good morning first time we like to thank
for the invitation second I have to
apologize because my English is not
going to be as good as the previous
speaker but I do my best I have a
challenge this morning I have to show
you in less than 18 minutes and I have a
counter down there it’s already 70 by
the way I have to show you I had less
than 18 minutes the evolution of surgery
for centuries what was behind what is
now what night and probably will be the
future but again I’ll do my best
those are surgical instruments used
about 4000 years ago there was a
surgical instrument use about 2,000
years ago and those are surgical
instruments used about 100 years ago as
you can realize not much difference in
terms of the shape of the instruments
for 4000 years the surgeons whatever
they were doing were using the same
instruments and essentially surgery
developed itself through two ways first
the prevention and the control of
infection because patients were dying of
infections before those measures were
taken and second the control of pain
imagine that a few centuries ago surgery
was done without any anesthesia except
alcohol and some strong hanging of the
patients but due to antisepsis and the
control infection and prevention due to
the control of pain surgery has been
able be able to develop itself and
surgeons have been able to describe
surgical operations surgery for
centuries maybe four thousand years was
done this way the surgeons was watching
the operating field with his eyes was
having his hands into the abdominal
cavity the thorax cavity wherever it was
and of course had a wide-open field this
was surgery for centuries now about 30
years ago
since things have completely changed
those are the new instruments will you
what we call minimally invasive surgery
whether it’s laparoscopic surgery or
thoracic surgery minimally invasive
surgery so we use instruments that are
introduced into the abdominal cavity in
this example through t hole incisions
really tiny incisions and we can change
the instruments so of course there’s no
vision of the operating field one of
those instruments is the camera and the
camera basically is going to give you a
picture on the screen a 2d vision
not anymore 3d vision the surgeons here
is going to operate in a darkroom normal
lights because he’s watching TV
basically and the instruments he is
using he are very limited in terms of
mobility so it’s a complete change of
paradigms in doing surgery we’re in a
dark room we don’t see your brain
feeling 3d we don’t move like we used to
mobility decreased those are like I used
to call them Chinese sticks like the one
you used to eat you know they go up and
down they go left and right and that’s
it at the end there is a movement like
this so either it’s a scissors or it’s a
clamp whatever but it’s the only
movement you lose completely the
mobility of your hand so basically the
first progress of surgery is to bring
surgeon as a handicapped person
decreased vision decreased mobility 30
years ago we were hoping that this type
of surgery would not only do as good as
the open surgery but even better as the
open surgery imagine how difficult it
was but it did basically did not
surprising 40 years ago man was on the
moon imagine how much technology is into
this and many other progress that have
been done around us all the technology
in equipments in electronics in
materials yet the surgeon was still
working in the operating room with his
fork and his knife all handicapped by
vision and by mobility now it’s time
that all the technology that is
surrounding the operating room
comes into the operating room and this
was done about 20 years ago by the first
robot that was introduced in the
operating room and still today it’s the
only one that is mostly used there are
some others for auto paddock surgery but
this is the most used one it’s called
da Vinci and it’s been built by an
American factory called intuitive and
the world is perfectly well chosen it’s
really an intuitive surgery every one of
you can in a few minutes do very
sophisticated movements why why because
we have a very simple kind of joysticks
to use and this joysticks is linked to
an instrument that gives you again the
mobility of the hand not only the
mobility of your hand but even more and
I’m sometimes amazed how much I can move
the tip of its these instruments with
these joysticks it’s so easy to handle
that you concentrate not on how shall I
do this but what do I want to do it’s
like moving your hands it’s completely
rapidly automatic vision we restore a 3d
vision we have two optic Channel it’s a
real 3d vision so you are really
recovering your normal vision not only
this but you have the size of the
picture is increased by 10 times you
have an enlargement of 10 times so you
really have your nose on the object if
and you can see it very clearly clearly
and you can move very easily so at least
we recover our natural senses now you
can see on the left a standard suturing
with a laparoscopic technique and it’s
the same surgeon and here using the
robot the same suturing look a few
seconds left
old laparoscopic I would say and then da
Vinci of course having recovered our
vision having recovered our mobility we
do better we do faster we do safer not
surprisingly this instruments the robot
has been sold worldwide very largely and
is still of course
unfortunately it’s a very expensive
equipment and as you will see other are
coming on the market with probably
cheaper instruments
this is suturing two pieces of bow
together but it could be anything look
on the right how easy it is to make
knots everybody of you can do this in a
few minutes with the robots now this is
used this is an example of my hospital
and my my problem of surgery we started
in January 2006 we have yet almost
achieved three thousand operation
essentially this whole surgery that I’m
responsible off but also urology very
active gynecology also very active so
it’s used in several fields of surgery
not only from one surgery initially this
robot was built for Cali vascular
surgery but then moved on for other
types of surgery so it’s a widely used
equipment so we moved from open surgery
3d vision and 3d manipulation to a
progress so called progress with
minimally invasive surgery to division
2d manipulation that is still widely
used now at least in the Western world
to the last one which is robotic surgery
robotic surgery gives three division
enlargement by ten times manipulation
that is far beyond our hands but
essentially foresee the future by being
an interface between the surgeon and the
patient you realize that the surgeon is
not at the operative table he’s sitting
on what we call a console working with
his hands looking in the binocular a few
meters away from the patient so it’s a
really completely different approach
surgeon is working here console is he
console is he the robot is he and there
is of course a link between them and
this link can be used to introduce add
the additive information new information
for example hydrological information
that the surgeon can see in real time so
not only he can see the operating field
by but by introducing those data he will
at the same time will be a table at the
same time to see the x-ray pictures or
the 3d reconstruction of the page
in itself so this interface will allow
for the development of surgery initially
patient was close to the surgeon open
surgery big incision big surgeon
laparoscopic surgery robotic surgery
like I mentioned and then computer-aided
surgery we will be able to bring
information to the surgeon that will
help him to do his surgical operation we
have devices for this this is an x-ray
this is a stomach CT scan and we have
now devices that will allow us to work
on this non those pictures to bring them
to a 3d 45 division even six division
this is a patient with a liver tumor
this is the liver this is a tumor from
the CT scan by 3d reconstruction of 4d
you can bring this type of picture you
can bring the surgeon not only to see an
x-ray but to really watch what he is
going to see during surgery and of
course by looking at those pictures the
surgeon can plan his operation can draw
lines can decide where he wants to go he
can raise those lines which he cannot do
in real-time he can plan his operation
and then one day record the best shot
that he has done and then in real time
the day of surgery deliver this best
shot to the patient being sitting there
for unforeseen events it is not the case
now but this is really going to come in
a few years you can move the organ you
can draw lines you can decide where you
want to go and it’s specially important
in the liver which is an organ where the
anatomy is very complex and it’s of
course very important in the brain where
the anatomy is even more complex so
hydrology is bringing us very
interesting tools that will allow for
the surgeon to work prior surgery what
we call augmented reality and of course
navigation virtual reality augmented
reality delivered in real-time to the
surgeon during surgery
helping him to navigate in the body of
the patients and this can be achieved
and I won’t go into details but this can
be achieved with a robot by a system
that is close to the GPS in the GPS you
have the map in this system you have the
anatomy of the patient in the GPS you
have you the movement of your car
whatever in this system you have the
movement of your instruments so you
exactly know where you are according to
the anatomy of this single patient so a
significant progress basically this will
lead to withdraw from the operating room
the most dangerous thing for the patient
and the most dangerous thing is the
surgeon himself why because we are human
beings you can have back pain you can be
tired you can be late you can have known
you had no time to prepare surgery all
things that can happen in a human being
with the new system you have to plan
your surgery before you have to record
your planning so you can really as I
said have your best shot and deliver to
the patient the very best care that you
can give him not only you can do it
yourself you can share your surgery your
plan with other surgeons or other
physicians so robotic surgery in 2018
how many of those da Vinci robot have
been sold
well almost 4,000 today and it’s only a
20 25 years old story this is Jerry
Gortat working with the first robot look
at this machine now the development is
really speeding up no it’s driven and
oriented to patient care to the
well-being of the surgeon yes to the
deliver of safe care but to improve the
care and the results in the patient it
is of course something that has to be
shown scientifically valid and this is
the number of publications per year
regarding the use of this da Vinci robot
now you can see the number of operation
that are done early 2016 almost 700,000
so it’s widely used and we will be able
to develop this system in collaboration
with intuitive as you can see urology
one third of the operation gynecology
one third and general or visual surgery
another third now there are other
factories of course interested in
developing those and I will show you a
few examples
Medtronic Avatara and this is one of the
biggest one and probably the most
important one that is linking Google
with always means not only money but
brains and Johnson and Johnson which is
already involved in surgical instruments
this is again the development brought by
intuitive and you will see how
sophisticated just the instruments can
be I don’t talk about cardiology and all
this technology this is a about one
point 8 centimeter channel that is
brought through the skin into the
abdominal or the thoracic cavity and
look how many instruments can be used
this is a camera with again 3 Division 2
channels with light and yet 3
instruments so you can really move
around with both hands having a third
one to hold something so through a one
point 8 centimeter channel you bring
your vision you bring your light you
bring your instruments so this will lead
to what we call the single side surgery
what does it mean it means that we
decrease the size of the scar but it
will also mean that those instruments
can be controlled by a pre operative
recording that will in fact organize the
movement of the instruments and organize
the sequences of the surgery before the
surgery miniaturization is of course
also going to come and the idea behind
this is to drop those mini robots into
the abdomen electracy cavity and to
guide them from the outside so you can
drop one but you can drop 10 15 20 each
of one will do his job and then will be
whisked on to the same whole patient
being treated so it’s a whole new
concept that is going to evolve not only
we will have instruments to hold tissue
but we will have instruments that will
record some specificity of the teach
tissue temperature oxygenation pH
tension on the tissue resistance of the
tissue giving to the surgeon much more
information of course this information
cannot be analysed in real time
by the surgeon and a lot of other
equipments let’s call it this way will
be necessary for the surgeon to guide an
operation now maybe one day the surgeon
will himself be a robot and when you see
those pictures you wonder if really it’s
not going to be one day the case look at
the movements the stability of these
robots he’s going to play football
I mean imagine how much technology is
necessary to achieve this kind of
movement this kind of sophistications
and you cannot hear it but he’s speaking
he’s talking warning that he’s going to
shoot the ball so you know actually he’s
using his feet but one day he will be
able to use his hands and the recording
of the operation can also be delivered
by this type of robots well yes it’s a
bit frightening but like I used to say I
look forward to become a patient because
so much technology is around so much
development is around that you’ll get
the best care in 10 years 20 years this
is maybe for me in 50 years it’s going
to be completely changed and the young
people among you will be treated in a
complete different way surgically at
least but not only then they are now
they would be today but of course the
future sometimes surprising and sometime
you are concerned but what’s going to
happen we can foresee the future but
there might be curves that we have to
take anyway it’s going to be a
fascinating world and I think the good
side of human being to bring a balance
with the previous talk there’s also a
good side of human being lots of people
involved in trying to improve care to
other humans being thank you very much [Applause]
for the invitation second I have to
apologize because my English is not
going to be as good as the previous
speaker but I do my best I have a
challenge this morning I have to show
you in less than 18 minutes and I have a
counter down there it’s already 70 by
the way I have to show you I had less
than 18 minutes the evolution of surgery
for centuries what was behind what is
now what night and probably will be the
future but again I’ll do my best
those are surgical instruments used
about 4000 years ago there was a
surgical instrument use about 2,000
years ago and those are surgical
instruments used about 100 years ago as
you can realize not much difference in
terms of the shape of the instruments
for 4000 years the surgeons whatever
they were doing were using the same
instruments and essentially surgery
developed itself through two ways first
the prevention and the control of
infection because patients were dying of
infections before those measures were
taken and second the control of pain
imagine that a few centuries ago surgery
was done without any anesthesia except
alcohol and some strong hanging of the
patients but due to antisepsis and the
control infection and prevention due to
the control of pain surgery has been
able be able to develop itself and
surgeons have been able to describe
surgical operations surgery for
centuries maybe four thousand years was
done this way the surgeons was watching
the operating field with his eyes was
having his hands into the abdominal
cavity the thorax cavity wherever it was
and of course had a wide-open field this
was surgery for centuries now about 30
years ago
since things have completely changed
those are the new instruments will you
what we call minimally invasive surgery
whether it’s laparoscopic surgery or
thoracic surgery minimally invasive
surgery so we use instruments that are
introduced into the abdominal cavity in
this example through t hole incisions
really tiny incisions and we can change
the instruments so of course there’s no
vision of the operating field one of
those instruments is the camera and the
camera basically is going to give you a
picture on the screen a 2d vision
not anymore 3d vision the surgeons here
is going to operate in a darkroom normal
lights because he’s watching TV
basically and the instruments he is
using he are very limited in terms of
mobility so it’s a complete change of
paradigms in doing surgery we’re in a
dark room we don’t see your brain
feeling 3d we don’t move like we used to
mobility decreased those are like I used
to call them Chinese sticks like the one
you used to eat you know they go up and
down they go left and right and that’s
it at the end there is a movement like
this so either it’s a scissors or it’s a
clamp whatever but it’s the only
movement you lose completely the
mobility of your hand so basically the
first progress of surgery is to bring
surgeon as a handicapped person
decreased vision decreased mobility 30
years ago we were hoping that this type
of surgery would not only do as good as
the open surgery but even better as the
open surgery imagine how difficult it
was but it did basically did not
surprising 40 years ago man was on the
moon imagine how much technology is into
this and many other progress that have
been done around us all the technology
in equipments in electronics in
materials yet the surgeon was still
working in the operating room with his
fork and his knife all handicapped by
vision and by mobility now it’s time
that all the technology that is
surrounding the operating room
comes into the operating room and this
was done about 20 years ago by the first
robot that was introduced in the
operating room and still today it’s the
only one that is mostly used there are
some others for auto paddock surgery but
this is the most used one it’s called
da Vinci and it’s been built by an
American factory called intuitive and
the world is perfectly well chosen it’s
really an intuitive surgery every one of
you can in a few minutes do very
sophisticated movements why why because
we have a very simple kind of joysticks
to use and this joysticks is linked to
an instrument that gives you again the
mobility of the hand not only the
mobility of your hand but even more and
I’m sometimes amazed how much I can move
the tip of its these instruments with
these joysticks it’s so easy to handle
that you concentrate not on how shall I
do this but what do I want to do it’s
like moving your hands it’s completely
rapidly automatic vision we restore a 3d
vision we have two optic Channel it’s a
real 3d vision so you are really
recovering your normal vision not only
this but you have the size of the
picture is increased by 10 times you
have an enlargement of 10 times so you
really have your nose on the object if
and you can see it very clearly clearly
and you can move very easily so at least
we recover our natural senses now you
can see on the left a standard suturing
with a laparoscopic technique and it’s
the same surgeon and here using the
robot the same suturing look a few
seconds left
old laparoscopic I would say and then da
Vinci of course having recovered our
vision having recovered our mobility we
do better we do faster we do safer not
surprisingly this instruments the robot
has been sold worldwide very largely and
is still of course
unfortunately it’s a very expensive
equipment and as you will see other are
coming on the market with probably
cheaper instruments
this is suturing two pieces of bow
together but it could be anything look
on the right how easy it is to make
knots everybody of you can do this in a
few minutes with the robots now this is
used this is an example of my hospital
and my my problem of surgery we started
in January 2006 we have yet almost
achieved three thousand operation
essentially this whole surgery that I’m
responsible off but also urology very
active gynecology also very active so
it’s used in several fields of surgery
not only from one surgery initially this
robot was built for Cali vascular
surgery but then moved on for other
types of surgery so it’s a widely used
equipment so we moved from open surgery
3d vision and 3d manipulation to a
progress so called progress with
minimally invasive surgery to division
2d manipulation that is still widely
used now at least in the Western world
to the last one which is robotic surgery
robotic surgery gives three division
enlargement by ten times manipulation
that is far beyond our hands but
essentially foresee the future by being
an interface between the surgeon and the
patient you realize that the surgeon is
not at the operative table he’s sitting
on what we call a console working with
his hands looking in the binocular a few
meters away from the patient so it’s a
really completely different approach
surgeon is working here console is he
console is he the robot is he and there
is of course a link between them and
this link can be used to introduce add
the additive information new information
for example hydrological information
that the surgeon can see in real time so
not only he can see the operating field
by but by introducing those data he will
at the same time will be a table at the
same time to see the x-ray pictures or
the 3d reconstruction of the page
in itself so this interface will allow
for the development of surgery initially
patient was close to the surgeon open
surgery big incision big surgeon
laparoscopic surgery robotic surgery
like I mentioned and then computer-aided
surgery we will be able to bring
information to the surgeon that will
help him to do his surgical operation we
have devices for this this is an x-ray
this is a stomach CT scan and we have
now devices that will allow us to work
on this non those pictures to bring them
to a 3d 45 division even six division
this is a patient with a liver tumor
this is the liver this is a tumor from
the CT scan by 3d reconstruction of 4d
you can bring this type of picture you
can bring the surgeon not only to see an
x-ray but to really watch what he is
going to see during surgery and of
course by looking at those pictures the
surgeon can plan his operation can draw
lines can decide where he wants to go he
can raise those lines which he cannot do
in real-time he can plan his operation
and then one day record the best shot
that he has done and then in real time
the day of surgery deliver this best
shot to the patient being sitting there
for unforeseen events it is not the case
now but this is really going to come in
a few years you can move the organ you
can draw lines you can decide where you
want to go and it’s specially important
in the liver which is an organ where the
anatomy is very complex and it’s of
course very important in the brain where
the anatomy is even more complex so
hydrology is bringing us very
interesting tools that will allow for
the surgeon to work prior surgery what
we call augmented reality and of course
navigation virtual reality augmented
reality delivered in real-time to the
surgeon during surgery
helping him to navigate in the body of
the patients and this can be achieved
and I won’t go into details but this can
be achieved with a robot by a system
that is close to the GPS in the GPS you
have the map in this system you have the
anatomy of the patient in the GPS you
have you the movement of your car
whatever in this system you have the
movement of your instruments so you
exactly know where you are according to
the anatomy of this single patient so a
significant progress basically this will
lead to withdraw from the operating room
the most dangerous thing for the patient
and the most dangerous thing is the
surgeon himself why because we are human
beings you can have back pain you can be
tired you can be late you can have known
you had no time to prepare surgery all
things that can happen in a human being
with the new system you have to plan
your surgery before you have to record
your planning so you can really as I
said have your best shot and deliver to
the patient the very best care that you
can give him not only you can do it
yourself you can share your surgery your
plan with other surgeons or other
physicians so robotic surgery in 2018
how many of those da Vinci robot have
been sold
well almost 4,000 today and it’s only a
20 25 years old story this is Jerry
Gortat working with the first robot look
at this machine now the development is
really speeding up no it’s driven and
oriented to patient care to the
well-being of the surgeon yes to the
deliver of safe care but to improve the
care and the results in the patient it
is of course something that has to be
shown scientifically valid and this is
the number of publications per year
regarding the use of this da Vinci robot
now you can see the number of operation
that are done early 2016 almost 700,000
so it’s widely used and we will be able
to develop this system in collaboration
with intuitive as you can see urology
one third of the operation gynecology
one third and general or visual surgery
another third now there are other
factories of course interested in
developing those and I will show you a
few examples
Medtronic Avatara and this is one of the
biggest one and probably the most
important one that is linking Google
with always means not only money but
brains and Johnson and Johnson which is
already involved in surgical instruments
this is again the development brought by
intuitive and you will see how
sophisticated just the instruments can
be I don’t talk about cardiology and all
this technology this is a about one
point 8 centimeter channel that is
brought through the skin into the
abdominal or the thoracic cavity and
look how many instruments can be used
this is a camera with again 3 Division 2
channels with light and yet 3
instruments so you can really move
around with both hands having a third
one to hold something so through a one
point 8 centimeter channel you bring
your vision you bring your light you
bring your instruments so this will lead
to what we call the single side surgery
what does it mean it means that we
decrease the size of the scar but it
will also mean that those instruments
can be controlled by a pre operative
recording that will in fact organize the
movement of the instruments and organize
the sequences of the surgery before the
surgery miniaturization is of course
also going to come and the idea behind
this is to drop those mini robots into
the abdomen electracy cavity and to
guide them from the outside so you can
drop one but you can drop 10 15 20 each
of one will do his job and then will be
whisked on to the same whole patient
being treated so it’s a whole new
concept that is going to evolve not only
we will have instruments to hold tissue
but we will have instruments that will
record some specificity of the teach
tissue temperature oxygenation pH
tension on the tissue resistance of the
tissue giving to the surgeon much more
information of course this information
cannot be analysed in real time
by the surgeon and a lot of other
equipments let’s call it this way will
be necessary for the surgeon to guide an
operation now maybe one day the surgeon
will himself be a robot and when you see
those pictures you wonder if really it’s
not going to be one day the case look at
the movements the stability of these
robots he’s going to play football
I mean imagine how much technology is
necessary to achieve this kind of
movement this kind of sophistications
and you cannot hear it but he’s speaking
he’s talking warning that he’s going to
shoot the ball so you know actually he’s
using his feet but one day he will be
able to use his hands and the recording
of the operation can also be delivered
by this type of robots well yes it’s a
bit frightening but like I used to say I
look forward to become a patient because
so much technology is around so much
development is around that you’ll get
the best care in 10 years 20 years this
is maybe for me in 50 years it’s going
to be completely changed and the young
people among you will be treated in a
complete different way surgically at
least but not only then they are now
they would be today but of course the
future sometimes surprising and sometime
you are concerned but what’s going to
happen we can foresee the future but
there might be curves that we have to
take anyway it’s going to be a
fascinating world and I think the good
side of human being to bring a balance
with the previous talk there’s also a
good side of human being lots of people
involved in trying to improve care to
other humans being thank you very much [Applause]
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