Digital twin

Twinical, the GPS for surgeons

Changed on 23/05/2024
The visor on the augmented reality headset is lowered over the surgeon's eyes. In the midst of a liver operation, the surgeon and the surgical team are presented with a digital replica of the patient's organ. This digital model reveals the presence of previously imperceptible tumours, invisible to the naked eye, while also revealing real-time deformations in the organ. Once the visor lifted, the surgeon's hand seamlessly resumes the procedure. This ground-breaking operating theatre scenario embodies the futuristic vision of the Twinical team, awarded with the prestigious i-Lab Grand Prize in 2022. The project is now ready to post-Inria Start-up Studio launch later this year.
Exemple de visualisation de l'anatomie interne de foie pendant la chirurgie
© Twinical

A digital twin for surgery

My name, formed from the combination of "twin" and "surgical," aptly conveys my contribution to the field of medicine: the technology of digital twins, which enables the creation of virtual reality replicas of organs to use before, during, and after medical procedures. My primary goal is to develop "twinicals," which will serve as comprehensive digital references for healthcare professionals. Through my capabilities, surgeons will harness digital models to enhance surgical planning and increase the likelihood of successful procedures. According to Mario Aricò, one of our co-founders, "the digital twin concept has already gained momentum in orthopaedic surgery. However, we intend to adapt it for modelling the liver and subsequently expand its use to other soft organs. Ensuring real-time accuracy for a dynamic model proves to be more challenging with soft, shape-shifting organs, where tumours may reposition." The ability to generate these precise models will play a pivotal role at every stage of the surgical process.

The digital twin will play a crucial role in shaping surgical strategies. Currently, surgical plans are formulated based on static MRI (magnetic resonance imaging) or CT scan (x-ray) images. These images, however, are inherently limited, as they provide only two-dimensional representations and can be challenging to interpret. Our objective is to streamline the creation of three-dimensional models." With the aid of my digital models, medical professionals and surgical teams will gain the ability to proactively design a surgical roadmap before the operation. During the procedure, they can leverage this digital twin as a virtual reference, facilitating their navigation and enabling them to pinpoint tumours within the intricate context of the patient's anatomy.

Treating liver cancer

Surgery is the most effective approach for treating liver cancer, whether it originates within the liver itself or results from the spread of cancer cells via the bloodstream, a scenario often seen in hepatic metastases, a common complication of colon cancer. In both primary and secondary liver tumours, surgeons and their teams face the intricate task of planning operations that entail the complete removal of cancer while maintaining healthy tissue margins to prevent recurrence. This process also involves preserving enough of the liver for proper regeneration. Professor Eric Vibert, an experienced surgeon specializing in liver and biliary diseases at Paul Brousse Hospital in Paris, notes, "With the increasing use of pre-operative medical treatments, identifying lesions during surgery has become increasingly challenging. We find ourselves in a situation where we have to remove something we can no longer visualize, all the while working within a dynamically changing anatomical context."

Medical teams can depend on me to chart their surgical "flight plan," encompassing the pre-operative selection of the surgical route, choice of instruments, and precise mapping of the liver section. My contribution aims to enhance the quality of care, reduce financial costs, and create a more conducive treatment environment by mitigating the risks of recurrence, complications, and potential equipment issues. In the words of Professor Eric Vibert, "Twinical will serve as a GPS guiding us to the optimal route." He further emphasizes that "Twinical will prove invaluable in meticulously planning surgical procedures and anticipating contingencies. The challenge in future clinical trials will be to demonstrate that with Twinical, we can execute the actions in the operating room exactly as we had planned beforehand."

Award-winning technology

Twinical - Remise Grand prix i-Lab 2022
The Twinical team at the i-Lab 2022 Grand Prize ceremony.
From left to right: Erik Pernod, Stéphane Cotin, Mario Aricò and Eric Vibert

My technology is built upon three foundational pillars: simulation through the use of a digital twin, real-time image acquisition to ensure that this model replicates its organic counterpart, and the utilization of artificial intelligence for image processing. This combination places my project at the forefront of innovation and was recognized with the prestigious Grand Prize in the 2022 i-Lab innovation competition, providing invaluable financial support for my forthcoming launch. As I constantly evolve, I finished the Inria Start-up Studio program in the spring of 2023. The next phase will involve transitioning into clinical testing over the coming years: "digital twins are feasible, but the real challenge lies in integrating this technology into the operating theatre, a process that will demand time and diligent effort, given the complexity of the endeavour." In preparation for my introduction and deployment in medical facilities, it is imperative that my technology is refined and my digital twins evolve into dependable, resilient models. To overcome these scientific challenges, we can count on the expertise of Stéphane Cotin, founder and senior researcher of the Mimesis team at the Inria Strasbourg branch, a key partner in our project. With the backing of Inria, an organization where healthcare research is a top priority, and with the support of Paris Hospitals (AP-HP) who have welcomed our collaboration, our entire team holds optimistic prospects for my future success.

The Twinical 3

The Twinical journey began in 2021 when Mario Aricò, Ph.D. in surgical robotics, was in search of an engaging and entrepreneurial project. Thanks to his professional network, he discovers the SOFA platform, which was developed by Stéphane Cotin and his team. The goal of SOFA is to help research teams develop accurate and real-time models of deformable objects. Virtual surgical training is one of the most promising applications. Mario delves deep into better identifying surgical needs for high-fidelity simulation, a pursuit that ultimately leads to digital twin technology. The next step was to reach out to Stéphane Cotin, an eminent reserarcher in the field, and subsequently to Éric Vibert from AP-HP, the founder of the BOPA Innovation Chair, who had been actively engaged in digital twin research alongside Stéphane Cotin since 2019. The Twinical team was officially born in late 2021, and in March 2022 the project entered the Inria Start-up Studio for its maturation phase. The company will be officially established in Autumn 2023, and preparations are underway to recruit the necessary personnel for initiating a development phase in the path to clinical trials, with the official commercial launch set for early 2027.

In early 2023, Twinical reached a significant milestone with its visit to the United States. As the recipient of the i-Lab Grand Prize, the start-up gained entry into the NETVA competition (New Technology Venture Accelerator), a bespoke support program organised by the French Embassy in the USA, aimed at facilitating the entry of innovative French companies into the North American market. This opportunity, coveted by many, is extended to only a select few among the pool of French enterprises. Twinical made its way to Houston in 2023 to further its work on digital twin technology.

Twinical and its members on social networks