In his quality of Honored Guest and President of the French Academy of
Sciences, Professor Carpentier will address the audience of MICCAI 2012
during the opening ceremony along with the CEO of INRIA, Professor
Michel Cosnard, and will introduce the keynote lecture of Professor
Haïssaguerre the next day.
2 October morning
3 October morning
Prof. Marescaux MD, Hon. FRCS – Hon FJSES - FACS, is Chief of digestive surgery Department of University of Strasbourg Hospital and president and founder of IRCAD. Prof Marescaux. He is also founder and Chief Executive Officer of the newly created IHU-Strasbourg, a center of excellence aiming at developing Image Guided Minimally Invasive Surgery and fostering technology transfer.
Professeur Marescaux began his academic career as a researcher at INSERM in the fields of cell biology and experimental surgery. At the age of 32, he was appointed Professor of Digestive Surgery and rapidly built a track record of achievement.
In the early 1990’s, Professor Marescaux was one of the first to recognize that the field of surgery was shifting – from the industrial era to the information era and from open procedures to minimally invasive techniques. With strong support from private partners, he created IRCAD, a uniquely structured institute to advance the field of surgery into the information era. In 1994, IRCAD opened on the grounds of the University of Strasbourg Hospital. Since its creation, IRCAD has gained world renown as a leading institute for surgical research and education.
Since its creation, IRCAD has 2495 international publications and communications. Furthermore, the institute has been honored with many prestigious international awards, including: Computerworld Smithsonian Award (Washington - 1999), Computerworld Honors Award (Washington - 2002), Excel Award and World Summit Award (Geneva – 2003), Robotics Award (Osaka – 2004), Gimbernat Award (Barcelona 2009), Georges Berci Lifetime Achievement Award (Washington 2010).
In 2001, Professor Marescaux electrified the surgical world with “Operation Lindbergh”. Sitting at a robotic console in New York City, he performed the first transcontinental laparoscopic surgery on a patient in Strasbourg France – the perfect blend of information technology and minimally invasive surgery, made possible by a multidisciplinary team of academic and private engineers Just as Lindbergh’s solo flight across the Atlantic revolutionized our thinking, so too did this worldwide first, proving that distances were no longer an obstacle in surgery [Nature 2001, 41].
IRCAD has focused research efforts on the development of less invasive surgical techniques. The creation of new concepts and instruments enabled the IRCAD team to carry out the first fully natural orifice transluminal endoscopy surgical (NOTES) procedure in April 2007.
EITS was founded by Professor Marescaux as a training facility to disseminate the ground breaking work at IRCAD. Over the last 16 years this center has gained international acclaim by training more than 38,000 surgeons from 124 countries. The demand for EITS training has driven the creation of mirror IRCAD institutes in Taiwan and Brazil.
Professor Marescaux has been recognized worldwide in for his contribution to surgery. His work has been reflected in major publications, membership in every important surgical organization, honorary degrees from the Universities, position in many Editorial Boards and honorary fellowship in the Royal College of Surgeons (London) and the Japanese society of endoscopic surgery.
Introducing an optical device into the abdomen of a patient so as to carry out the surgical procedure via a miniaturized camera, represented the major change the surgical world experienced throughout the 20th century : the "minimally invasive" surgery era was born. Recent decades saw amazing progress in such minimal access procedures that replace radical surgical resections. Unfortunately, minimally invasive techniques were developed by separate and distinct specialties and are inevitably limited by the expertise of individual specialists such as surgeons, radiologists and gastroenterologists.
In parallel, medicine entered the world of computer sciences via great revolutions among which 3D medical imaging (CT, MRI and ultrasound) is surely the most obvious. Digitalisation of patient own data is nowadays present in all fields, from anatomy to the surgical intervention. This ever growing data flow remains however difficult to interpret and to exploit. This is the objective of computerized post-processing of this data. Interpretation consists in extracting from the signal (image or other) emitted by the data capturing device the information useful for diagnosis, therapeutic choice or medical treatment. In order to be understandable, this information has to be quickly, reliably and clearly translated and given to practitioners, by exploiting the principles of virtual reality. Useful information is thus mainly recreated as 3D images. Beyond diagnosis support, this data exploitation can allow to plan and simulate an intervention preoperatively. These two preoperative steps can be used intra-operatively thanks to the development of augmented reality (AR) which consists in superimposing the pre-operative 3D modeling of the patient onto the real intra-operative view of the patient. AR aims at providing surgeons a view in transparency of their patient and can also guide surgeons thanks to the virtual improvement of their real surgical tools that are tracked in real time during the procedure. This awaited technique is however currently not available for soft tissue surgery essentially due to large intraoperative deformations and topological changes of organs resulting from surgeon interactions.
A last major medical innovation which appeared early 21st century is robotic surgery. Developed to improve surgical gesture precision and efficiency, existing robots are essentially telemanipulators. Steering articulated arms reproducing all motions under control, the surgeon is able to perform operations from a distance, sitting in a comfortable seat, with no risk to make any awkward movement due to trembling or to a brusque gesture. But as for augmented reality, automatic control remains today not available due to huge difficulties to predict, analyse or control organ deformations and to adjust in real-time the robotic movements.
The evolution of surgery thus needs a revolution to overcome all these current limits. This revolution will consist in combining the best aspects of minimally invasive techniques from separate specialties, image analysis techniques, patient-specific simulation, augmented reality and robotics. The resulting approach will lead to Image-Guided Minimally Invasive Hybrid Surgery. The associated new operating room will integrate intra operative imaging technologies, especially open MRI. This integration will be a tremendous challenge, due to the difficulty to perform a surgical procedure in a high magnetic field: this environment prohibits the use of ferromagnetic surgical instruments, anesthesia machines and standard electronic energy devices. The evolution of surgery to incorporate image guidance, computer assistance, robotic augmentation and telecommunications will require a paradigm shift in the training of physicians, engineers, and other healthcare workers. The classic boundaries between medical, surgical and radiological disciplines must be reorganized to produce multidisciplinary teams who are proficient in all tools relevant to patients. It is a challenge but it will lead to the future of surgery.
Born in Bayonne, France, in 1955, Prof. Michel Haïssaguerre graduated in medicine in 1982 and specialized in cardiology in 1984. He became assistant-professor in 1988 at the University. He became a Professor of Cardiology in 1994 and he currently teaches at the Hôpital Cardiologique du Haut-Lévêque, Bordeaux- Pessac.
His scientific and clinical work focuses on cardiovascular electrophysiology, particularly on cardiac fibrillation. He is best known for his remarkable contributions in the area of atrial fibrillation ablation. He was the first to detect the importance of pulmonary vein triggers and drivers in the genesis of atrial fibrillation. In addition, he was first to propose the technique of pulmonary vein isolation, which underlies current methods used throughout the world for atrial fibrillation cure. His team has also demonstrated that Purkinje cells were the main triggers of human ventricular fibrillation, with or without heart disease.
M.Haïssaguerre has published more than 460 publications in the leading peer-reviewed cardiology journals dealing mainly with radiofrequency current endocardial ablation of tachyarrhythmias. He serves on the editorial boards of many major journals of cardiology, including European Heart Journal, Circulation Arrhythmia, Europace, The Journal of Cardiovascular Electrophysiology, Journal of Interventional Cardiology, Heart Rhythm, and Pacing and Clinical Electrophysiology: PACE.
Michel Haïssaguerre enjoys an outstanding national and international scientific reputation. He has received numerous honors and awards, including the Prix Robert Debré (1982), the Prix de l’Information Cardiologique (1990), the Prix Ela Medical (1992), the Nylin Swedish Prize (2002), the Best Scientist Award Grüntzig 2003 (European Society of Cardiology), the Pioneer in Cardiac Electrophysiology award 2004 by the North American Society of Pacing and Electrophysiology (NASPE) – currently the Heart Rhythm Society, and the Mirowski Award 2009 for excellence in clinical cardiology and electrophysiology.
In 2010, he received the Lefoulon-Delalande Price (Institut de France), the Louis Jeantet Prize for Medicine (Switzerland), and became a member of the Académie des Sciences; and the Distinguished Scientist Golden Lionel prize (Italy) was awarded to him in 2011. Eight of recipients of Louis Jeantet Prize have obtained later the Nobel Prize.
Sudden cardiac death is responsible for 350 000 deaths each year in Europe, almost 1 000 every day, equivalent to the cumulative mortality of the three most lethal cancers (breast, lung and colon-rectal). This hecatomb is often likened to a natural death by ‘heart attack' or "cardiac arrest". It is in 50-80 % of the cases linked to an arrhythmia instantly lethal: a real electric "tornado" termed ventricular fibrillation.
This devastating arrhythmia can be bound to a myocardial infarction but mainly concerns individuals with a healthy or slightly altered heart. It leads to the immediate death of the individual in the absence of cardiac massage and electric shock delivered by a defibrillator. The source cells generating the triggering impulses come from the Purkinje network: a tiny fraction (2 %) of the cardiac mass. Their responsibility has been proved by local thermo-ablation eliminating the arrhythmia.
The identification of the vulnerable subjects is the fundamental problem in the reduction of this pathology, and a major scientific challenge.
Role of Structural (MRI) and Functional Imaging
In the current era, non-invasive diagnostic tools have improved patient-care by providing valuable and unprecedented guidance in the therapeutic management of several cardiac and non-cardiac disorders. Many of these modalities have replaced the invasive imaging techniques as gold standards (eg. MRI or CT have largely replaced cardiac catheterization in congenital heart problems).
Cardiac MRI not only provides the information at the organ level but also at the myocardial tissue level. Delayed enhancement of the myocardium with gadolinium has been shown to represent electrically silent fibrotic tissue laid into the interstitial platform holding the syncytia of electrically active atrial and ventricular cells. The tissue structure information like myocardial scar and fibrosis can thus be imaged non-invasively, today.
More recently, a novel use of diffusion MR called track density imaging has been able to reveal the 3D arrangement of fibres within the ventricular syncytium and differentiate healthy muscle fibres (long continuous strands) from those surviving within the scar or at its borderzone (broken strands). The later are considered to form an arrhythmogenic substrate and generate the so called ‘late potentials' during sinus rhythm. Thus, they are very valuable targets of VT ablation.
Non invasive mapping: Besides non-invasive structural imaging of the heart tissue, the imaging of normal and abnormal cardiac bioelectric function can also be accomplished, non-invasively. After several decades of ongoing research, electrocardiographic mapping (ECM), a novel three dimensional, 252-lead, body surface ECG based tool has been developed as a non-invasive epicardial imaging modality. This technique images potentials, electrograms and activation sequences (isochrones) on the epicardial surface of the heart. This tool has been investigated in the normal cardiac electrophysiology and various tachyarrhythmic, conduction and anomalous depo-repolarization disorders. It has been emerging as a tool of substantially higher clinical value than the 12-lead ECG providing better sensitivity, specificity and accuracy in the management of cardiac rhythm disorders.
Modeling based on integration of multiple parameters in realistic models (based on human data) will provide further understanding and therapeutic directions.