Computer-assisted technologies have revolutionized surgery, with more changes to come

Jacques Marescaux, MD, FACS, FRSC(Hon), FJSES(Hon), FASA(Hon)
Jacques Marescaux, MD, FACS, FRSC(Hon), FJSES(Hon), FASA(Hon)

The intersection of information technology, imaging, and robotics is transforming surgery more fundamentally than the transition from open to laparoscopic procedures, according to Jacques Marescaux, MD, FACS, FRSC(Hon), FJSES(Hon), FASA(Hon), professor of surgery and chief of digestive surgery, University of Strasbourg Hospital, France, and founder of the Institute de Recherche contre les Cancers de l’Appareil Digestif (IRCAD).

“Computers, virtual reality, augmented reality, 3-D [three-dimensional] medical images, virtual models—these are all here today and will be in every operating room [OR] in 10 years. The development of smart cars is a good analogy of what is happening in surgery,” said Dr. Marescaux, who will present the annual Distinguished Lecture of the International Society of Surgery Wednesday. His lecture is titled Computer-Assisted Technologies: The Magic Wand of Surgery.

An easy way to explore the future of surgery is to visit the nearest interventional cardiology lab, Dr. Marescaux said. Image-guided procedures are standard in the catheterization lab and a reality in the most advanced hybrid ORs. The goal is to augment surgical skills, not to replace the surgeon, he added.

The first step toward that goal is to improve surgical vision. That means not just helping the surgeon see fine details via magnification, but to see in ways not possible with natural vision using virtual reality and augmented reality, Dr. Marescaux said.

Instead of describing the location and size of a tumor, why not create a 3-D image of the patient’s organ, with the tumor in contrasting color for easy visualization? The 3-D model can help surgical planning and, with the right software, allow the surgeon to try different approaches and practice each surgery using an anatomically precise model. The entire surgical team, including the patient, can work from the same model.

“When we show the patient a CT [computed tomography] scan, it’s impossible for him to understand,” Dr. Marescaux said. “When we show a 3-D image of his organ, with the tumor in green, and we explain just how we are going to remove the tumor, the disease is immediately not so severe because the patient understands what happens next. And when the patient understands, the surgery always goes better.”

Put that 3-D model of the tumor into the surgical robot and the surgeon has the same precision guidance that GPS (global positioning system) can bring to driving, Dr. Marescaux said. No more wrong turns and no more searching for anatomical landmarks. The next generation of surgical robots are likely to transform endoluminal surgery in ways today’s gastroenterological surgeons can only dream about, he added.

And artificial intelligence (AI) will bring even greater changes, he said. IRCAD has already put AI to work on 150 common surgical procedures.

“After 50 cholecystectomies, the computer has understood that whoever the surgeon, there are seven stops to the procedure,” Dr. Marescaux said. “When we have a million cholecystectomies with good follow-up, the computer will be like a control tower. If the surgeon operates in a way the computer has never seen, an alarm will sound for the surgeon to stop and check the procedure. This will be an entirely new way to avoid complications. And as we all know, the biggest cost in surgery is malpractice and complications, not the procedure itself.”