Editorial
Since its inception, IRCAD has worked to bring together multidisciplinary expertise (surgeons, researchers, engineers, industrial partners, etc.) around a shared goal: improving patient care worldwide. While this diversity of expertise is an exceptional asset, it only finds its true value when accompanied by a collective culture of scientific rigor, both in the search for innovative solutions and in the teaching of surgical practice.
Training surgeons from all over the world is not merely about transmitting theoretical and technical knowledge; it is also necessary to encourage critical thinking, the evaluation of evidence, and the questioning of certitudes. The same applies to the development of innovative technologies, which must above all rest on solid scientific foundations.
However, innovation is moving at an accelerated pace, with technologies, algorithms, and applications constantly evolving. This acceleration presents a tremendous opportunity for medical progress, but it carries an essential responsibility: we must continuously ensure that there is a genuinely proven benefit for patients. This is why scientific validation serves as a fundamental pillar of IRCAD’s approach, with the critical analysis of available evidence guaranteeing sustainable progress.
This scientific rigor is all the more crucial at a time when artificial intelligence is transforming our environment, as its capabilities open up vast perspectives for accessing global information. Rigorous evaluation is indispensable to support evolving surgical practices and to integrate innovation in a reasoned manner, in service of a medicine that is increasingly effective, safe, and humane.
An internationally recognized expert in liver, biliary, and pancreatic surgery, Professor Olivier Soubrane discusses the evaluation role of IRCAD’s Scientific Council. He also presents therapeutic advances and future perspectives in the hepato-biliary-pancreatic field.
Interview of the month
Innovation, Evaluation, and Knowledge Sharing: The Foundations of Tomorrow’s Surgery
President of APHP-International, Consultant Surgeon at Institut Montsouris, & Member of the Scientific Council of IRCAD
Professor Soubrane, you are a member of IRCAD’s Scientific Council. Could you tell us about the role and responsibilities of the council?
The objective of the Scientific Council is to support IRCAD’s evolution through a strategic analysis of scientific and technological challenges related to surgery and its environment. The council consists of a limited number of members, allowing us to be highly reactive in our exchanges and to maintain a real capacity for recommendations. We are also connected with numerous experts worldwide who represent various surgical specialties and constantly enrich our perspective.
Our responsibility is to advise IRCAD’s leadership on scientific priorities, which requires continuous monitoring. Surgery is currently evolving at a staggering speed, with every week bringing new publications on new medical devices, robotic approaches, or digital tools. It is therefore essential to distinguish genuine breakthroughs from simple announcements to anticipate developments that will have a concrete impact on surgical practice and patient care.
This surveillance covers operating techniques as well as education, such as simulation software and methods that allow surgeons to learn and practice, or tools for assessing their skills. To perform this role as effectively as possible, we rely on artificial intelligence (AI) to help us navigate a vast body of scientific literature and information arriving from across the globe. Naturally, AI does not replace human expertise, but it serves as a powerful accelerator for analysis. Based on queries derived from our own expertise, it allows us to identify major publications or innovations developed on the other side of the world. Our role then is to interpret these findings, confront them with our clinical experience, and evaluate their real value.
The Scientific Council also supports IRCAD’s research teams. Researchers are often fully immersed in their projects, and our external perspective can highlight the exceptional potential of an innovation they are working on or suggest new directions. For example, our monitoring might uncover a publication capable of helping our researchers solve a difficulty by showing that another team developed an adaptable solution, or it might inspire new ideas for a project or foster collaboration with industrial partners to accelerate the transition to clinical practice.
I consider IRCAD to have become a true think tank for the future of surgery, a place of continuous reflection on the technologies, pedagogical methods, and innovations that will shape surgery in the coming decades.
Globally, you are one of the most renowned experts in liver, pancreas, and biliary tract surgery. Could you tell us about the most recent advances in this field and, in particular, the contribution of robotic surgery?
Hepato-biliary-pancreatic surgery is likely one of the disciplines that adopted the minimally invasive approach (laparoscopy) latest, as it is characterized by frequently complex procedures. It is not always a matter of simply removing a tumor; the procedure may also require complex reconstruction of vessels, bile ducts, or the pancreas. This complexity long remained a barrier to the development of laparoscopy compared to open surgery, even in the most experienced centers. Today, it is estimated that about half of liver or pancreatic surgeries can be performed via laparoscopy, with clearly demonstrated benefits for patients.
The arrival of robotic surgery has profoundly altered this situation. The robot obviously does not replace the surgeon; it amplifies their capabilities by offering exceptional three-dimensional vision with high magnification, miniaturized instruments that move at angles impossible for human wrist joints, and complete tremor filtration. Every gesture becomes more precise, stable, and reproducible. Thanks to the robot, we can now perform interventions that were previously very difficult, if not impossible, via laparoscopy. This is likely the single greatest contribution of robotic technology: it considerably broadens the indications for minimally invasive surgery, pushing back the boundaries of laparoscopic surgery. However, we must remain cautious with indications for use, as any new technology involves a learning curve that must be respected, and not all procedures justify robotic use, particularly from an economic standpoint. It is therefore essential to reserve robotic surgery for situations where it delivers genuine medical benefit.
One of the most fascinating areas of our specialty is liver transplantation, long considered an insurmountable boundary for minimally invasive surgery due to its technical complexity and the extreme fragility of the patients. However, a major milestone was achieved through living donors who consent to donate part of their liver to a loved one within intra-family transplantation. The safety of these donors is paramount, and minimally invasive surgery, whether laparoscopic or robotic, has helped enhance it. Building on this, pioneering teams have taken the step with recipient patients, demonstrating that certain transplantations can also be performed with robotic assistance through advanced programs developed in the United States, Asia, the Middle East, and Europe. Since 2024, several hundred procedures have already been performed worldwide. We are at the beginning of this evolution, but initial results are highly promising. Patients appear to benefit from the usual advantages of minimally invasive surgery: faster recovery, fewer abdominal wall complications, reduced infection risk, and shorter hospital stays. I am convinced that not all transplantations can ever be performed via robot or laparoscopy; certain situations will remain too complex and require open surgery. However, a significant proportion of patients will be able to benefit from the minimally invasive approach in the coming years.
Beyond robotic surgery, this evolution illustrates a broader reality: surgery advances in successive stages. Each innovation, technological or otherwise, unlocks new possibilities that seemed impossible just a few years earlier, and it is precisely this dynamic of permanent innovation that IRCAD has supported since its creation in 1994.
How do you see the treatment of liver, biliary, and pancreatic diseases evolving, particularly in oncology? What are the main remaining challenges to improving patient care?
Although genuine therapeutic progress has been made in recent years, liver and pancreatic cancers still rank among the most challenging diseases to treat.
As we just discussed, surgery has undergone major evolution, making it possible today to perform procedures that were unthinkable just a few years ago. Progress also comes from non-surgical treatments: chemotherapy has improved, targeted therapies and immunotherapy are playing an increasing role, and new molecules appear regularly. Some recent data is particularly encouraging, notably in pancreatic cancer, where new treatments targeting specific genetic mutations appear capable of significantly extending patient survival.
Improving patient care most likely lies in this synergy between surgical and pharmacological approaches, with decisions always made through multidisciplinary consultation. The more medical treatments can control the disease, the more we will be able to offer a surgical solution to patients who were previously considered inoperable.
For example, liver transplantation is experiencing a remarkable evolution, with indications gradually broadening, particularly for certain liver cancers and, in highly selected cases, certain liver metastases. In parallel, advancements in graft preparation and preservation, especially through progress in perfusion machines, open up extremely promising prospects, as we will likely be able to use more grafts and improve their quality prior to transplantation.
The true challenge remains the personalization of treatment, as every patient presents a unique disease, specific anatomy, and distinct biological features. Advances in imaging, artificial intelligence, and data analysis will make it possible to build therapeutic strategies tailored ever more precisely to individual situations.
In this evolving context, IRCAD will continue to play an essential role by ensuring that technical innovations quickly become accessible to surgeons worldwide, notably through its network of mirror institutes established across various continents. Training practitioners in new technologies, supporting their dissemination, and objectively evaluating their clinical utility represent a major contribution to improving care.
As a highly experienced surgeon and university professor, what advice would you give to younger generations of surgeons?
I have had the privilege of devoting a large part of my career to training young surgeons, and if I had only one piece of advice to give them, it would be to cultivate their curiosity. Being a good surgeon is not just about mastering an operative technique; one must understand diseases as much as techniques, how they evolve, and how to contribute to their improvement.
In particular, I recommend that they engage in research and dedicate a portion of their career, even a short one, to it, so as not to limit their horizons solely to clinical practice. The forms of research have evolved significantly. For my generation, it primarily meant biological research conducted in a laboratory. More recently, the growth of computer science and large databases offered young doctors the opportunity for clinical data research. Today, a third path exists: technological research. Robotics, new medical devices, artificial intelligence, and digital tools will be an integral part of their future practice. Participating in their development and learning to work with multidisciplinary teams will be a major asset.
I strongly encourage them to explore the research opportunities IRCAD offers. The institute is a fantastic technological melting pot, bringing together surgeons, engineers, researchers, and industrial partners from all over the world under one roof.
This proximity fosters dialogue, resulting in an exceptionally fast transfer between ideas, prototypes, and their clinical implementation. It is a particularly effective translational research model, where innovation stems directly from the needs expressed by practitioners.
Young surgeons can pursue a master’s or doctoral thesis there, working on projects that directly link technological innovation with patient care. This type of research is particularly stimulating because it leads to concrete solutions in service of patients.
Curiosity and open-mindedness, that is what I wish to pass on to younger generations. While technique is essential, it cannot be an end in itself. One must remain open-minded, continue learning throughout one’s career, and view research in all its forms as a powerful driver for advancing surgery and improving patient care.
About IRCAD:
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/
We hope you enjoyed this 25th edition of the IRCAD newsletter.
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