Cybersurgery: Augmented Reality for Medicine

Four firsts of cyber-surgery combining robotics and digital imaging were performed between January and July at the brand new University Hospital Institute of Strasbourg in eastern France, announced Monday an expert in this specialty, Professor Jacques Marescaux.

A liver operated thanks to "augmented reality", an oesophagus repaired thanks to virtual surgery, a neck cleansed using 3D images: less intrusive, cyber-surgery is a surgery of the future, according to a specialist who reports four firsts performed this year in Strasbourg.

"This hybrid surgery is the convergence of techniques and specialties (surgeons, gastroenterologists, radiologists...) and a mix of instrumentation, imaging equipment and robotics," explains Professor Jacques Marescaux, surgeon and founder of the IRCAD (Institute for Research into Cancer of the Digestive System).

"This is the surgery of the future", according to this expert who, in 2001, made a name for himself by operating from New York, using a robotic console, on the gall bladder of a patient in Strasbourg ("Operation Lindbergh").

He thus presided over four firsts of image-guided "mini-invasive" surgery between January and July at the brand new Institut Hospitalo-Universitaire de Strasbourg (IHU). An establishment, within the University Hospital Center, equipped with state-of-the-art equipment, of which he is the initiator.

Three of these operations represent world firsts, Prof. Marescaux told AFP: the use of virtual reality as an aid to diagnosis and surgical strategy in neck surgery, major surgery for colorectal cancer, without scarring, through natural channels, and robotic liver surgery assisted by augmented reality.

Moreover, an operation without scarring on the oesophagus by natural means had not been performed in France until now.

For the neck surgery of a 66-year-old patient suffering from a pathology of a parathyroid gland (an adenoma), virtual surgical exploration - a reconstruction from 3-dimensional scanner (or MRI) images of the gland using software developed at the IRCAD - made it possible to detect an anomaly of an artery, which is associated with an anomaly of the path of the voice nerve not detected by the standard preoperative check-up.

"The use of virtual reality made it possible to guide the surgical procedure in a personalized way and to preserve this hidden nerve," says the surgeon.

Transparent Liver

Ce type de logiciel, avec l’IRM, pourrait aussi servir à des opérations de la prostate pour éviter de toucher les nerfs dont les lésions peuvent entraîner une impuissance. L’intervention « mini invasive » sur l’oesophage d’une patiente de 82 ans qui ne pouvait plus s’alimenter s’est faite avec un instrument flexible introduit par la bouche (endoscope), au lieu de recourir à la laparoscopie (encore appelée coelioscopie). La patiente, de retour chez elle trois jours après l’intervention, mange à nouveau normalement.

In ten years' time, this type of intervention by natural means will be the rule," says Prof. Marescaux. They have the merit of shortening the length of hospitalisation and reducing surgical trauma. »

En juillet dernier, le Pr Patrick Pessaux a ouvert la voie à une cyberchirurgie du foie guidée par la réalité augmentée. Cette impressionnante opération sur une tumeur du foie a recouru à la robotique et à des images de réalité virtuelle qui ont été fusionnées en temps réel pendant l’opération avec les images fournies par la caméra introduite dans le corps du patient. Les échanges constants entre le chirurgien et l’ingénieur informatique permettent une navigation à vue dans les structures anatomiques, rendant le foie transparent avec visualisation de tous les vaisseaux sanguins normalement invisibles, pour plus de sécurité. La patiente de 36 ans a pu regagner son domicile une semaine après. (Source AFP)

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