A Decission Support System for Endoprosthetic Patient-Specific Surgery of the Human Trachea

This chapter presents a patient specific decision support system for helping surgeons in endoprosthetical tracheal surgery. The system is based on a set of 3D finite element numerical simulations of the human trachea during swallowing with and without prosthetic insertion. The associated code uses the constitutive behavior derived from a set of experimental and histological tests performed for its main components: smooth muscle and cartilage. A complete set of numerical results is derived from those simulations using a parametric approach relying on a robust design of experiments and on a automatic mesh adaptation process. These results feed a tool for statistical analysis of human swallowing without and with prosthesis that, together with the response surface method, allows getting a set of response functions for the most important variables of the problem (displacements and principal stresses) for every point of the trachea in terms of a set of patient-specific parameters that define the geometry of the trachea and prosthesis. This provides the thoracic surgeon a fast, accurate and simple tool for predicting the stress state of the trachea and the reduction in the ability to swallow after implantation thus helping in taking decisions during pre-operative planning of tracheal interventions. This tool is also useful for performing patient specific studies of pathological swallowing and for the design of new types of prostheses.