Report on the comments of Professor Jacques Marescaux at The Big Bang Santé 2018 Conference organised by Le Figaro.

« A surgeon prepares for his operation just as a pilot simulates his flight »

Could one speech have affected you in such a way that it guides your actions today? Jacques Marescaux discussed the conference of a US Army surgeon in Cologne in 1991. He discussed the possibilities of robotics and the internet in the health service. All of these tools that assist practitioners today did not exist at the time.

This pioneering spirit defines Jacques Marescaux. He set up a team in 1994 and created a non-profit organisation dedicated to cancer research and augmented surgery: IRCAD (the research institute against cancers of the digestive system).

Moving towards computer-assisted surgery 

The needs of surgeons are as follows: see what the eye can not see, improve one’s manual expertise and increase one’s cognitive abilities.

This is where the use of computers and artificial intelligence comes in.

An early technique involved transforming complex scanner images into simpler and more comprehensible 3D images using software. The surgeon in his operating room then has an image of the patient, he can thus simulate his operation using virtual instruments on a computer.

Augmented reality also opens itself up to surgeons. We can now superimpose images to have access a transparent visualisation of the patient’s entire body. We can see through his organs. But a problem quickly arose; how can we make the computer understand the real-time position of moving parts?

The Operating Theatre of the Future

IRCAD and a team of 8 Siemens engineers tackled the problem for more than 13 months. Their work led to the creation of the Rolls-Royce of operating rooms. It is a resounding success for computer-assisted medicine, but also the largest investment of Siemens in France. CT, MRI and 4D ultrasound can all work together thanks to artificial intelligence and the end result is an image of the highest quality. It is today the most efficient operating theatre in the world.

The surgery of tomorrow will also welcome real robots into the operating room. These automata assist the doctor who gains greater precision by operating on a screen. Dozens of models are expected to hit the market in the next two years.

Training courses from Pr. Marescaux

As for improving the cognitive abilities of the doctor, artificial intelligence is now at his service, especially with the Watson tool developed by IBM. It can centralise a colossal amount of information, an impossible task for the human brain. Thus, when entering information on a patient, Watson consults thousands of books and articles to assist in diagnosis.

Note that this is an upheaval and a challenge for medical education. In 2017, the Chinese artificial intelligence Xiaoyi passed the national exam in just 60 minutes!

But surgeons are asking for more. IRCAD has developed a system for centralising all patient data (preoperative imaging, physiological data of anaesthesia). These are then displayed on a control panel, once again thanks to artificial intelligence.

Sharing these innovations

Making this technology inclusive is a real challenge. That is why since the creation of IRCAD in 1994, other institutes have been built around the world (Taiwan in 2008, Sao Paulo in 2011 and Rio de Janeiro in 2017). In addition, a project in Kigali, Rwanda is currently underway. Rwanda is the frontrunner of an Africa that is constantly innovating in health. “It’s [Rwanda] the Singapore of Africa”. These are more than just research institutes for robotic surgery, they are training centres.

Jacques Marescaux finishes by recalling that surgery is a story of companionship. The training of a surgeon involves observing and reproducing the techniques of his peers.

Upcoming training from Prof. Marescaux

*Professor. Jacques Marescaux is the co-organiser (with Professor Arnaud Wattiez) of the ENDO Dubai conference which will bring together gynaecologists and colorectal surgeons in Dubai from the 21st to the 23rd of this coming February, for a meeting with lectures and hands-on workshops.

Posted by Rory Macnair

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