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Computational medicine

Françoise Breton - 31/01/2012

Inria's skills furthering the surgery of the future

© Inria / Photo Kaksonen

Inria is participating in three of the six projects selected as part of the "Future Investments" programme organised by the French Ministry of Higher Education and Research and launched in 2010. These projects are all being carried out within university health institutes combining care, research and training (IHUs). We take a closer look at MIX-Surg, Strasbourg's IHU for image-guided minimally invasive surgery, with Stéphane Cotin, whose team, Shacra, is a key contributor to the project.

What is the aim of the MIX-Surg IHU?

Stéphane Cotin:  IHUs are intended to boost research activity in relation to hospital applications for very specific fields, in which there is already a recognised skill base to work from. Strasbourg is known for its expertise in abdominal and pelvic laparoscopic surgery, in particular as a result of Ircad [research institute against digestive cancer], which is chaired by Professor Jacques Marescaux. In this context, MIX-Surg aims to develop and prepare for marketing technologies to facilitate the surgical procedure . Technology transfer will take place via industry partners involved in the projects or specifically created start-ups. One of the interesting things about this approach is that it enables us to integrate a cost-effectiveness impact analysis: in order to move forward, it must be demonstrated that the technologies developed will be beneficial to patients but also that they will offer practical advantages for surgeons and not represent an undue expense in relation to the expected benefits.

What is Inria's role within this new IHU?

S.C.: Inria is a founding member of MIX-Surg. It plays a central role, as the IHU is resolutely focused on new technologies. Inria's involvement was actually an obvious decision, as we have in fact been working together for a number of years. For example, Nicolas Ayache (leader of the Asclepios team and member of the IHU's scientific board) and I worked together on the very first project to combine surgery and computing, with Professor Jacques Marescaux a little over ten years ago.

Minimally invasive surgery has been practised since the nineties; what is different about the approach developed within this IHU?

S.C.:  This approach brings together aspects of imagery, simulation, modeling, and even robotics. Let's take the example of laparoscopic liver surgery, which is directly related to our team's work. At present, surgeons are able to view the surface of the liver, thanks to a micro-camera, but not the vascular network, which they must be careful not to section, nor the internal tumour that they want to excise. They are obliged to estimate the location of the tumour on the basis of patient data collected prior to the operation, in a liver which undergoes considerable deformation during the procedure. We can help surgeons, through techniques that combine simulation and augmented reality, by superimposing details on the view of the surgical field, which will enable them to see  through the liver , as if it were transparent, to view the tumour and blood vessels. In order to be useful, this information must reflect reality and take into consideration the deformation of the organ during the surgical procedure. This requires the use of 3D models of tumours and the vascular network based on pre-operative examinations. These models are then deformed virtually, on a real-time basis, to ensure that the 3D model superimposed on the image during the operation corresponds to the reality at all times.

And where does robotics come in?

S.C.:  This convergence between medical imaging, simulation and modeling can also integrate aspects of robotics. For example, the interventional radiology used in the treatment of liver tumours consists in inserting a needle or electrode through the abdominal wall and liver until it reaches the tumour, which it then destroys through the use of heat, cold or drug treatments. The difficulty lies in determining the best route for the instrument and then monitoring, and if necessary correcting, its positioning during the operation. By combining imagery with our skills in simulation and robotics, we can guide the needle using a robot, so that the route is followed more accurately, and the instrument inserted in a more gradual and steady manner, and synchronised with the imaging systems. Once again, this involves modeling and simulating the liver and the way it moves with the patient's breathing, and is deformed by the insertion of the needle, etc.

A very ambitious project

With support from the University of Strasbourg, the Inserm and the Strasbourg teaching hospital, the MIX-Surg IHU will officially be inaugurated at the beginning of 2012. Many people are already working at the site, although the building which is to house the IHU will not be completed for another two years. With 17 hybrid operating rooms dedicated to treatment, training and research, the institute will bring together researchers, clinicians and imaging equipment. This unique and stimulating environment located within a fast-growing medical and university hub is already attracting high-level interest from around the world: 7 leading medical organisations and 33 industrial operators have already agreed to be actively involved in the project. With growth in the international market for minimally invasive hybrid procedures being estimated at 8% per year on average (i.e. €37 billion in 2014), the IHU will also promote the development of French start-ups in this field.

Keywords: Stéphane Cotin Shacra team Inria Lille – Nord Europe Computational medicine