What is Sentinella : A truly global opportunityWhat 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!

Radioguided Surgery: Present SituationRadioguided 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.sv.s

Radioguided Surgery: Present SituationRadioguided Surgery: Present SituationLimited depth of detection with conventional Gamma probes

Problem

~2 or 3 cm

Dificulty of localizationDificulty of localization

Distance (cm)

3 6

Dificulty of localizationDificulty of localization

Distance (cm)

FOV(cm)

3 6 9

4x4 8x8 12x12

Innovation is the vital spark of all human change

Radioguided Surgery: wanted SituationRadioguided Surgery: wanted Situation

NO technological limitations: A complete system for radioguided surgery. Revolutionary integrated cancer A complete system for radioguided surgery. Revolutionary integrated cancer detection equipment for ease use in / out the OR.detection equipment for ease use in / out the OR.

GAMMACAMERA + POINTERS + PROBE + VERIFICATION SOFTWAREGAMMACAMERA + POINTERS + PROBE + VERIFICATION SOFTWARE

Real time vision in OR of tumours and related drainage + lymph nodes, with high sensibility and sensitivity (>75% than Real time vision in OR of tumours and related drainage + lymph nodes, with high sensibility and sensitivity (>75% than probesprobes11): variable FOV and collimator, acquisition time, comparative images IN VIVO / EX VIVO + node verification ): variable FOV and collimator, acquisition time, comparative images IN VIVO / EX VIVO + node verification softwaresoftware.

EVIDENCE BASED MEDICINE: EVIDENCE BASED MEDICINE: Wide range of international publicationsWide range of international publications

WhatWhat can Sentinella improve? can Sentinella improve? Part 1Part 1

• Optimized skin marking in NM department ( image A )Optimized skin marking in NM department ( image A )• Deep draining tumors: better localization of the SLNDeep draining tumors: better localization of the SLN• Enhanced verification between Enhanced verification between first SLNfirst SLN and other nodes and other nodes• Real time imaging of drainage and SLNReal time imaging of drainage and SLN• In-vivo and ex-vivo comparison ( image B )In-vivo and ex-vivo comparison ( image B )• Peace of mind warranty for surgeons, i.e ROLL ( image C )Peace of mind warranty for surgeons, i.e ROLL ( image C )

A B C

Innovation is the vital spark of all human change

accurate localisation ex vivo verification: rollaccurate localisation ex vivo verification: roll technique – tumor margintechnique – tumor margin

WhatWhat can Sentinella improve? can Sentinella improve? Part 2Part 2

• Detecting SNL in a more accurate manner Detecting SNL in a more accurate manner • Better marking of the SLN to plan surgical extirpation routeBetter marking of the SLN to plan surgical extirpation route• Real time vision of tumors and SLN during surgeryReal time vision of tumors and SLN during surgery• Better sensitivity and specificityBetter sensitivity and specificity

Conclusion:Conclusion:

A B C

Innovation is the vital spark of all human change

Sentinella specifications :Sentinella specifications :

A B C

Innovation is the vital spark of all human change

Sentinella procedures :Sentinella procedures :

A B C

Innovation is the vital spark of all human change

Practical example I: Sentinella in ROLL techniquePractical example I: Sentinella in ROLL techniqueImages 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

ROLL technique (Radioguide Occult Lession Localization):

Eliminating harpoon- allows for breast tumour margin verification inside OR.

It is made injecting the radiotracer inside the tumor

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

SNOLL technique (Sentinel Node and Occult Lession Localization)

SN biopsy + ROLL

Centered lesion

No Centered lesion

Innovation is the vital spark of all human change

Practical example 2: Sentinella in H&N cancer Practical example 2: Sentinella in H&N cancer Images from NKI-AvL / Dr. Renato Valdes Olmos

Head & Neck /Oral Cavity +/- 80MBq of 99mTecnetium-nanocolloid (0.4ml)

injected from 4 to 24h before surgeryDynamic lymohoscintigraphy & static images at 15

minutes and 2 hours.SLNB performed in:

breslow thickness>1mm or Clark invasion lefel 4

T1 T2 oral cavity carcinoma patients-experimental-multicenter study.

Practical example 3: Sentinella in Practical example 3: Sentinella in Prostate cancerProstate cancer Images from NKI-AvL / Dr. Renato Valdes Olmos

Innovation is the vital spark of all human change

Absence of perfusion: confirmation of death

Normal encephallic blood perfusion

Anterior Left Lateral Anterior Left Lateral

Confirmation of possible donors for transplants, encephalic deathConfirmation of possible donors for transplants, encephalic death• 70.000 transplants per year wordwide• Mandatory absolute confirmation of death, and organ viability (biological perfusion vs simple blood flow) • After transplant, easy and secure assessment of implant viability• Sentinella is a safe, portable and user-friendly alternative / new standard

Practical example 4: Hospital Univ.Virgen MacarenaPractical example 4: Hospital Univ.Virgen Macarena

Innovation is the vital spark of all human change

Succesful experience in 4000

patients!