inomed Medizintechnik GmbH of Emmendingen at MEDICA 2018 in Düsseldorf -- MEDICA - World Forum for Medicine

inomed Medizintechnik GmbH

Im Hausgrün 29, 79312 Emmendingen
Germany
Telephone +49 7641 941410
Fax +49 7641 941494
info@inomed.com

Hall map

MEDICA 2018 hall map (Hall 9): stand C66

Fairground map

MEDICA 2018 fairground map: Hall 9

Contact

Srinath Berthold

Phone
+49 7641 94 14-0

Email
info@inomed.com

Our range of products

Product categories

  • 01  Electromedical Equipment / Medical Technology
  • 01.01  Diagnostics
  • 01.01.06  Neurological diagnosis, apparatus and instruments

Neurological diagnosis, apparatus and instruments

  • 01  Electromedical Equipment / Medical Technology
  • 01.04  Therapy and physical medicine
  • 01.04.04  Cryotherapy, cryosurgery equipment

Cryotherapy, cryosurgery equipment

Our products

Product category: Neurological diagnosis, apparatus and instruments

ISIS Switchmatrix

ISIS Switchmatrix switches between iEEG and electrical stimulation – an intuitive and scalable solution

Stimulation and recording of  iEEG has never been so easy

The intracranial EEG, or iEEG, is a method of evaluating epileptic activity in the brain. In case of intractable epilepsy, surgical intervention is an option. To narrow down the focus of the epileptic activity, an iEEG is measured and the pathological sites in the brain are identified. Applications of iEEG are found in neuroscientific research, e.g. in cortical mapping and functional studies.

Flexibility, speed and simplicity

The ISIS Switchmatrix has a range of areas of application. These include applications with iEEG in the diagnosis of epilepsy or with chronic or acute electrophysiological studies of the cortical surface. The complete study is often supported with a VEEG. The ISIS Switchmatrix is an open system and works with all stimulators and digital amplifiers for iEEG recording. Whenever flexibility, speed and simplicity are required, the inomed Switchmatrix provides a powerful and simple stimulation switching tool for use with invasive multi-channel recording or an intracranial EEG. The ISIS Switchmatrix benefits from a history of developing electrical stimulation systems for IOM and diagnostic applications. The design of the Switchmatrix and corresponding software applications both benefit from extensive cooperation with neurologists, neurosurgeons and other specialists to ensure optimal usability and performance.

Individually controllable electrodes

The ISIS Switchmatrix is powered by a USB port and connects one or two of the 64 channels from iEEG to electrical stimulation. The ISIS Neurostimulator is the perfect partner for the ISIS Switch Matrix with iEEG. In combination with a digital amplifier, the ISIS Switchmatrix can connect individual electrodes of the iEEG lead with the ISIS Neurostimulator or other nerve stimulators. At the same time, the other non-switched channels continue to record the iEEG. However, the ISIS Switchmatrix also offers the ideal starting point for complex applications. Up to three expansion modules - ISIS Switchmatrix extensions - can be connected to the ISIS Switchmatrix. Each of these expansion modules also contain 64 channels and the option to connect up to two additional stimulators. inomed offers a complex solution to meeting complex neurological testing challenges. A maximum of eight stimulators can be connected to individual electrodes for up to 256 channels for the iEEG.

Features
  • Simple and intuitive operation
  • Expansion option with up to 3 ISIS Switchmatrix extensions
  • 64 to 256 channels
  • Connections for up to 8 external neurostimulators

Applications
  • Presurgical evaluation of epilepsy
  • Electrocortical stimulation mapping
  • Fast switching within an electrode array

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Product category: Neurological diagnosis, apparatus and instruments, Neurosurgical instruments and equipment

C2 NerveMonitor

The C2 NerveMonitor from inomed combines simplicity of use with high quality stable EMG signals and acoustic tones output. The matched electrical stimulation accessories enable intermittent & continuous monitoring to be performed.

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Product category: Neurosurgical instruments and equipment, Other surgical instruments and products

C2 Thyroid Surgery

C2 NerveMonitor – Easy-to-use neuromonitoring for thyroid surgery, ENT, spine and a range of other applications

Innovation delivering quality and reliability for preservation of nerve function
The C2 NerveMonitor is the result of inomed's 20+ years of experience in the field of nerve monitoring (IONM). The C2 is available as a 4 or 8 channel EMG monitor. The system includes high performance differential amplifiers and two independent stimulators: one stimulator may be used for direct nerve stimulation with handheld probes and the second for applications such as continuous vagus nerve monitoring, delivering stimulation at a user-defined rate and amplitude.

Proven methods of neuromonitoring - Simplified
Designed for everyday use in the operating room, the C2 NerveMonitor benefits from an intuitive user interface that makes the system very easy to use indeed. The C2 combines simplicity of operation with a clear visual display showing waveform, trends and numbers, as well as auditory feedback. All monitoring sessions are recorded and can be printed in the form of a comprehensive user-defined report. All the device’s components have been designed to meet European and international safety and quality standards. Procedures that can be monitored using the C2 NerveMonitor include thyroid surgery and a range of user-specific programs for ENT and spinal surgery. The sophisticated easy-to-use interface and a comprehensive range of accessories make the C2 NerveMonitor a versatile and portable system for the OR.

Neuromonitoring as the standard of care
Neuromonitoring is becoming the standard of care for a wide range of revisionary surgical procedures. This is particularly true of procedures for the thyroid gland. Common to all surgical interventions, the requirement for documentation from monitoring thyroid surgery is either mandatory or becoming an essential part of patient care. A major strength of the C2 NerveMonitor is the ability to document and produce fast and accurate reports. The C2 NerveMonitor provides a barcode scanner to enable fast input of patient identification, while the systems also includes tools for easy data integration into patient management databases and intuitive ways to easily create patient monitoring reports. The C2 exemplifies the application of innovation in delivering quality patient care.

Features
  • Ease of use for Operating Room staff
  • Synthetic sound technology for easy audio interpretation of nerve response
  • Clear presentation of the muscle response in the form of EMG waveforms
  • Channel Select software for optimal signal quality in thyroid surgery
  • High quality loudspeakers
  • Continuous vagus nerve monitoring during thyroid surgery
  • Integrated patient database
  • Barcode scanner for patient ID input
Applications
The C2 NerveMonitor was developed to provide real-time feedback for neural pathway integrity. Surgical procedures monitored using the C2 NerveMonitor include:
  • Thyroid gland procedures
  • Parotid surgery
  • Acoustic neuroma
  • Cochlear implantation
  • Pedicle screws and XLIF
  • Neurosurgery (motor cranial nerves)

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Product category: Neurological diagnosis, apparatus and instruments, Neurosurgical instruments and equipment

C2 Spine Surgery

Neuromonitoring for Spinal Column Surgery

C2 Spine Software – simple, fast and intuitive
inomed is pleased to announce the availability of our new Spine Software for the C2 NerveMonitor. The new Spine Software is coupled with a release of a set of matching accessories to enable easy and intuitive neuromonitoring during spinal surgery. The software is available on the C2 NerveMonitor platform, which is already used across the world for a wide range of surgical monitoring where user-friendly operation and quality signal acquisition is of paramount importance e.g. in thyroid surgery.

Intuitive controls –   positioning needle electrodes  and connecting cables
When monitoring spinal surgery with the C2 Spine Software, the user is guided step by step. The program provides simple options for setup ensuring the user is ready to perform the test very quickly.  The especially designed accessories have been adapted to the Spine Software. The user is guided intuitively through each step, starting from the correct positioning of the needle electrodes to connecting the cables to the system.  This makes neuromonitoring during spinal surgery an easy standard to adopt as a part of the surgical procedure. The C2 Spine Software combines efficient neuromonitoring during spinal surgery with simple and intuitive operation that has been tried and tested for other applications of the C2 NerveMonitor.

Automatic monitoring of the pharmacological relaxation status of patients
The C2 Spine Software includes an integrated twitch-test (relaxation monitoring). This test is used to automatically check the pharmacological relaxation status of the patient's muscles. This is crucial for effective recording of signals during spinal surgery.
The muscles are continuously monitored when the software is in measuring mode. If a relevant activity occurs – for example, by direct nerve manipulation – the surgeon is informed of this visually and acoustically. Pedicle screw testing and stimulation capabilities of the C2 make automatic identification of the respective stimulation threshold value possible and thus the position of the screw within the pedicle can be inferred. Essential information is provided quickly and easily and is displayed for users during spinal surgery.

The C2 Spine Software automatically saves all muscle responses and stimulation limits in one document for the subsequent report. As a result, it is possible to review every stimulation response for the procedure at a later date.

Features
  • Ease of operation by OR staff
  • Clear representation of the EMG signal
  • C2 Spine Software for operations on the spinal column
  • Good quality loudspeakers
  • Twitch-test for automatic relaxation monitoring
  • Barcode scanner for patient data
Applications
  • Posterior cervical interbody fusions
  • Lumbar interbody fusions

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Product category: Neurosurgical instruments and equipment, Other surgical instruments and products

C2 Facial surgery/ENT

Ear, nose and throat medicine: Acoustic neuroma to the parotid

The application of neuromonitoring techniques can considerably reduce risks during parotid surgery

Surgery in ear, nose and throat medicine is delicate, complex and high-precision. This is also the case for surgery of the parotid (parotid gland surgery). During parotid surgery, the location of the branches of the facial nerve poses a major challenge for the surgeon. Monitoring, localization and function-testing of nerves located in the operating field is indispensable in supporting the surgeon during the parotid procedure. Neuromonitoring serves as a method of choice, delivering lower risks and an improved patient outcome. The most common ENT interventions in which inomed products are used include the following:

  • Parotid surgery (surgery of the parotid gland)
  • Thyroid surgery
  • Acoustic neuroma
  • Tympanoplasty
  • Mastoidectomy
Monitor nerves, mitigate risk and improve patient outcome: Parotid gland surgery and other ENT procedures can be performed safely

During a parotid gland (parotid) procedure, the facial nerve is particularly at risk.

For thyroid surgery, neuromonitoring with inomed nerve monitoring technology can help  reduce the risk of nerve injury to the vocal cord nerves and thus minimize the possibility of  temporary or complete vocal cord paralysis.

During tympanoplasty procedures, neuromonitoring reduces the risk of injuring nerve tissue when milling near the boney facial canal. Additionally, during mastoidectomy procedures, neuromonitoring techniques are also used to reduce the risk of injury during milling in the vicinity of the bony facial canal.

Surgery in ear, nose and throat medicine is more challenging without the use of neuromonitoring equipment and techniques. Nerve-sparing parotid surgery (surgery of the parotid gland) improves the quality of intraoperative management and shortens operating times. Patients respond positively to the reduced surgical time leading to improved outcomes.

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Product category: Neurosurgical instruments and equipment

C2 Xtend

C2 Xtend - Specialist for cortical applications

Advanced Brain Mapping for safe tumour resection in neurosurgery

Precision and safety have highest priority in the resection of brain tumours. Interventions in neurosurgery are among the most complex surgical procedures since important neuronal structures are located close to the operating field.

So-called mapping - the localisation of functional areas - is of central importance in the field of neurosurgery for the targeted and sparing removal of gliomas and other cerebral tumours. This technique allows localising language relevant and motor regions, while subsequent continuous monitoring enables gentle resection of tumours.

Proven C2 concept with extended functions

Based on the well-proven concept of the C2 NerveMonitor, the C2 Xtend was perfected for cortical use. Absolutely convincing is its specially developed software for neurosurgery, which besides its simple and intuitive operation offers parameters specially adapted to cortical stimulation.

C2 Software modules for other surgical disciplines

With the upgrade to all other C2 NerveMonitor applications the C2 Xtend offers versatile application options and opens up access to a wide range of surgical disciplines and needs, not only in neurosurgery.

In addition to its diverse features on the surgical level, the C2 Xtend offers user-oriented add-ons such as a barcode scanner, which can input patient data and store them in the integrated database of the C2. To ensure trouble-free operation, the C2 has an automated impedance control.

Features
  • Especially developed C2 SEP software for cortical mapping in neurosurgery
  • Easy handling
  • Clear display of the EMG signals
  • Stimulation parameters for all cortical stimulations - biphasic pulse form and train stimulation
  • Barcode scanner for storage of patient data
  • Integrated database
Applications
  • Direct cortical stimulation
  • Speech mapping
  • Motor mapping
  • Mapping of cranial nerves

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Product category: Neurosurgical instruments and equipment, Other surgical instruments and products

NeuroExplorer Software for intraoperative Neuromonitoring

Next generation of ISIS IOM Software

NeuroExplorer Software 6.0 for intraoperative Neuromonitoring

The powerful NeuroExplorer Software 6.0 is the latest inomed innovation in the field of intraoperative moni­toring and meets the highly demanding requirements for comprehensive monitoring: improved signal quality resulting from optimized digital signal processing, high user-friendliness and complete documentation.

The NeuroExplorer Software 6.0 is available for all versions of the latest ISIS IOM systems ISIS IOM system, ISIS IOM system compact and portable ISIS Xpress. The modular design of the NeuroExplorer Software 6.0 offers users flexible configuration of individual types of measurement and can be expanded to meet individual requirements.

Proven technology meets intelligent usability improvements

The next software generation NeuroExplorer 6.0 refines proven technology of the neuromonitoring software with innovative tools and offers a precise and efficient monitoring for optimal measurement data during the entire monitoring procedure.

NeuroExplorer Software 6.0 allows a quick creation of individual scenarios by using templates with predefined standard parameters. High-user-friendliness supports an easy application and efficient operation procedure through simple adjustment of electrode positions, detail window for signal key information, easy to use comment function and live analysis of signals during ongoing monitoring process. 

Further significant and innovative feature of the NeuroExplorer Software 6.0 is the improved digital signal processing (DSP). DSP allows a more detailed identification and reduction of stimulation artefacts and a significantly improved signal quality. The automated, exact peak detection simplifies the analysis of signals during the procedure. Through intelligent data capturing immediate missed spontaneous activity will be subsequently captured when starting EMG and EEG recording. Automated recording of all monitoring data in EDF+ format simplifies the analysis process with any free analysis software.

The NeuroExplorer Software 6.0 and its comprehensive datamanagement offers further advantages to the users. The new SQL Server based DataSync-Module offers a synchronized database for several ISIS IOM systems enabling the synchronization of patient data between multiple workstations. DataSync is the optimal solution for a central data and backup management.

The Screen2Video feature providing all activities as video file, offer advanced service and a helpful tool for presentations and training purposes.

Features

New usability
  • Electrode positioning – quick and easy configuration
  • Signal key information in one view
  • Timeline – live analysis during ongoing monitoring
  • Default Editor for quickly creating indivdual scenarios
  • Individual and quick arrangement of monitoring windows
Comprehensive datamanagement
  • New report generator
  • DataSync – synchronized database for several ISIS IOM systems
New DSP toolbox
  • Improved digital signal processing (DSP)
  • Identification and reduction of stimulation artefacts
  • Optimized filter algorithm for raw signals
  • Improved peak detection of evoked potentials
  • All signals saved as EDF+ data
  • Intelligent data capturing
Advanced Service
  • Screen Capturing – Screen2Video function for presentations and education
  • ServiceZip – fast support assistance
Applications
  • Neurosurgery, including SEP and MEP monitoring during spinal cord surgery
  • ENT surgery, including AEP and EMG monitoring in acoustic neuroma
  • General & visceral surgery, for example, EMG monitoring in surgery of the thyroid gland
  • Vascular surgery, for example, SEP monitoring in the event of carotid stenosis
  • Orthopedics and spinal surgery, such as SEP and MEP monitoring spine and scoliosis surgery
  • Cardiothoracic surgery, such as SEP and MEP monitoring for aortic aneurysms

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Product category: Neurosurgical instruments and equipment, Other surgical instruments and products

ISIS IOM System

Intraoperative Neuromonitoring: From SEP to MEP

inomed Neuroexplorer software includes EMG, AEP, SEP, MEP, phase reversal SEP, EEG and VEP capabilities enabling the monitoring clinician to deliver a comprehensive monitoring service.

Intraoperative neural monitoring (IONM) refers to a variety of methods that are used to monitor the integrity of nerves during surgery (including SEP). Neuromonitoring forms an important part of the range of services offered to patients in a modern hospital.  IONM is used in the fields of neurosurgery, cardiothoracic surgery, ear, nose and throat medicine, orthopedics, trauma surgery, vascular surgery, abdominal surgery, as well as general surgery. These systems and techniques can also be used in the ICU.

IONM techniques are used to minimize and prevent risks to motor and sensory nerves during surgery. The technique also assists clinicians to identify nerve structures using neurostimulation, and helps prevent nerve impairment during the operation. IONM applications include aortic aneurysm surgeries, including spinal monitoring with SEP and MEP and SEP monitoring during carotid surgery. In addition, it is also possible to measure and monitor a full range of electrophysiological modalities, including EMG, AEP, MEP, SEP, EEG and VEP, and correlate the results against a common time base.

One system – Configured to meet all your application requirements

The inomed ISIS IONM system delivers impressive performance, ease of use, flexibility and a comprehensive range of applications. The ISIS IONM system provides a complete and user-configurable package for multi-modal intraoperative neurophysiological monitoring.

The ISIS IONM system is available in three different forms – the ISIS IONM system, the ISIS IONM compact system, and the ISIS IONM Xpress (portable). The type and number of amplifiers can be selected and configured in accordance with the user’s intended application. The ISIS neurostimulator is the heart of every ISIS IONM system.

The stimulation adapters used with the ISIS neurostimulator are color-coded and clearly labeled, enabling easy connection to probes and electrodes at the patient’s bedside.

Regardless of the ISIS IONM system you choose – all inomed IONM system configurations are based on USB technology and are designed to be upgradable. The systems can be enhanced with additional channels and applications as required to meet your changing monitoring needs. Our ultimate aim is to provide powerful, flexible tools that improve the level of information available during surgical procedures, enabling clinicians and surgeons to minimize nerve impairment and deliver improved outcomes for patients.

Features
  • The ISIS IONM system is available as an 8, 16, 24 or 32 channel system and can be upgraded up to 128 channels, if required
  • Constant current stimulator with 12+1 outputs for direct neural, cortical, muscular, transcutaneous and transcranial electrical stimulation
  • Stimulation current of 0.01mA to 250mA can be set at individually definable levels
  • Continuous impedance measurement and current flow control indicator
  • Each stimulation channel can be used flexibly for all measurement types and freely selected to create montages or muscle groups
  • Easily create an unlimited number of application-specific, pre-installed measurement programs. The system includes a large number of predefined programs for application areas, including tibialis, EMG, SEP, MEP and SEP
  • Simultaneous, clear presentation of all measurement types, including tables, stacks and trends for selected modalities
  • Patient documentation database with the option to synchronously analyze data from another PC
Applications
  • Neurosurgery, including SEP and MEP monitoring during spinal cord surgery
  • ENT surgery, including AEP and EMG monitoring in acoustic neuroma
  • General & visceral surgery, for example, EMG monitoring in surgery of the thyroid gland
  • Vascular surgery, for example, SEP monitoring in the event of carotid stenosis
  • Orthopedics and spinal surgery, such as SEP and MEP monitoring spine and scoliosis surgery
  • Cardiothoracic surgery, such as SEP and MEP monitoring for aortic aneurysms
  • Pelvic Intraoperative Neuromonitoring

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Product category: Neurosurgical instruments and equipment, Other surgical instruments and products

ISIS Neurostimulator

A general-purpose neurostimulation system 

The ISIS Neurostimulator is a USB powered module that can be used with stand-alone Windows based PC software to deliver electrical stimulation. The ISIS Neurostimulator can also be configured to form a part of the ISIS IOM system using the NeuroExplorer software. The device provides a multifunctional constant current stimulator, which is specially designed for Neurostimulation and intraoperative neurostimulation.
 
Easy to use – safe and reliable connection
The stimulation adapters used with the ISIS Neurostimulator are color-coded and clearly labeled enabling easy connection to probes and electrodes at the patient’s bedside.
The ISIS Neurostimulator can also be configured to be used with neurodiagnostic systems to deliver neurostimulation for EMG and iEEG procedures.

The ISIS Neurostimulator – powerful and flexible
The ISIS Neurostimulator includes 12 channels for high-power stimulation (max. 250 mA) and a single channel for direct nerve stimulation (max 25 mA). The range of outputs allow for the simultaneous use of a range of neurophysiological measurement techniques in surgery, including neurosurgery, epilepsy surgery, general and visceral surgery and ENT. In addition to the 12 channel stimulation capability, the ISIS Neurostimulator also includes technology that continuously monitors the impedances of the stimulation electrodes. This technique ensures that the current delivered to the patient is constant and kept within safe limits. Stimulation parameters can be modified and saved in the control software.

Features
  • Constant current stimulator with 12+1 outputs for direct neural, cortical, muscular, transcutaneous and transcranial electrical neurostimulation
  • Stimulation current of 0.01 mA to 250 mA can be set at individually definable levels for each channel
  • Impedance measurement and current flow control indicator
  • Each stimulation channel can be used flexibly for all measurement types and freely selected
  • Simple programming of an unlimited number of application-specific stimulation programs
  • Patient documentation database
  • All adaptor/connection boxes required are included
Applications
  • Transcranial electrical neurostimulation of motor evoked potentials
  • Direct cortical and subcortical neurostimulation of the speech and motor cortex
  • Direct intracerebral neurostimulation for localization of functional disorders in pre-surgical diagnostics for certain pharmaco-resistant epilepsies.
  • Direct neurostimulation for monitoring cranial and peripheral nerves
  • Neurostimulation of peripheral nerves, neural lesions to measure nerve action potentials
  • Neural and muscular stimulation for surgery in the small pelvic region and anal atresia

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Product category: Neurosurgical instruments and equipment

inomed planning software - iPS

Target point planning, biopsy and DBS

inomed planning software - iPS

Accurate and precise planning is essential for all forms of neurosurgery that require targeting structures in the brain. For example, targeting the STN for DBS procedures requires that the target is identified and a precise and accurate trajectory is defined for use with stereotactic devices. In order to achieve this, it is essential that a high-precision and easy-to-use planning tool is employed. The inomed iPS software is such a tool, enabling the clinician to easily assemble all of the necessary imaging modalities and create an optimum set of planning coordinates to target the area of interest.

State-of-the-art imaging techniques in combination with developments in the field of IT have led to breakthroughs in stereotactic and functional neurosurgery. These technologies have enabled accurate and tissue-sparing interventions in the human brain.  All the planning tasks are carried out by the inomed iPS planning system.  

Safe intervention during DBS requires precise planning

Before any surgical intervention, surgeons use the iPS from inomed to plan their access and target point coordinates for specific surgical interventions in the brain. The target defined may be verified prior to surgery using the inomed target point simulator.

What sets the IPS planning software apart is the high quality of its image manipulation tools and the methods and algorithms used to merge images together. If required, anatomical atlases can be projected onto the patient's own data. In turn, this allows verification based on anatomical principles and provides for safe intervention.

Seamless connection to IT systems

Interfacing with hospital imaging tools is a prerequisite for successful and effective operation in planning and stereotactic interventions. The inomed iPS software connects seamlessly to hospital-specific imaging equipment and IT structures. In addition, the iPS software supports a variety of different image formats, allowing for a wide range of applications. Once planning is complete, the resulting data is transferred to the stereotactic system, paving the way for an accurate and safe surgical intervention.

There is currently no other stereotactic planning software besides iPS that supports the wide range of different stereotactic systems on the market. Whether carried as a laptop or in stationary mode with a network connection, iPS provides reliable coordinates and helps ensure successful interventions.

Supporting all planning approaches

iPS supports all planning approaches, whether free-hand, functional, atlas-based or metabolically-oriented. In each case, various options are available that can complement each other to provide greater safety in interventions, such as DBS.
A powerful multi-level fusion algorithm allows the merging of digital and digitized image information, always preserving the exact patient geometry in the foreground, with simultaneous optimization of anatomical visibility and image quality. This forms the basis for a secure, high-risk intervention, such as DBS.

Additionally, post-operative imaging can, after an intervention such as DBS, be combined with pre-operative information so that complications can be excluded and the accuracy of the procedure verified.

Features
  • PACS connectivity
  • DICOM import and export
  • Automatic image fusion
  • 3D simulation
  • Visualization of electrodes
  • Anatomical atlases
  • Supports all imaging systems
  • Post-operative checks
Applications
  • Stereotactic target planning
  • Biopsy planning
  • Deep Brain Stimulation (DBS)
  • SEEG planning

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Product category: Neurosurgical instruments and equipment

inomed planning software iPS - brachytherapy planning

Unique software module for brachytherapy planning in brain tumor application

inomed Planning System 6.0 with innovative features

The inomed Planning System iPS Version 6.0 is the only CE certificated planning software on the market to implement stereotactic brachytherapy planning for brain tumor application.

The powerful software allows the user to carry out safe and precisely calculated brachytherapy planning and includes a wide range of features for the evaluation of the plan quality. Thanks to the clear and userfriendly software design, the user is intuitively guided through all the necessary steps of stereotactic brachytherapy planning.

Advanced tools for precise and target-oriented brachytherapy planning   
             
Due to the highly advanced Optimization Tool the dose distribution at the target volume can automatically be improved by modifying seeds strength and/or seeds position within the catheters.

The precise isoline drawings allow assurance of the irradiation effect on the target volume. The dose can be displayed at any point.

The included Statistic Function offers an automatic calculation of statistical parameters and the dose-volume histogram (DVH). Especially for quality assurance and documentation purposes in brachytherapy planning, this is a helpful and beneficial tool.

To evaluate possible target deviation in the catheter placement, post- or intraoperatively, as well as its influence on the resulting dose distribution, stereotactical X-Ray imaging of the patient can be fused. Postoperative evaluation is possible and if necessary, the dwell time can be adjusted according to the brachytherapy plan so the resulting prescribed dose optimally fits to the planned dose for the target volume.

Further properties of the brachytherapy planning software:
  • Brachytherapy plans and trajectories adjustable in different views
  • Automatic calculation of statistical parameters and dose-volume histogram (DVH)
  • Optimization tool allows the improvement of the dose distribution at the target volume
  • Precise isoline drawings and calculation of the gray dose at any defined point 
  • Calculations are based on the recommendations of the Working Group TG43
  • Print protocol of all trajectories and possible device settings
  • Supports most common ring based stereotactic devices
  • Supports most common seed types
The brachytherapy planning has been developed and clinically evaluated in cooperation with the Department for Stereotaxy and Functional Neurosurgery at the University Clinic of Cologne.

Parameter selection of the brachytherapy plan:
  • Seed type (overall 5 different seed types)
  • Number of seeds and seed distance used per trajectory
  • Seed strength at the implantation date
  • Dwell time and prescribed dose
Seed types supported by the Planning Software:
  • Bebig IsoSeed® 125.S17 plus
  • Bebig IsoSeed® 125.S17
  • Amersham 6702
  • Amersham 6711
  • Theragenics I Seed AgX100®

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Product category: Neurosurgical instruments and equipment

Stereotactic systems

Stereotactic systems from inomed

inomed continues the tradition of uncompromising precision in stereotactic tools

Modern functional neurosurgery procedures are now so minimally invasive that they have to be planned and performed with the highest degree of precision. The inomed stereotactic systems are defined by their reliability, precision and stability in their overall function. The fact that the work of the surgeon and the OR team is so simplified - because inomed’s systems are so easy to operate - is one of the qualities of inomed’s stereotactic systems that our customers appreciate most.

To date, there are no other systems on the market that are more convenient or have higher precision than the stereotactic systems created by inomed. The following reasons will help to explain why.

High stability for stereotactic interventions

The ring-based stereotactic system used by inomed provides the highest level of stability. The basic physical properties of a ring are superior to all other basic geometric shapes in terms of strength and tolerance. This basic design element of the system and structure avoids common sources of error.

inomed stereotactic systems are the only systems worldwide with an advanced target point simulator. With the inomed target point simulator, theoretical planning from the planning software tools can be measured and verified according to the real-world geometric environment. There is no better way to ensure maximum patient safety combined with optimum precision. In addition, the use of inomed target point simulator results is a second and clear practical advantage. This means that when using the planning software, stereotactic frame and MicroDrive system, it is easy to check that the instruments used are functioning properly and within tolerances prior to surgical intervention. No other system on the market is more capable of providing this level of safety and design. inomed stereotactic systems set the absolute benchmark in terms of accuracy.

Choose the right system for optimal patient treatment

inomed offers a choice of stereotactic systems to suit customer-specific requirements our customers are able to choose between the Riechert-Mundinger system (RM) and the Zamorano-Duchovny (ZD) system. Both systems were developed by fellow neurosurgeons. Both systems are also an indelible part of the history of stereotactic neurosurgery. This is a further reason why inomed enjoys an international reputation for providing the highest precision and is respected for continuing the tradition of the application-driven and patient-oriented development of stereotactic devices.

Verification of the stereotactic planning coordinates is performed by the inomed target point simulator, also known as a phantom. All the systems combine methods of traditional stereotactics with the modern requirements of stereotactically-guided microsurgery, deep brain stimulation, thalamotomy/pallidotomy, and stereotactic biopsies.

Using inomed products for stereotaxic surgery means you will be benefiting from the reliability of a system where the functioning of all individual components is perfectly coordinated into one complete system.

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Product category: Neurosurgical instruments and equipment

RM Stereotactic System

RM – the most accurate stereotactic system in the world

High-precision from Germany: The inomed RM system

The Riechert Mundinger (RM) system is the only stereotactic system on the market with three fixation points. This gives the device a very high level of stability and precision. The RM is regarded to be the most precise stereotactic system in the world and, with its unique design, provides uncompromised accuracy in stereotactic surgery.

The RM system from inomed is based on the polar coordinate principle. This concept was developed by the two well-known stereotactic experts, Prof. Traugott Riechert and Prof. Fritz Mundinger. The RM aiming arm with its probe mount delivers a high level of mechanical precision. A wide range of accessories ensure that the RM system delivers universal application for the modern stereotaxy service.

Stereotactic system offering the highest precision

The high precision of the inomed RM system was specifically developed for stereotactic interventions in functional neurosurgery. The configuration can be easily adapted for stereotactic brachytherapy. The precision and stability of the RM stereotactic system means that it is the frame of choice, particularly for interventions in functional neurosurgery.
The RM stereotactic system consists of an RM stereotactic base ring and an RM aiming arm unit. The application of the stereotactic base ring and the use of localizers for imaging are described in separate manuals (patient immobilization, localization systems). The RM target device allows the attending neurosurgeon to reach every point in the brain precisely. In order to achieve optimum results, it is a requirement that the patient's head, the position of the target and the trepanation point are taken into consideration when mounting the ring. Different mounting options can be applied both positively and negatively. The standard mount method is used for all acquisitions in the frontal and occipital region of the skull. With negative mounting of the RM, the posterior fossa and pituitary gland can be reached.

Vernier scale for accurate setting

To ensure the settings are as accurate as possible, Vernier scales are attached to the corresponding scales on the RM system. The Vernier scale allows surgeons to define small measurement units that can no longer be read on the main scale. A Vernier scale line corresponds to 1/10 of a degree. In the Vernier scale, 9° are divided into 10 equal sections. Using the Vernier scale in this way, the RM coordinate values can be adjusted precisely to decimal points (1 -, 1 -, 3, etc.). The digits after the decimal point are read from the scale line on the Vernier.

Components of the inomed stereotactic product can be adapted as part of a modular system directly on the aiming arm carriage of the RM system. Other components can also be used separately, and provide further helpful tools for the attending neurosurgeon.

Features
  • Polar coordinate system, with 5 setting parameters allowing for extremely high precision
  • Three fixation points for unmatched stability
  • Trepanation in the target direction
  • MicroDrive with depth sensor for micro-electrode recording (MER)
  • Target point verification using target point simulator
  • Artifact-free, optimized for medical imaging
  • Compatible with inomed iPS planning software
Applications
  • Deep Brain Stimulation
  • Pallidotomy
  • Thalamotomy
  • Brachytherapy
  • Stereotactic biopsy
  • SEEG depth electrodes

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Product category: Neurosurgical instruments and equipment

ZD Stereotactic System

The ZD stereotactic system – for neurosurgery and neuromodulation

Aiming arm system for frame-based stereotactic neurosurgery

The inomed ZD frame derives its name from partners who developed it, Prof. L. Zamorano and Prof. M. Dujovny. This ZD localization system is most often used for neurosurgery and neuromodulation surgery applications.

The ZD system is an unparalleled combination of classical stereotaxy methods with the modern requirements of stereotactically-guided microsurgery. The procedures include stereotactic endoscopy, laser therapy and other cutting-edge applications, including neuromodulation and stereotactic biopsy.

The design of the ZD frame combines precision engineering and manufacturing with easy and intuitive operation. The ZD system therefore provides an important tool for the modern neurosurgeon. The minimally invasive neurosurgery techniques undertaken using the ZD frame offer patient-friendly and life-sustaining treatment options for disorders of the brain.

Almost unlimited access to all intracranial regions

The ZD system is based on the center-of-arc principle, which allows almost unlimited access to all intracranial regions, with a free choice of trepanation point. The surgeon is able to select the access point, offering the greatest safety to the patient and ensuring that all the settings for neuromodulation are configured on the ZD system with the highest level of mechanical precision.

The ZD system is compatible with all imaging procedures used with advanced therapy requirements, including DBS. The ZD head ring unit is made of titanium and guarantees artefact-free CT and MR images. The head ring is also transparent for X-rays. By design, the modular nature of the ZD system makes it possible to quickly and easily pick up whilst accurately and safely performing a number of diagnostic and therapeutic stereotactic procedures and neurosurgery. This is true for DBS procedures in the field of neuromodulation and also for stereotactic biopsy performed on the brain.

Variety of accessories for neuromodulation

When using the ZD system in neurosurgery and neuromodulation procedures, the surgeon is advised to take into consideration all indications and contraindications that generally apply to frame-based stereotaxis.

The ZD system can be used together with all inomed stereotactic rings. There are a variety of accessories and tools available for use with the ZD system. Using the inomed planning system (iPS), surgery can be planned and mapped on to the ZD frame. This includes all steps leading to a neuromodulation (DBS) implantation.

Features
  • Center-of-arc principle, target point remains the same from different trepanation points
  • 6 possible mounting positions for best possible access
  • Single-point fixing for easy and flexible mounting
  • MicroDrive with depth sensor for micro-electrode recording
  • Target point verification using target point simulator
  • Compatible with inomed IPS planning software
Applications
  • Deep Brain Stimulation
  • Pallidotomy
  • Thalamotomy
  • Stereotactic biopsy
  • SEEG depth electrodes

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Product category: Neurosurgical instruments and equipment

Target point simulator

The inomed target point simulator – Stereotaxic phantom

Recommended by leading neurosurgeons – inomed target point simulator (Phantom)

The stereotactic target point simulator from inomed, also referred to as a phantom, is a unique product and only available from inomed. Professors Riechert and Mundinger, globally recognized pioneers in neurosurgery, have developed the phantom alongside the development of the RM stereotactic system. The target point simulator has become internationally established and is regarded by leading neurosurgeons to be an essential and recommended tool for planning and conducting complex operations on the brain. The use of the phantom becomes especially significant for the highly complex neuromodulation (DBS) techniques.

The target point simulator (phantom) is used primarily to translate the coordinates from the planning software and mechanically setting the target point in real-space prior to surgery. A steel target point rod is moved with three movable thumb screws in the X-, Y-, and Z-axis (coordinates from the planning software). The tip of the rod forms the target point, in accordance with the planning software. A base ring is attached to the target point simulator and the aiming arm unit can be placed on this ring. The phantom consequently simulates the respective target point for the patient.

There are two options for setting the target direction on a phantom:

a) Mechanical adjustment on the phantom:

The desired stereotactic coordinates are set on the phantom. The trepanation marker is brought and fixed to the patient's head in the position of the desired trepanation gap. This is transferred to the base ring on the target point simulator by loosening the retaining screw and attaching in the same place (number of degrees on the ring).

After attaching the aiming arm to the base ring on the phantom, a puncture probe is directed through the opening of the trepanation marker directly to the target point. In order to do this, all screws on the aiming arm and carriage are loosened. This enables the assembly to be moved in all directions. By looking through the depth gauge, with the instrument holder and the trepanation marker, it is relatively easy to slide the assembly in all directions and move until the tip of the aiming point marking rod is visible. Once the best possible setting is reached on a phantom, all fixing screws are locked and secured and the entire aiming arm is attached to the base ring.

b) Mathematical adjustment on the phantom:

Using X-ray, CT and MRI scans with the inomed planning software (iPS),  the target and trepanation point coordinates are calculated and converted to stereotactic angles. The coordinates calculated by the iPS can be set directly on the aiming arm carriage of the RM or ZD stereotactic system. The aiming arm is then mounted on the phantom for verification.

Despite this rather simple target setting, an additional check on the phantom is always recommended. Any errors in adjusting the angle on the aiming arm or curved/bent instruments are detected immediately with the phantom. The phantom is therefore the final authority for preventing stereotactic errors. Only the use of a phantom can ensure the highest level of safety for patients during neurosurgery and neuromodulation.

Features
  • Patient-customized checking of target points
  • The setting of the stereotactic system in relation to the patient's target point is guaranteed to be accurate and correct for the given coordinates
  • Faulty instruments are detected before being used
  • Perfect for training beginners
  • X, Y and Z axes can be set for the patient-specific target point
  • Autoclavable
Applications
  • Target point verification for the stereotactic system and instruments

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Product category: Neurosurgical instruments and equipment

ISIS MER System

The inomed ISIS Micro Electrode Recording (MER) system

inomed ISIS MER - The most compact and intuitive MER system available

Deep brain recording and stimulation or extracellular recording in other regions of the brain is potentially a high-risk intervention requiring a precise and systematic approach. The ISIS MER system is a self-contained, micro-electrode recording system that provides all of the hardware and software elements necessary for targeted measurement in MER and neuromodulation  techniques. The ISIS MER system can be configured for a wide range of applications and is designed to be easy and intuitive to use.

ISIS MER System: Modularity in neurosurgery

The portable ISIS MER system comprises all the equipment the neurosurgeon will need in one box: ISIS MER USB Headbox module for micro-electrode recording and ISIS EMG USB Headbox module for electromyography. The system includes a high specification Notebook computer and medical grade power supply. The MER system carry case includes space for the high-precision inomed MicroDrive and sterilization box. The ISIS MER system also includes a small yet powerful and portable workstation for the OR.

Within the cart configuration, the system also includes a wide-screen monitor with an easy-to-clean surface and optional touchscreen operation. A high-performance speaker system and laser printer complete the cart configuration. The cart also benefits from additional space for accessories.

The intuitive interface of the ISIS MER Headbox ensures that both the surgeon and the operator of the MER system can see the electrode depth at all times throughout the procedure. This is critical to target localization during deep brain stimulation or when measuring local field potentials. Easy access to this information is also vital to ensuring accurate and safe procedures.

Hightech Systems combine to deliver the ultimate MER

The ISIS MER system has an intuitive and easy-to-use user interface. This means that the surgeon and the MER operator can focus on the procedure and patient during the critical recording and stimulation phases of the procedure.
System integration with the inomed MicroDrive and the micro-macro electrodes delivers seamless performance. The design is stunningly simple. This means that only one plug-in connection is required per electrode. Switching between recoding and stimulation for a given electrode/channel is very simple – internal computer-controlled switching means there is no need to swap cables from recording to stimulation. All raw signal information is recorded for each channel used and signal filtering is an online function of the software. This results in the complete signal spectrum being recorded and available for post-operative investigation and intra-operative display.

Features
  • 5 MER channels for recording and stimulation
  • Up to 16 EMG channels
  • Intuitive and easy to use
  • Upgradeable with additional functions and additional ISIS USB headboxes
  • High-quality loudspeakers
  • Online analysis functions
  • Depth sensor for electrode position display
Applications
  • Target localization for extracellular recording and deep brain stimulation
  • Recording and localization of the core area in case of lesions

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Product category: Neurosurgical instruments and equipment, Other surgical instruments and products

MSV - MicroDrive

MSV – MicroDrive for deep brain recording and stimulation

A mechanical masterpiece

This is the fourth generation of the sophisticated high-precision instrument used by surgeons and medical professionals around the world to position electrodes during stereotactic interventions and in deep brain stimulation.

The inomed MicroDrive was developed in cooperation with leading international practitioners and experts. The resulting standards and specifications set by the experts were extremely high. inomed has delivered on the specifications required and achieved mechanical precision delivering unique performance. The inomed MicroDrive is known to most specialists in the field and the device is favored for deep brain recording and stimulation applications.

Professionals and subject matter experts use the MicroDrive routinely. Using the inomed MicroDrive delivers the best possible neurophysiologically targeted diagnostics (deep brain recording and stimulation).

Modern imaging technology can identify physical structures of the brain, however, imaging modalities alone are not able to clearly and finitely identify target areas. In addition to this, target location can be affected by brain shift or indeed the functional target point may differ from the imaging results. For all of these reasons, microelectrode recording is used to further improve target point localization and precision. Precise localization, recording and stimulation are particularly important for DBS and neurmodulation procedures. For this entire spectrum of uses, the inomed MicroDrive is an indispensable tool. Correct application of the MircoDrive enables users to determine the optimum target point, for optimal treatment outcome in deep brain stimulation (DBS).

The universal nature of the MicroDrive design means that the inomed MicroDrive can be used with other Stereotactic systems and a wider range of users are able to benefit from the technology. With the addition of a suitable adaptor available from inomed, the MicroDrive can be used on all currently available stereotactic systems.

Functional neurosurgery requires more than just manual dexterity

Surgeon’s tools become an extension of his hands. The tools and technology used in the OR must work in perfect synchronization with the surgeon and be entirely reliable too. This is especially the case when positioning electrodes during a stereotactic procedure, such as deep brain stimulation (DBS).

The depth stops on the inomed MicroDrive ensure that fitting the electrodes and guide tubes incorrectly is not possible. The tactile feedback (‘click’) allows the neurosurgeon to ‘feel’ when a full turn of the MicroDrive spindle has been completed.
The inomed MicroDrive is able to position and deliver up to five electrodes for recording and stimulation for deep brain stimulation (DBS) procedures. The inomed MicroDrive has a resolution of 50 µm per division and allows the surgeon to position the electrodes accurately, with tactile feedback after each full turn.

With the addition of the optional depth sensor to the MicroDrive, the stereotactic position of the electrodes is automatically transferred to the ISIS MER system and is indicated on the screen and recorded as part of the patient recording process.

Features
  • Implanting of DBS electrodes from Medtronic® , St. Jude® and Boston Scientific®
  • Positioning resolution of 50 µm
  • Tactile feedback after one complete turn (0.5mm)
  • Optional depth sensor available
  • Autoclavable
Applications
  • Deep Brain Stimulation
  • Recording and localization of the core area in the case of lesions
  • Micropositioning of other probes and electrodes

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Product category: Neurosurgical instruments and equipment

Stereotactic biopsy for the brain

inomed delivers the best instrument for every biopsy requirements

When the diagnosis of a brain tumor is uncertain, a stereotactic biopsy can provide clarity and confidence. To ensure that such clarity and confidence is delivered during a biopsy, inomed offers a sophisticated set of biopsy instruments for intra-operative stereotactic surgery.

From an evidence-based perspective, histopathological diagnosis of a brain tumor is the method with the highest accuracy rate for classifying a tumor. In this sense, stereotactic biopsy is the best method of treatment, especially for smaller and more deeply-seated lesions. This is considered to be the best way to classify a lesion accurately, and only this way can each and every patient receive the optimal treatment for their specific disease.

Working lengths for every application

Depending on the application and the requirements of its intended use, inomed biopsy sets offer a range of working lengths. Biopsy sets are selected to suit the stereotactic system that is being used. This means all systems with internationally established stereotactic working lengths, i.e. both 190 mm and 280 mm, can use inomed stereotactic instruments.

Planning a stereotactic biopsy can be performed with the inomed planning software (iPS): inomed's software supports current methods for target point definition, visually, functionally and metabolically. Due to the high quality of inomed’s biopsy instruments, users are able to work precisely at the point from where tissue is to be removed. The inomed target point simulator helps to validate the design and verify the exact calibration of the instruments used.

Safety and precision during the biopsy

inomed provides a safe process within the framework of planning and implementing a stereotactic biopsy for the brain. Using the unique inomed target point simulator, inomed is uniquely positioned to offer the highest levels of precision in the field of stereotactic biopsy. inomed continues to set standards for accuracy and precision.
The inomed portfolio comprises all current types of biopsy instruments, including forceps and probes (Sedan-type and Backlund).

Depending on personal preference or clinical requirements, disposable products and reusable products are also available. The sets include guide tubes and, if necessary, Mandarin and sterilization boxes.

  • inomed ZD System (Zamorano-Duchovny)
  • inomed RM System (Riechert-Mundinger)
  • Leksell
  • Micromar
  • CRW Radionics
Features
  • Available as single-use or reusable instruments
  • Available as forceps, probe or needle
  • Working length 190 mm or 280 mm
Applications
  • Controlled removal of tissue in the brain (biopsy)

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Product category: Cryotherapy, cryosurgery equipment

C3 CryoSystem for cryotherapy

Freeze pain with the C3 CryoSystem

Using cryotherapy (cryolesion) techniques, the inomed C3 CryoSystem allows the pain therapist to "put the pain on ice". Effective treatment of pain has been the goal for clinicians and pain treatment experts throughout human history. Both acute and chronic pains represent a huge challenge for patients, as well as their clinicians, and diminishes the patient’s quality of life. The pain-relieving effect of cold has been known since ancient times. By building on the past and using the latest advances in cryotechnology and pain relief, patients and clinicians are now choosing the state-of-the-art inomed C3 CryoSystem for cryotherapy and pain treatment.

Treatment-resistant, chronic pain in the spinal column region is one of the main indications of cryotherapy and thus the main area of application for the inomed C3 CryoSystem. When medicated pain or injection treatments for chronic back pain do not bring relief, neurodestructive procedures such as cryotherapy and thermolesion can be the solution. Using the inomed C3 CryoSystem and disrupting the conduction pathways of pain with cryotherapy, effective pain relief can be delivered to the patient. The precision cryoprobes from inomed allow for a targeted application of the cooling effect on the affected peripheral nerve.

Cryotherapy method

The basic principle of cryotherapy requires that the affected nerve is located and identified using imaging and visual techniques, followed by precise targeting using the built-in electrical stimulator in the inomed C3 CryoSystem. Once the nerve has been located and targeted, the CryoSystem probe starts the process and freezes the nerve. During the freezing process, an ice ball of about 3-5 mm in diameter is formed on the nerve. This process takes around 2 minutes and reduces the temperature of the nerve to approximately -60 °C. The inomed C3 CryoSystem provides the user with a choice of gases to enable the freezing process. These include carbon dioxid (CO2) and nitrous oxide (N2O) gas supplies and adaptors are available to allow connection to the respective gas cylinders. Freezing causes axonotmesis of nerves (disruption of the axon), but the connective tissue remains intact and allows the nerve to regenerate. In view of the precise targeting of the sensory nerve, there is no direct risk from cryotherapy to the nerves responsible for motor activity and sensitivity.

Features of the C3 CryoSystem for cryotherapy:
  • Intuitive and easy to use
  • User-friendly menu navigation
  • The entire cryotherapy treatment and documentation process can be carried out with the footswitch (optional)
  • Integrated electrical stimulator (motor and sensory stimulation)
  • Excellent low-temperature (cryo) results
  • Automatic control and regulation of all relevant parameters, such as gas flow and pressure
  • Automatic purging procedure
  • Patient management system
  • Treatment report with comments
  • Documentation of all functions used, including stimulation and cryo processes
  • Barcode reader for patient identification
  • Device communication via USB
  • Data import and export
  • Connection to a printer
Applications for cryotherapy
The main indication for cryotherapy is treatment-resistant, chronic pain in the spinal column region, most commonly lumbar facet syndrome. Additionally, they include:
  • Facet syndrome
  • Pseudoradicular postnucleotomy syndrome (radiating pain after disc surgery)
  • Discogenic pain without disc herniation (nucleus pulposus prolapse)
  • Coccygodynia (pain in the coccyx)
  • Post-thoracotomy pain
  • Primary and secondary intercostal neuralgia
  • Neuroma-related pain syndromes
This technique offers significant pain relief lasting several months, while additional treatment procedures, such as physiotherapy, can ensure further and continued pain relief. The cryotherapy procedure can be repeated at any time.

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Product category: Other surgical instruments and products

LG2 Lesion generator

RF Thermolesion with the LG2 Lesion generator

Modern device for pain treatment and brain lesion

The LG2 is the new, portable radiofrequency (RF) lesion generator from inomed with attractive design, graphical touchscreen user interface, remote control, and a lot more.

The two-channel RF lesion generator supports a large variety of instruments for pain and brain applications. Suitable TC-Electrodes and cannulas complement the product range of inomed for pain treatment. TC Brain-Electrodes round off the product range for the application in functional neurosurgery.

Lesion generator with comprehensive features for precise thermolesion

The LG2 lesion generator is a modern and portable lesion generator for all common lesion techniques (continuous RF and pulsed RF with different control modes) in pain treatment and functional neurosurgery. All critical application parameters are permanently monitored by the device, thereby providing maximum safety and comfort for both the user and patient during thermolesioning.

All inomed mono- and bipolar TC electrodes can be used with the LG2 lesion generator. The LG2 includes two independent RF channels, which can be used at the same time. The combination of two monopolar electrodes for a bipolar application is possible.

The temperature control of the LG2 lesion generator allows to perform controlled thermal lesions. The volume of the thermolesion will be determined by the cannula diameter, the size of the active tip, and the target temperature and therefore becomes reproducible. An integrated temperature sensor in the tip of the TC electrode is used to monitor the temperature in the tissue. The LG2 lesion generator features continuous RF application with temperature control and temperature step profile or pulsed RF application with control of temperature, pulse duration or voltage.

Integrated electrical stimulation and impedance

In addition to RF application, localisation and differentiation of sensory and motor nerves with electrical stimulation, for even more precise electrode positioning is possible. With the LG2 lesion generator, thermolesion, electric stimulation, and impedances can be performed quickly, precisely and safely.

RF Thermolesion for reduction of chronic pain

Interventional pain therapy uses minimally invasive procedures such as thermolesion or cryotherapy with the aim of achieving a prolonged reduction of chronic pain through selective disruption or modification of the pain pathways of the affected nerves. This is carried out either by targeted drug injections or the interruption of pain transmission by minimally invasive neurodestructive procedures (e.g. thermolesion).

As an example, chronic pain within facet joint syndrome can be treated accurately, effectively, and safely with the proper indications using radio frequency thermolesioning.

Features of LG2 Lesion generator
  • Continuous RF in two different modes: Temperature or Preset Temperature-Profile
  • Pulsed RF in three different modes: Temperature, Pulse Duration, or Voltage
  • Direct Nerve Stimulation for the localisation of motor and sensory nerves
  • Continuous Temperature and Impedance Monitoring
  • Neutral Electrode Contact Quality Monitoring (CQM)
  • Saving of up to 25 pre-set programs
  • Touchscreen monitor to manage the intuitive workflow
  • Digital display of all relevant application parameters
  • Remote control to operate the device from sterile field
  • Compact and light-weight system design
  • Compatible with all inomed TC electrodes for pain and brain application
Applicationfields of RF Thermolesion
  • Facet denervation of lumbar, thoracic and cervical spine
  • Sacroiliac joint
  • Trigeminal neuralgia (Thermolesion of Ganglion Gasseri)

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Product category: Neurosurgical instruments and equipment, Other surgical instruments and products

Electrodes for stimulation and recording

inomed stimulation and recording accessories have been specifically developed to meet intraoperative applications.
Our accessories portfolio includes stimulation probes and electrodes (e.g. subdermal needle electrodes) for stimulation and recording. These are complimented by color-coded adapter boxes and connecting cables in a wide range of lengths.

Electrodes for stimulation and recording

In addition to their use in relation to signal recording, electrodes, including needle electrodes, can also be used for stimulating nerve and muscle tissue. Application-specific electrodes with a range of different geometries have been optimized for use with a range of multimodality applications (surface and needle electrodes). All electrodes, including needle electrodes, can be used for all measurement modalities (AEP, EEG, EMG, MEP, SEP, VEP >>) in a multimodal neuromonitoring application. All electrodes also feature a 1.5 mm safety connector and are compatible with a variety of connection schemes on other manufacturer systems.

Subdermal needle electrodes (SDN electrodes)
The subdermal needle electrodes available from inomed provide an easy and reliable patient connection to enable the high-quality recording of electrophysiological signals. These electrodes can also be used for the electrical stimulation of nerve and muscle tissue. Subdermal needle electrodes are also available in the form of corkscrew electrodes, hookwire electrodes, hook electrodes and short needle electrodes for pediatric applications. In addition, the range offers various bipolar needle electrodes, including electrodes for vocalis and oculomotor nerve recording.

D-wave electrode
The inomed D-wave electrode is a bipolar flexible drainage and stimulation electrode. It can be used for recording both D- and I-waves. The D-wave electrode can also be used to stimulate the spinal cord and enables electrical intraoperative functional testing during the procedure. In addition, this flexible electrode is also used in the postoperative prognosis of spinal cord function in neurosurgery, spinal surgery and vascular surgery.

Strip and grid electrodes (including needle electrodes)
inomed strip and grid electrodes are typically used for reverse-phase SEPs, direct cortical stimulation – bipolar or monopolar against a counter electrode (e.g. needle electrodes). In addition, these electrodes can also be used for epilepsy surgery. The electrodes are available in a range of designs with 4, 6 or 8 contacts per strip. The strips are combined in a range of configurations to deliver grinds of differing numbers of electrodes.

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Product category: Neurosurgical instruments and equipment, Other surgical instruments and products

Stimulation probes

Hand-held stimulation probes are used for electrical stimulation of nerves and neural structures. When used in conjunction with needle electrodes, probes and electrodes can be used to record electrophysiological signals. A wide variety of bayonet-shaped probes are available from our product range. These products help ensure that working under the microscope remains unobstructed and easier for the surgeon. The probes are sterilized with ETO and have a cable with length of 3 m, leading to a standard safety plug for connection to a full range of stimulation outputs and headboxes. All monopolar probe packages include a needle electrode used as a ground electrode. Reusable probes are connected to the systems via a 4-meter probe cable.

Bipolar stimulation probes
Bipolar probes are available in the following form factors; bipolar concentric probes, fork sensors and hook probes. In order to accommodate the various application requirements from direct cortical stimulation to stimulation and recording of direct nerve action potentials (NAPs), bipolar probes can be delivered in a variety of geometries.

Monopolar stimulation probes
Monopolar stimulation probes are primarily used for motor mapping and muscle stimulation in spinal surgery and pedicle screw stimulation. The probes have an active electrode (the probe) and a return electrode (ground), which is placed outside the stimulation region. The electrode used for ground can be in the form of a needle electrode or stick-on pad electrodes.

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Product category: Neurological diagnosis, apparatus and instruments, Neurosurgical instruments and equipment, Other surgical instruments and products

VEP goggles

inomed offers a range of a VEP stimulators that can be used for intraoperative stimulation of the visual pathways. With two independent LED pads, disturbing immobilizing elements are not necessary. The recording of electro-physiological signals takes place on the primary visual cortex and can be carried out using surface electrodes, as well as subdermal needle electrodes.

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Product category: Other surgical instruments and products

ALM – Advanced Laryngeal Monitoring

High-tech technology for advanced signal recording in thyroid surgery

C2 Channel Select Software for ultimate reliability

The innovative and user-friendly Channel Select Software, especially developed for the C2 NerveMonitor and application in thyroid surgery, automatically selects the optimal trace from the 4 channels of the ALM Tube and displays the strongest signal. This allows a seamless and reliable detection of muscle responses even under poor signal conditions.

8 contacts – 4 channels – 1 best signal

The ALM Tube is a multifunctional combination of a clear PVC ET tube and a surface electrode, together providing the best possible EMG signal recording from the vocal cords. Thanks to the easy placement of the recording electrode at the vocal cords and the extended length of the 8 sensor pads, the ALM Tube offers optimal signal recording of the M. vocalis during intraoperative neuromonitoring in thyroid surgery. The 360° surface sensor coverage with 8 long electrode contacts ensures ultimate signal stability, even if the tube is rotated or vertically shifted.

All signals are displayed acoustically and visually via the C2 NerveMonitor. The C2 NerveMonitor is known as a smart specialist for various surgical applications, and is the result of inomed‘s several years of experience and intensive research in the field of intraoperative neuromonitoring.

Synergistic effects combined to one high-tech technology

Using the ALM technology, the users benefit from the synergistic effects of individual key technologies. The ALM Tube, C2 NerveMonitor, and the C2 Channel Select Software build an intelligent end-to-end solution, ensuring efficient application in thyroid surgery, especially during RLN monitoring.

Together with more than 25 years of expertise, ALM represents the most innovative cutting-edge technology for advanced signal recording and ultimate reliability in thyroid surgery to date.

Features
  • Efficient end-to-end solution for ultimate reliability in IOM for thyroid surgery
  • ALM Tube – tube for EMG signal recording with 360° surface sensor coverage and 8 long recording electrodes
  • C2 Channel Select - software module for C2 Nerve Monitor for automatic selection of the optimal signal
  • C2 Nerve Monitor - available as four or eight channel EMG monitor
Application
  • Thyroid surgery

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Product category: Other surgical instruments and products

Delta electrode

Delta electrode – continuous monitoring of the recurrent laryngeal nerve during thyroidectomy

Improved information on nerve state using continuous neuromonitoring of the recurrent laryngeal nerve

Thyroid disorders affect millions of people worldwide. In many cases, surgical treatment is necessary and often the only solution. For example, where a goitre, an enlargement of the thyroid gland, has formed, or if malignant changes are found, surgical intervention is recommended.

Perfect fit on the nerve

In continuous recurrent laryngeal nerve monitoring, the vagus nerve is stimulated so as to monitor and protect the recurrent laryngeal nerve in the surgical area.

The delta-electrode is placed around the vagus nerve and thus always keeps contact with the nerve and delivers stimulation pulses at the defined rate and threshold.
The distinct advantage of the electrode is its delta-like shape and form factor. The shape enables the electrode to be positioned optimally on the nerve and prevents the electrode from slipping or sliding off. As a result of the constant contact with the vagus nerve, technically-induced signal attenuation and even signal loss can be avoided. The surgeon can thus immediately see if the recurrent laryngeal nerve is at risk and can act before a reduction in nerve conductivity becomes an irreversible vocal cord paralysis.

The ALM Tube is ideally suited for obtaining the best possible EMG signal recording from the vocal cords. Its multifunctional combination of a clear PVC ET tube and a surface electrode with eight long recording contacts offers the ultimate signal stability. Due to its all-around 360° surface sensor coverage and the extended length of the 8 sensor pads, the ALM Tube provides reliable signal recordings independent from tube shift or rotation. The surgeon benefits from easy placement of the recording electrode. Thanks to the flat surface and smooth bevelled tube tip, trachea injuries can be avoided.

Using intraoperative nerve monitoring, and depending on nerve performance during the procedure, the surgeon has the option of ending the procedure after a unilateral thyroidectomy if the results from nerve monitoring are inconclusive or sub-optimal. After successfully maintaining the ipsilateral function of the recurrent laryngeal nerve, the surgeon is able to continue operating contra laterally with a higher degree of confidence. This method helps to identify nerve impairment at an early stage and therefore avoid bilateral vocal cord paralysis.

Improved patient safety using continuous neuromonitoring of the recurrent laryngeal nerve

In the case of surgical intervention where partial removal of the thyroid gland (subtotal thyroidectomy) or its complete removal (total thyroidectomy) is required, these procedures carry a risk of damage to the vocal cord nerve, the recurrent laryngeal nerve. If the recurrent laryngeal nerve is impaired or damaged, this can have serious consequences for the patient. Impairment or damage to the recurrent laryngeal nerve can result in short-term hoarseness after surgery or even lead to permanent bilateral vocal cord paralysis.

Avoiding bilateral vocal cord paralysis

Intraoperative neuromonitoring during thyroid surgery enables the function of the recurrent laryngeal nerve to be monitored throughout. The continuous monitoring process enables the surgeon to make informed decisions during surgery. Following surgery, a definitive statement can be made as to nerve function. The ultimate goal of recurrent laryngeal nerve monitoring is to minimize nerve impairment and to avoid bilateral vocal cord paralysis.

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Product category: Other surgical instruments and products

pIOM accessories

pIOM accessories - for professional pelvic monitoring

The pIOM technique enables the intraoperative monitoring of autonomic nerves in the small pelvis. The nerve structures can be monitored and nerve impairment avoided, thereby enabling the patient to maintain quality of life. The pIOM accessories developed by inomed for this specific procedure form an important part of the success of surgical interventions in the pelvis.

Methodology for pelvic monitoring

The world's newest methodology for pelvic monitoring is based on proven neuromonitoring techniques and technologies developed by inomed. The techniques and technologies have been developed following many years of clinical research in the processes of monitoring autonomic nerves in the pelvis. Following exhaustive testing and validation processes, the pIOM technique is now available for pelvic monitoring during intraoperative procedures.

Pelvic intraoperative monitoring helps surgeons to protect the anorectal and urogenital functions, and thus helps to maintain the patient's quality of life following surgery. As a result, pelvic monitoring can reduce postoperative follow-up costs and contribute to the delivery of state-of-the-art medicine.

pIOM technical applications currently include pelvic neuromonitoring and are especially useful for  total mesorectal excision. The technology has other applications, for example, in small pelvis interventions nerve impairment may be prevented by the use of pelvic monitoring. Other surgical indications include proctology, gynecology and urology.

pIOM accessories for professional pelvic monitoring

In order to use the pIOM technique for pelvic monitoring during surgery on a colorectal carcinoma, a range of pIOM accessories are required. Monitoring the anorectal function requires that electrodes are placed on the anal sphincter to conduct the EMG muscle response. The function of the bladder is monitored via bladder pressure measurement. Neuromodulation is performed by stimulating the corresponding nerve structures using a bipolar handheld probe. With an intact nerve function, a response signal is recorded from the anal sphincter electrodes and, depending on the nerve structure stimulated, a corresponding pressure measurement is performed and then made available. These responses are presented on screen, with an audio signal output being optional. With pelvic monitoring, the surgeon is able to localize nerve structures and test their function. The results are stored with the patient records and can be documented in accordance with procedure.  

Nerve impairment and physiological dysfunction can be avoided

The monitoring of nerves and nerve structures is an important tool for surgical procedures in the small pelvis. The anorectal and urogenital functions can be monitored with accessories specially designed for pelvic monitoring. In this way, nerve impairment and any resulting dysfunctions can be avoided, while the quality of life for patients can be maintained postoperatively. Standardized implementation of pelvic monitoring can result in an improvement in patient care and a reduction in complication rates.

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About us

Company details

inomed is a pioneer in medical research - delivering medical device innovation to improve patient outcomes

inomed is a leading medical device company. We develop products that help clinicians satisfy the basic principal of the Hippocratic Oath, "Primum nil nocere" - "First, do no harm".  Within the context of this solemn undertaking, patient safety is the highest priority for every clinician. And while patient safety and welfare are priorities within all aspects of medicine, patient safety takes a preeminent role in the more complex and sophisticated neuro-diagnostics, neurosurgical interventions and related therapies.
The origins of inomed lay in intraoperative monitoring of neurological function. Our research in the field of our core competences is recognized as pioneering. To date, our products have been used to successfully treat a huge number of patients. inomed has been recognized by the “Top 100” Society as one of the most innovative medium-sized German companies. We are currently engaged in four research partnerships with universities and specialized institutes. For the 2012 to 2016 period, 1.5 million euros have been approved for various research projects – investment in this type of activity will result in the creation of new jobs in the areas of product development and engineering at inomed. Further benefits arising from research and development projects will be seen in the product manufacturing and production segments of our business.

Our daily activities are focused on the requirements of clinicians, medical practitioners and their patients. This provides us with a valuable calibration and reference point for our research and development programs.  Being a partner and a team player are both at the heart of our values. We are engaged in the interdisciplinary exchange of knowledge and experience between the researcher, medical engineer and users in hospitals, with the ultimate aim of improving patient outcomes and medical practice. At inomed, we aim to raise standards in the sector in a creative and forward-looking manner. We are focused on improving the medical practitioner’s tools and techniques, resulting in a positive impact on patient quality of life.

"Share knowledge – improve outcomes": inomed

With our headquarters in Emmendingen, near the city of Freiburg-Breisgau, the gateway to the Black Forest in Germany, inomed employs more than 165 people. The Research and Development Department consists of 19 scientists, engineers and technologists. The R&D team, working closely with research partners, is engaged in the development of new products and technologies for the healthcare professional. The inomed R&D team has created a portfolio that includes products in the fields of intraoperative neuromonitoring, functional neurosurgery, pain treatment and neurological diagnostics.

Our subject matter experts, working in the fields of biology, medicine, informatics, mechanical engineering and the humanities, work together with  medical experts from hospitals, clinics and other research partners. Our commitment at inomed is to develop ideas, share knowledge and combine the best possible ideas to create innovative and trendsetting products. Our commitment to our customers extends to developing and delivering educational and training programs that are accredited and recognized as industry-leading. Our ultimate goal is to provide the most effective tools to the clinician, thereby improving outcomes and helping to enhance quality of life for patients. The benefits to healthcare providers also include a mitigation of risk for the most complex and risky procedures in healthcare.

inomed: better outcomes for patients and clinicians

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Company data

Number of employees

100-499

Foundation

1991

Area of business

Electromedical equipment / Medical Technology