroperative partial three-dimensional anatomical model;
• calculate, based on at least information obtained with the registering of the preoperative three-dimensional anatomical model, and of the current position and orientation IP(t) of the surgical piercing instrument:
• a current zone L of localization, in a current peroperative two-dimensional image I(t), of a piercing end of the surgical piercing instrument,
• a first projection PA comprising a current estimation of a zone of localization of a first orifice of a bone tunnel to be produced,
• a second projection PB comprising a current estimation of a zone of localization of a second orifice of a bone tunnel to be produced,
• at least one of:
• in the first projection PA, first projections of a first part of the representation of the anatomical structures of interest during an operation phase, or
• in the second projection PB, second projections of a second part of the representation of the anatomical structures of interest, and
• at least one of:
• a first intersection between the current estimation of the zone of localization of the first orifice with the first projections of the first part of the representation of the anatomical structure of interest, or
• a second intersection between the current estimation of the zone of localization of the second orifice with the second projections of the second part of the representation of the anatomical structures of interest;
• and
• display on the visualization unit:
• a superimposition of the current peroperative two-dimensional image I(t) and of the current zone L of localization of the piercing end of the surgical piercing instrument,
• a first superimposition of the first projection PA and of the first projections of the first part of the representation of the anatomical structures of interest, and
• a second superimposition of the second projection PB and of the second projections of the second part of the representation of the anatomical structures of interest.