Translator: Soraya Phitidis Reviewer: Els De Keyser
Hello everyone, thank you Magalie.
So, indeed I'm going to try to give you a speech about the evolution of surgery,
from its origins until the development of robotics, in other words until today.
Actually I think I need to let someone know.
I don't know where it's coming from but,
I have light shining in my eyes...
I don't know who is in charge....
ah it's okay, perfect.
Alright, so what is surgery?
Surgery consists of all the manipulations
performed on the human body for therapeutic purposes.
For many years, for a very long time actually,
the effectiveness of surgery was limited
by a number of very precise factors.
The first is, the lack of understanding of our anatomy.
Without understanding of the functions of the human body,
people had no reason to concentrate on vital organs
but instead, tended to concentrate their efforts
on peripheral organs and on wounds.
This is therefore the first limiting element.
The second limitation, for a very long time
was hemorrhage,
which has been the cause of many, many deaths ;
as soon as any type of surgical procedure was performed on a patient,
they would start to bleed out.
The phenomenon of blood coagulation was observed very early on,
but we actually had to wait until the 20th century
to truly start to understand hemostasis
and improve problems in that area.
The third element which has been limiting for a very long time
is simply, pain.
You can imagine that patients, centuries ago,
would twitch and convulse during surgery.
These reflexes are completely natural,
but they posed a problem when trying to
perform surgery with precision.
Last but not least,
another limiting factor was infection,
which also caused many deaths.
We had to wait for the advent of Louis Pasteur
whose knowledge about microbes eventually will lead to the discovery of
what we today call, sepsis.
All of these phenomena limited surgery
and it is the improvement of the management of these issues
which enabled surgery to advance.
Fossilized skeleton parts give evidence of surgery
performed in the neolithic period,
a very long time ago.
When observing the wounds and in particular, the edges,
the scarring suggests that patients survived these acts
despite the size of these craniotomies which can be seen on the picture.
The rustic conditions that we can imagine,
imply that from the very beginning
we were able to have very precise tools and gestures.
We're often surprised when we look at tools used in that period.
They look quite modern, even if they are extremely old.
Today, we developed extremely precise tools
which enable us to further secure surgery,
to make accurate diagnoses.
We can say that we have entered
the era of modern surgery.
We could even call it the digitization of surgery.
Surgical robotics, which appeared in the 90's
have been and are still considered like the future of surgery.
It's not the future of surgery, it's today's surgery,
because in many surgical specializations,
robotic tools are as essential as standard tools.
It is the case in prostate surgery for example.
Thanks to these tools, in certain cases
the surgeon doesn't need to be physically present.
We had quite an interesting surgery in September 2001,
some time before the infamous event.
We had a surgeon, professor Marescaux, who was in New York
and remotely operated on a patient who was in Strasbourg.
So we are starting to enter an era
in which surgical robotics are able
to offer us renewed precision as well as renewed security.
To illustrate all this
I suggest we look at a very specific example.
Since we have been revolving around the brain, it's perfect.
I suggest we look at Parkinson's disease,
it's most famous patient being Michael J. Fox,
as this disease illustrates how technology
and knowledge of anatomy
were able to improve the ways in which patients are treated.
This resulted in something quite spectacular,
which you will see in just a few minutes.
Parkinson's disease is a neurodegenerative disease
of the central nervous system.
It is one of the diseases which the preceding speaker was referring to,
which are the types of diseases we'll see devolop in a sizeable way
particularly due to the ageing populations.
Parkinson's disease is the second most important neurodegenerative disease
the first being Alzheimer's.
The point is that even current research
will eventually help us understand,
the truth is that today very little is known
about the causes and functions of Parkinson's disease.
That's why we're not yet able to cure Parkinson's disease.
We are however able to treat the symptoms of the disease
which evidently, are disabling and debilitating for the patient.
There is a technique which can be applied in such cases,
it's a surgical procedure called deep cerebral stimulation.
It consists of implanting micro electrodes
in very precise areas of the brain
and send electrical impulses at a very high frequency
to an area that is slightly larger than a pea.
This will inhibit the areas of the brain
which are responsible for tremors and stiffness, etc.
This deep cerebral stimulation technique was invented by a Frenchman
at the end of the 80's, Professor Alim-Louis Benabid.
He is a world renowned surgeon.
The technique was developed at the C.H.U Grenoble,
here in France.
It is now a technique which is used worldwide,
and is increasingly applied by various centers in the world.
The functions I've described for this technique
are similar to the functions of pacemakers.
The mini electrodes are linked to a stimulator
which is implanted under the patient's skin.
So, rather than continuing a long speech, I suggest we now watch a video.
I'd like to inform you, there won't be too much blood on screen,
I tried to ensure it but if anyone feels unwell
please let me know and we can stop the video immediately.
Here we have a patient, before surgery,who is suffering
from a relatively severe form of Parkinson's disease,
he has difficulty moving
and as I was explaining earlier,
the surgical procedure will serve to implant electrodes
in very precise areas of the brain.
These electrodes are connected to stimulators under the skin.
Here we have the same patient post surgery,
we can clearly see that one of his hands,
I don't remember which one, is shaking.
And now the neurophysiologist is going to activate one of the stimulators,
which, as you can see, causes the tremor in his right hand to stop.
Next, the doctor will activate the second stimulator,
Though it is now less common nowadays,
there used to be two stimulators, one for each electrode.
So to recap, the neurophysiologist activates the first stimulator,
then the second, and as you can see, it's almost like magic.
The patient, who, only minutes before, could hardly move,
can suddenly stand up, walk around, even does a dance.
This procedure is truly spectacular.
It almost has an ''on/off'' approach,
in the sense that its full benefits
can be activated or deactivated.
I take this opportunity to mention that,
this deep cerebral stimulation procedure
has been applied to treat other conditions,
such as Dystonia and also for obsessive-compulsive disorders.
The progress of such surgical procedures,
as well as the development
of modern tools today, greatly contribute
to achieve this kind of procedures,
starting with imaging.
Medical imaging, high definition MRI imaging,
which, today, allows us to accurately identify the areas
which are potentially responsible for the tremors.
This progress continues with the use of medical robotics,
in particular, the ROSA robot, which is used to place
a very precise guide in order to achieve a specific path,
which was previously planned with the help of a computer.
This will enable the surgeon to place the electrodes.
It is a very impressive and interesting surgery.
It is a so-called 'awake brain surgery',
meaning that the patient is awake during the procedure.
This is very impressive. The patient has various elements implanted in his skull.
Then the electrodes are stimulated at different intensities
and we can observe the patient's reactions.
This allows us to fine tune perfectly to each patient's needs --
this is unique to each patient --
and find the right adjusment
which will permanently stop the patient's tremors.
Thank you very much.
(Applause)