American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Jacques Marescaux: Cutting-edge technologies augment the surgeon’s eyes, hands and brain

OCTOBER 24, 2018
Clinical Congress Daily Highlights, Wednesday First Edition


“Medicine will switch from the industrial age to the information age.” Hearing those words at a lecture in 1991 changed the career trajectory of the founder and president of the Institute for Research into Cancer of the Digestive System (IRCAD) Jacques Marescaux, MD, FACS, University Hospital of Strasbourg, France.

“Even though I maybe understood only 20 percent of the lecture,” Dr. Marescaux recalled in his Distinguished Lecture of the International Society of Surgery on Wednesday, “I said, ‘This is it!’”

At the time, cutting-edge science meant incorporating tools of molecular biology. There was no internet or virtual reality, said Dr. Marescaux, who thanked attendee Richard Satava, MD, FACS, Professor Emeritus of Surgery, University of Washington, Seattle, for his transformative lecture so many years ago. Dr. Marescaux would soon become a pioneer of computer-assisted technologies, making real what was once considered science fiction.

In his lecture, Dr. Marescaux traced the development and impact of these “magic wands” of surgery, which include virtual and augmented reality and robotic-assisted surgery. At a practical level, surgeons often wish for three things, said Dr. Marescaux — improved vision, finer skills, and a better brain. Computer-assisted technologies have already made major inroads in the first two, he noted, and advances in artificial intelligence are beginning to tackle the third frontier.

On the vision front, these technologies offer surgeons 3D reconstructions of the body, which can aid in preoperative planning. Like a digital anatomy book, the simulations reveal vascularization and other features in fine detail. Surgeons can also practice beforehand with a 3D replica of the actual patient, figuring out the best approach to reach, for example, an out-of-the-way tumor. By fusing 3D virtual images with video images during a procedure, a doctor can work in augmented reality, seeing the real and the virtual at the same time. With these technologies, a surgeon can make a procedure as precise and conservative as possible, said Dr. Marescaux, seeing a way, for example, to leave 50 percent of a kidney intact.

Advances in robotics have also given surgeons a new level of skill for performing a variety of procedures. Two such operations made headlines for Dr. Marescaux: In 2001 he performed the first transcontinental surgery, the Lindbergh operation, removing the gallbladder from a patient in Strasbourg, France, via robotic arms that he controlled from New York. In 2007 he performed an operation without leaving a scar, removing the gallbladder of a patient without making a skin incision. Such robotic-assisted procedures will only become more common, Dr. Marescaux said.

Artificial intelligence is also starting to change medicine, but its fruits are farther off. IBM’s Watson, for example, can make recommendations to doctors and explore the clinical trials literature for relevant studies, but the technology is still in its infancy. Machine-learning programs — which train on a known data set and then can make predictions about an unknown data set — have power, but they are only as good as the data they train on.

While these technologies continue to develop, Dr. Marescaux is also focused on setting up centers around the world to train young doctors who may be inspired as he was. “There is no limit to the imagination of the surgeon,” said Dr. Marescaux, “That’s how I was trained.”

Additional information

The Distinguished Lecture of the International Society of Surgery: Computer-Assisted Technologies: The Magic Wand of Surgery, was held October 24 at the 2018 Clinical Congress of the American College of Surgeons in Boston, MA. Program, webcast and audio information is available online at facs.org/clincon2018.

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