Since its creation in 1994, IRCAD has been committed to advancing minimally invasive surgery worldwide for the benefit of patients, whether through laparoscopy or robot-assisted surgery, by continuously developing research and training activities conducted at IRCAD France and its mirror Institutes. With the opening of IRCAD North America in Charlotte (USA) at the end of September 2025, the IRCAD network will now encompass 9 Institutes across various continents.
The alliance of the surgical robot and artificial intelligence helps surgeons perform their procedures with the greatest possible precision. The robot also offers better working comfort for the surgeon, which is particularly important since certain minimally invasive procedures are highly fatiguing, demanding precise, meticulous movements while standing still, with the gaze fixed on a screen, for long periods of time and short recovery times between operations. However, the cost of surgical robots slows down their acquisition, with the number of installations estimated at only around 300 in France.
Musculoskeletal disorders (MSDs) related to surgery are now identified as a major issue for professional health and longevity, and their prevention has become a priority in terms of awareness, learning proper postures, and the ergonomic design of operating rooms. In this context of prevention, or relief when MSDs are already present, the use of exoskeletons appears to be a promising alternative. Differing in design and use from surgical robots, these mechanical structures are intended to improve the physical comfort of surgeons, as well as nursing and care assistant staff, with the recent development of systems designed specifically for these health professions.
In this last 2025 edition of the year, we give the floor to Dr. Daichi Kitaguchi, a colorectal surgeon and expert in artificial intelligence, who came from Japan to IRCAD France to conduct a research program (“Fellowship”) on the application of artificial intelligence to surgery. He is also working on exoskeletons, with or without AI, and provides us with his perspectives on these highly innovative subjects.
Professor Jacques Marescaux
President & Founder of IRCAD
Dr Daichi Kitaguchi: The opening of IRCAD Taiwan in 2008 made it possible to train practitioners from all over Asia, including many Japanese surgeons, in minimally invasive surgery. A strong relationship has developed between Prof. Marescaux and his Japanese counterparts, such as Prof. Nobuhiko TANIGAWA (Osaka, Japan), who has regularly led training courses at IRCAD.
My decision was influenced by colleagues who had trained at IRCAD France; what they told me about their experience made me very keen to come myself. In addition, the Institute conducts research in surgery and AI, to which I was also very keen to contribute.
I had already made significant progress on such projects in Japan, with numerous publications, but I wished to exchange ideas and brainstorm with international experts and also collect data on non-Japanese patients. To develop an effective artificial intelligence model, you need the widest possible variety of data so it can adapt to all patient anatomies. However, in Japan, patients’ body types are nearly uniform, individuals are generally thin and lack significant fat. This makes them fairly “transparent” on imaging, which makes it quite easy to visualize and recognize a vessel or ureter.
To consolidate a model, data on different patients is therefore required, such as obese patients. The IRCAD, with its international network, provides access to a wide variety of patients around the world thanks to its network of international experts and courses across all specialties. Similarly, working at the IRCAD allows me to connect with many scientists in the various Institutes and develop an international network conducive to future research.
Dr. DK: For me, there is no real boundary between these three disciplines; they are part of a single whole. As doctors, we must do everything we can to improve patients’ outcomes. In my role as a surgeon, I am interested in what AI can offer, and I also question the human aspect of things. How can we improve patient care, but also how can we improve the lives of surgeons? For example, how can we reduce mental stress or fatigue to achieve greater efficiency? Now is truly the time to work on efficiency because the number of surgeons is declining worldwide. The job of a surgeon has become more difficult because the responsibilities are heavy, surgery always involves some risk, and more and more patients and their families are willing to seek litigation if they are not satisfied with the outcome. Consequently, some medical students prefer not to specialize in surgery.
AI certainly has the potential to help improve the lives of surgeons, but we still need to better understand how. There are many conference presentations that demonstrate the benefits of AI, but most of the time, these are showcased within a specific research context or involve highly skilled teams. The question today is how to deploy artificial intelligence to work for surgeons in their routine practice, and I am not just talking about a hospital in a developing country, but also a general hospital in a developed country. How can we develop models that will effectively reduce mental load or fatigue? And how can we help surgeons adopt this new way of working?
For example, in centers that already have AI tools, we see that some surgeons have not started using them. They have good skills and good surgical results, so they do not necessarily see the point of changing their practice. It is a bit like the “autonomous parking” feature in a car: many drivers do not use it because they know how to parallel park and do not necessarily see the need to spend time understanding how this new feature works. They are also not entirely sure they can trust it completely. So they continue to park manually, even though it can sometimes be time-consuming. By incorporating these “human” considerations, derived from comprehensive human science, into our work on AI, we aim to better connect these tools to surgeons’ routine practices to lighten their daily workload and make their lives easier.
Dr. DK: The subject of exoskeletons is very interesting because they can help improve the lives of surgeons, for example by reducing surgical fatigue. These are external articulated structures that attach to the body to assist, reinforce, or even replace movements. There are many models, with varying degrees of complexity depending on the parts of the body to be assisted and the specific movements to be performed.
My personal experience is that after thirty minutes of using a “passive” exoskeleton (without AI), I could already feel the difference in my arms, as if they were freed from gravity. Although my arms were suspended by cables from above, I felt as if there were armrests supporting them. I was able to maintain a high degree of stability in my arm position without effort, which I believe can reduce tremors, offering a major advantage in minimally invasive surgery. We need to use our instruments through very small incisions and to move them very precisely and carefully inside the patient’s body, avoiding tremors as much as possible.
The elimination of tremors is a key advantage of robot-assisted surgery, as the robot can reproduce our movements by transferring our commands to the instruments while correcting tremors, making robotic surgery highly precise. However, most minimally invasive procedures are currently performed without robotic assistance, as the cost is a barrier to widespread adoption. Passive exoskeletons are not expensive and can therefore be an attractive alternative, for example, for hospitals that cannot afford to purchase a robot or for procedures that do not necessarily require robotic assistance.
As I said, young doctors no longer necessarily want to become surgeons, so the average age of surgeons is increasing, and some feel particularly tired. They suffer from severe stiffness in their shoulders or back. This happens to me too; even though I am only 38 years old, I can come out of a long operation completely exhausted. We really need to be concerned about the health of surgeons, not only to help older surgeons continue to practice but also to encourage young people to enter the surgical profession by offering better working conditions. This is also true for other healthcare professionals, such as nurses and nursing assistants, who often handle and lift patients.
With my university in Japan, we are also conducting research on “active” exoskeletons, equipped with AI, which can analyze, anticipate, and adapt assistance in real time to the movements and intentions of the person wearing it. They can decode bioelectric signals sent from the brain to the muscles and send commands to the electric motors located in the device’s joints (hips, knees, ankles, etc.). In the event of spinal cord injury, for example, they pick up the bioelectrical signal sent by the patient (“I want to take a step”), which can no longer reach the leg muscles but is then interpreted and executed by the exoskeleton’s motors.
These AI exoskeletons are currently very expensive, costing about the same as the robots used to assist in surgery. Their purpose is not only to try to reduce fatigue but above all to compensate for patient motor impairments, whether congenital or resulting from an accident. To put it simply, I would say that an exoskeleton without AI is a good alternative for assisting a surgeon, while an exoskeleton with AI is more intended to compensate for a patient’s disability.
Indeed, we are considering setting up a pilot study that could clarify the benefits of the HAPO devices. IRCAD organizes numerous training courses in minimally invasive surgery, which involve diverse practical sessions. These sessions include a suture training phase at some point, during which participants repeatedly perform the same gesture on the same model and in the same environment. This provides a standardized context that is conducive to evaluating exoskeletons. In general surgical practice, conditions vary greatly (for example, the type of gesture or the patient’s body mass), which could make evaluation more complex. In addition, participants in these sessions are beginners and try to reproduce the movement as best as they can. They are tense, and so are their muscles, which quickly leads to muscle fatigue. By having the same participant complete sessions with and without HAPO, we should be able to highlight the intrinsic benefit of the exoskeleton. In the healthcare sector, particularly in surgery, exoskeletons are underused. If we publish results that clearly demonstrate their benefits, we could encourage hospitals in France and abroad to invest in them. At IRCAD, we are very aware of the need to improve working conditions for healthcare professionals as much as possible, and we would be happy to contribute to this improvement, which could also be of interest to other sectors.
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/
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