Strasbourg: world capital of robotic surgery

Editorial

Professor Jacques Marescaux
President & Founder of IRCAD

Interview of the month

Strasbourg: world capital of robotic surgery

After Melbourne in 2023 and Orlando in 2024, Strasbourg will host the Annual Congress of the Society of Robotic Surgery (SRS) from July 16 to 20, at the Palais des Congrès and at IRCAD, where hands-on sessions on various robotic platforms will be held. As a member of the SRS Strategic Committee, can you tell us why SRS chose France and Strasbourg?

Dr Armando Melani : France has a long-standing tradition of surgical excellence, which has extended to minimally invasive surgery and flexible endoscopy. The University of Strasbourg is highly regarded for its scientific research, with several Nobel Prizes awarded to its scholars. However, I believe the decisive factor in choosing Strasbourg is the presence of IRCAD, due to Professor Marescaux’s significant role in the history of surgery—particularly the development of telesurgery—and the global importance of the Institute, which continues, more than 30 years after its creation, to train a growing number of participants from around the world.

IRCAD is recognized as the global benchmark for training in laparoscopic and robotic surgery, and its robotic platform is the most extensive in the world. The Strasbourg Institute alone houses nearly forty robots, which is truly impressive. It’s a fantastic opportunity for us, as surgeons, to gather in one place to exchange perspectives and discover the newest surgical systems. The beauty of this congress lies in our ability to come together from all corners of the world—whether from South America like myself, or from Europe, the U.S., or Africa. One of IRCAD’s greatest strengths is its ability to unite people and facilitate exchanges on what’s best for patients, both through this kind of global event and through the mirror institutes established worldwide. Hosting this congress at IRCAD is a tremendous opportunity for the SRS to continue its development.

This congress is the major global event in the field of robotic surgery. It will highlight the latest advances in robotics, telesurgery, and artificial intelligence across a wide range of medical specialties. In your opinion, what will be the hottest topics of discussion this year?

Dr. AM: I believe we’ll have many discussions around our practices and how to improve the sharing of our experiences.

Another even more crucial topic—and one that explains why the Congress is being held in Strasbourg—is telesurgery. At last year’s SRS Congress, we addressed the topic of telesurgery from a global standpoint for the first time. The issue is that telesurgery is not regulated internationally, and no one really knows how to do it. Each country has its own legislation and rules. This year, we decided to organize a discussion focused specifically on this global dimension, because telesurgery is not just an issue for France, the U.S., or Brazil—it’s a truly global concern. Several healthcare regulatory agencies from around the world will be present. The U.S. was already involved in last year’s discussion, with representatives from the White House and the FDA, and they’re returning this year. Agencies from Europe, Japan, Asia, and even Brazil will also be present. This is very important, because we need to regulate not only the procedure itself but also the training involved.

Telesurgery can make a real difference for patients in areas where it’s difficult to find well-trained specialists. For example, globally, over 70% of stroke patients are not treated in time. Even within countries like the U.S., some regions lack stroke specialists. In such cases, telesurgery is a true therapeutic option and brings equity to healthcare access.

We hope this year’s discussion will lay the foundation for a global agreement to regulate telesurgery and make it viable across borders, because more and more countries are implementing strict, but different, rules. For instance, I used to go to France to perform live surgeries. Now, French regulations have changed and, as a foreign surgeon—even though I’m internationally recognized—I am no longer allowed to do that. In contrast, U.S. regulations are evolving to allow high-profile foreign surgeons to practice, as the country faces a shortage of surgeons; fewer and fewer Americans are choosing surgical careers.

We must reach an agreement so that the rules are the same worldwide and so that telesurgery can truly be practiced globally. I think this is the most important point of the Congress.

Twenty-five years after the first generation of surgical robots, these technologies are now present in almost every medical specialty, and manufacturers continue to improve them to meet practitioners’ needs. What developments do you foresee?

Many developments are underway that will benefit both practitioners and patients.

When Professor Marescaux decided to create an IRCAD in Africa, in Rwanda, we witnessed firsthand a very different reality in terms of access to healthcare, compared to Europe or even Brazil. To be clear, I’m not saying African professionals lack competence; the issue lies in access. For example, pregnancy follow-up is inadequate, which is why the “Disrumpere” research project was launched jointly by IRCAD France and IRCAD Africa. It aims to improve access to ultrasound by training non-specialist practitioners with the help of artificial intelligence. This initiative is even more promising because ultrasound can be used in situations beyond pregnancy. Imagine that instead of requiring a human operator, a robotic arm could perform the scan, thereby broadening access and allowing images to be shared with experts—or analyzed directly by an AI system. This would be very useful for procedures like mammography, potentially offering greater diagnostic accuracy than humans. This would open diagnostic access in regions lacking trained professionals.

Another area of development is autonomous robotics to assist surgeons. For example, performing laparoscopic gallbladder surgery typically requires two surgeons. But in isolated regions—or even in the U.S.—one surgeon may perform the procedure with help from a non-surgeon assistant. That’s why research is underway into autonomous movements like suturing. Of course, we can suture by hand, but robotic precision could be superior. In the future, certain steps in surgery could be performed by autonomous robots.

You are the Scientific Director of IRCAD America Latina, a mirror institute of IRCAD France that opened in Brazil in 2011. What are the main achievements of this institute, and what is your vision for the future?

One of our greatest achievements has been standardizing our procedures. We welcome experts from around the world to teach at IRCAD America Latina, and it’s much easier to align with them when we have clear teaching objectives and standardized approaches. In the years following our opening, we trained many people from Brazil and across South America (about 40% of our participants), thanks to our outreach at congresses and meetings across the continent. We’ve been able to observe the videos and presentations from that time, and after all these years, we’ve seen significant improvements in countries whose professionals trained with us. For example, in Peru, which is deeply committed to our training system, we can see a clear improvement by comparing their early videos to what they’re doing today. Seeing such progress in skills makes us extremely proud of our role in promoting equitable access to care through education.

To achieve this, we work constantly with IRCAD France, our “flagship.” Together, we’re developing several projects, particularly in robotic surgery, which is still being introduced in South America. Given the cost of these technologies, we aim to understand and teach the most efficient ways to use them given the resources available in Latin America, so that patients can benefit as much as possible.

Another achievement is the creation, a few years ago, of a hub fostering the emergence of companies developing solutions and platforms to improve healthcare access. These companies can join this hub to discuss not only surgical matters but also broader healthcare issues, such as how to best leverage new technologies and artificial intelligence, and how to generate new ideas for improving care delivery. For instance, one company is developing a WhatsApp-based system to assess patients’ condition after discharge on days 1, 2, and 3—because in Brazil, we need hospital beds and have to discharge patients as early as possible.

This hub is all the more valuable because we work closely with the other IRCADs, sharing ideas and experiences to continuously improve our practices. Since needs differ across South America, Europe, and Asia, it’s fascinating to understand these differences and collaboratively develop solutions that fit the needs of each institute. This collaboration is further strengthened by the recent creation of the IRCAD International Foundation, which connects all institutes through a structured framework with regular meetings, allowing us to discuss challenges, similarities, and opportunities to improve or create new training programs.

This strong interaction among institutes is essential to developing the best services and improving care worldwide. It perfectly reflects IRCAD’s philosophy of generosity: the generosity of experts who come to teach and share their experience, the generosity of participants who come to learn and enhance their skills, and the generosity of IRCAD’s staff who show passion and dedication in their daily work.

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/fen/

We hope you enjoyed this 19th edition of the IRCAD newsletter.
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