Just as in previous years, 2026 will undoubtedly be defined by the evolution of surgical practice and its accompanying technologies. In this context, IRCAD will determinedly pursue the mission that has been the foundation of its identity for over thirty years: making research the engine of increasingly innovative surgery, for the ultimate benefit of patients.
These research activities stem from a collective dynamic deeply rooted in clinical practice and focused on real-world impact on patient care. At the intersection of surgery, engineering, and digital sciences (particularly artificial intelligence), the Institute’s teams develop resolutely translational research, where each program aims to transform scientific breakthroughs into concrete solutions for surgeons and their teams.
This ambition cannot be achieved without a permanent openness to the world; IRCAD relies on a vast global network of academic, industrial, and institutional collaborations. By bringing together diverse ideas and experiences, these partnerships nurture the collective intelligence essential for innovation, leading to robust and validated solutions.
Research thus becomes a vehicle for dialogue, knowledge transfer, and shared progress. This ability to facilitate a dialogue between disciplines, technologies, and practices from diverse backgrounds is one of IRCAD’s greatest strengths, contributing to its international renown.
Research at IRCAD is also part of a long-term vision, striving to anticipate shifts in surgical practices and examine the ethical and organizational challenges associated with innovation. By integrating safety, training, and accessibility at a very early stage, the Institute works toward an “augmented surgery” that remains profoundly human.
At the start of this year, true to its pioneering spirit and constant scientific rigor, IRCAD reaffirms its commitment to actively contributing to the emergence of surgical practices that are ever more precise, safe, and equitable for current and future generations.
World-renowned expert Professor Mariano Giménez, Chair of General and Minimally Invasive Surgery at the University of Buenos Aires (Argentina) and Scientific Director of Image-Guided Surgery at IRCAD, speaks to us about the research conducted at the Institute, particularly in percutaneous surgery, and the training programs developed to integrate these advancements.
Professor Jacques Marescaux
President & Founder of IRCAD
Pr Mariano Giménez: I am a surgeon by training, specializing in diseases of the liver, pancreas, and biliary tract. However, very early in my career, in 1991–1992, I completed full training in interventional radiology, a specialty that was just emerging at the time. This approach is less invasive than “open surgery”; it allows us to reach a target by navigating inside the vessels through a very small incision, guided by imaging. Early studies published in the United States led me to believe that this minimally invasive approach would be a perfect complement to open surgery, which I felt would eventually evolve in this direction.
This dual background naturally shaped my practice. For over thirty years, I have worked at the intersection of surgery and medical imaging, with the constant goal of performing ever more precise and less invasive interventions. In percutaneous surgery (performed through a tiny incision in the skin) and ultra-minimally invasive procedures, unlike laparoscopy, it is impossible to use a camera because the access point is too small and there is insufficient space. The procedure relies entirely on external visualization, X-ray, ultrasound, CT, or MRI. Imaging has therefore always been central to my work, in both interventional radiology and general surgery.
On his part, Professor Jacques Marescaux, who is always one step ahead, anticipated the great surgical revolutions long before they became industry standards. He founded IRCAD in 1994, published one of the very first articles on robotic surgery at a time when almost no one was talking about it, and demonstrated the feasibility of telesurgery as early as 2001 by performing the first long-distance operation between Strasbourg and New York (the “Lindbergh Operation”). It then took nearly twenty years for the reality on the ground to fully catch up with that vision.
Around 2010, Prof. Marescaux formulated a new paradigm: surgery would not only be robotic but would become “computer-assisted surgery,” integrating robotics, advanced imaging, and artificial intelligence. At that time, he was looking for a surgeon capable of building a real bridge between these two worlds: surgery and imaging.
During a course at IRCAD Latin America in 2015, he met one of my colleagues who told him: “You should talk to my boss.” This meeting led to several discussions, followed by a visit from Prof. Marescaux to Argentina. Having observed that our team had a profile that was both unusual and complementary, he invited me to Strasbourg to discover IRCAD from the inside. When I understood the depth of IRCAD’s vision, not only technologically but also in its philosophy of innovation and integration, it immediately made sense to me. The collaboration was obvious.
IRCAD is an ideal environment for innovative ideas to be discussed, refined, and translated into real clinical practice. For many years, surgical innovation progressed through spectacular but isolated breakthroughs. Today, at IRCAD, we can develop innovation in a continuous and exponential manner, from concept to validation and then to implementation.
For me, working with IRCAD is not just a simple collaboration; it is a natural alignment of ideas, values, and a long-term vision for the future of surgery.
Pr. M.G.: Percutaneous surgery and interventional radiology are central pillars of research at IRCAD because they represent an advanced evolution of minimally invasive care.
At IRCAD, research is neither exclusively fundamental nor purely clinical. It is, above all, preclinical or translational research, designed to bridge the gap between technological innovation and the reality of surgical practice. Hospitals are ideal environments for clinical research, but their primary mission is patient care. Universities and laboratories are essential for fundamental research, but they often remain far removed from the constraints of clinical practice.
Thanks to its technological platform, the largest in the world for surgery, and the significant work conducted with universities, industrial partners, and global opinion leaders, IRCAD occupies a unique position between these two worlds. It has the capacity to focus on how technologies, robotics, imaging, navigation systems, and artificial intelligence, can best be combined, adapted, and reinvented to transform surgical practice and explore new indications for the benefit of patients.
Percutaneous surgery is particularly well-suited to this approach because its outcomes depend heavily on imaging, navigation, and procedural precision. The benefits of technological innovation are therefore immediate: success is directly linked to the quality of imaging, the accuracy of guidance systems, and the ability to interpret dynamic anatomy in real time.
Pr. M.G.: One of the major pillars of our research is the integration of imaging, particularly ultrasound, into robotic surgery. Today, robotic surgery relies almost exclusively on visual information provided by a 3D camera. While this offers an excellent view of the organ’s surface, it does not allow us to “see inside.” For organs as complex as the liver, which is large, mobile, and highly vascularized, this is a major limitation.
Ultrasound provides real-time visualization of the interior of organs without the need for radiation or contrast agents, and it naturally adapts to movements caused by breathing or manipulation. In 2025, our work focused on combining ultrasound with robotic platforms, studying the optimal way to position and integrate ultrasound probes within different robotic systems. We also explored how to best use ultrasound data, not just for visualization but for navigation and augmented reality.
In doing so, we achieved a major breakthrough by developing quasi-real-time 3D ultrasound, which considerably improves spatial understanding. Conventional ultrasound is two-dimensional (2D), requiring years of experience for a surgeon to mentally reconstruct the 3D anatomy during an operation. By providing intuitive 3D representations, we reduce the surgeon’s cognitive load, shorten learning curves, and make image-guided surgery accessible to a much broader community of surgeons.
Another important focus involves the development of robot-assisted percutaneous interventions, particularly for the ablation of liver cancers. Here, the challenge is not just positioning a needle with precision, but maintaining that precision within an organ in constant motion. The liver moves with respiration, deforms when instruments are introduced, and changes position throughout the procedure. The real challenge, therefore, is not the robot’s movement itself, but the continuous, real-time localization of a moving anatomical target.
Our work involves combining ultrasound imaging, navigation systems (electromagnetic or optical), and robotic guidance to constantly update the target’s position. Our goal is to improve procedural precision, reduce complications, and achieve oncological results comparable to surgical resection, while significantly decreasing morbidity and the length of hospital stays. This approach could redefine the standards of care for certain indications.
Pr. M.G.: If I had to define a long-term vision for innovation at IRCAD, I would identify three primary directions.
The first involves the total integration of imaging and Artificial Intelligence (AI) into surgical decision-making. AI must not be a theoretical concept or a tool for retrospective analysis; it must assist the surgeon during the intervention by identifying anatomical landmarks, flagging high-risk zones, tracking organ deformation, and supporting real-time decision-making. This requires not only high-performance algorithms but also a deep understanding of surgical protocols, which can only emerge from close collaboration between surgeons, engineers, and data scientists, exactly the environment IRCAD provides.
The second pillar of innovation is partial automation in robotic surgery. This does not mean replacing the surgeon, but rather automating specific, well-defined tasks. Repetitive and technically demanding actions, such as suturing or anastomosis, could be standardized and performed by the robot under the surgeon’s supervision with highly reproducible quality. This would reduce inter-operator variability, shorten learning curves, and decrease complications. Several studies already show that technology can bridge the performance gap between expert and non-expert surgeons, with major implications for patient safety and access to high-quality care.
The third pillar is the true democratization of surgical technologies. “High-end” hybrid operating rooms are remarkable achievements, bringing together surgical equipment, complex imaging (CT, MRI), and robotics in a single space to produce very high-quality images during surgery. However, their cost, maintenance, and infrastructure requirements severely limit their rollout; very few hospitals worldwide are currently equipped with them.
At IRCAD, we are working on alternative concepts for “smart hybrid operating rooms,” relying more on advanced ultrasound, modular imaging systems, and flexible robotic solutions. These solutions are more financially accessible, adaptable, and easily deployable. Our goal is to allow a much larger number of facilities, including those in emerging countries and smaller hospitals, to access high-quality, image-guided surgery.
Pr. M.G.: Alongside research, training is another fundamental mission of IRCAD, and it must evolve at the same pace as technology. Beyond specialized training in percutaneous procedures, ablation, and image-guided interventions, our goal is to systematically integrate imaging into all surgical training programs. Today, surgery cannot rely solely on manual dexterity; it also requires image interpretation, data comprehension, and intelligent interaction with technology.
This includes practical training in laparoscopic and intraoperative ultrasound, fluorescence imaging (such as indocyanine green, ICG), and various advanced visualization modes and navigation tools, for example, in general, urological, bariatric, or hepatobiliary surgery.
The objective is to train surgeons to reason in terms of image-guided decision-making, rather than relying solely on direct visual inspection. Surgery is increasingly performed via screens; over 90% of the information surgeons receive during an intervention is visual. It is therefore essential to understand how these images are produced, processed, and interpreted.
We are also developing programs dedicated to non-technical skills: communication, leadership, teamwork, and adaptability. Many studies show that these skills have a greater impact on outcomes than technical performance alone. This challenge is particularly critical in the context of telesurgery, where surgeons operating remotely must rely on structured communication, trust between teams, and shared decision-making.
Finally, we are working on programs designed to prepare the future leaders of surgery, individuals capable of navigating technological complexity, managing multidisciplinary teams, collaborating with engineers, adapting to rapid technological shifts, and driving innovation responsibly. Surgical leadership must evolve from an individualistic and hierarchical model toward a collaborative and multidisciplinary one. This cultural transformation is just as important as technological innovation.
Pr. M.G.: We are living through one of the most profound transformations in the history of surgery. Minimally invasive techniques were a major milestone, but the true revolution is computer-assisted surgery, which integrates imaging, artificial intelligence, and robotics into a unified ecosystem.
My advice to the younger generations is to remain open-minded, curious, and ready to challenge traditional boundaries. Technology will not replace surgeons, but surgeons who refuse to understand and use technology will become obsolete. At the same time, technology remains a tool: it improves technical execution but replaces neither clinical judgment, nor ethical responsibility, nor human empathy.
Future surgeons and interventional radiologists must also adopt a culture of collaboration and diversity, working across specialties, cultures, and disciplines. Innovation is not born from uniform thinking but from the dialogue between different perspectives.
The current era is demanding, marked by rapid change and uncertainty, but it is also an extraordinary opportunity for younger professionals. This is a unique moment to shape the future of surgery, redefine standards of care, and, more than ever, place the patient at the heart of medical progress.
Founded in 1994 by Professor Jacques Marescaux, IRCAD is an institute dedicated to training and research in minimally invasive surgery. The Strasbourg institute is internationally renowned for the excellence of its training programs, whether on-site, with nearly 8,800 surgeons trained in Strasbourg each year, or online through the free WebSurg university, which has more than 470,000 registered members worldwide.
For more information, visit: https://www.ircad.fr/fen/
We hope you enjoyed this 22nd edition of the IRCAD newsletter.
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