3D-Surg Project: The operating theatre of the future

National Scale

As part of the second phase of the Nouvelle France industrielle (New Industrial France), Marisol Touraine, French Minister for Social Affairs, Health and Women's Rights, Emmanuel Macron, French Minister for the Economy, Industry and Digital Affairs, and Axelle Lemaire, Secretary of State for Digital Affairs, defined three priorities for the future of medicine: medical biotechnology, medical devices and new health equipment, and digital health. With regard to medical devices and new health equipment, and the objective of bringing together leaders (large and medium-sized industrial groups) and SMEs, innovative projects were launched in 2015, such as HECAM (cancerology), Sight Again (eyesight) and 3D Surg (3D assistance for minimally invasive digestive tract surgery).

The 3D Surg project, with funding from Bpifrance, aims to design and industrialise the operating theatre of the future. The idea is to provide the surgical team, in the operating theatre, with tools to visualise the extensive medical data at their disposal: 3D visualisation of the patient, pre-op planning, visualisation and interaction during the operation, augmented reality aided surgery.

Centrale Nantes at the heart of research into medicine of the future

Centrale Nantes is one of the partners involved in this project. Professor Francisco Chinesta, internationally recognised for his research work, and Domenico Borzacchiello, research engineer, are working on the project in collaboration with IHU Strasbourg, one of the six centres of excellence in France, and with the initiator of the project, IRCAD (Research Institute against Digestive Cancer), world leader in minimally invasive surgical training.

As early as 2001, IRCAD outstripped science fiction with a world first: a long-distance surgical operation undertaken by a surgeon in New York on a patient in Strasbourg. It was the first time in surgical history that distance-related transmission delays were managed to make such an operation possible. Today's goal is to go even further.
 
It's one thing for a surgeon to see what's happening and to take action, but it's quite another for him/her to feel' the movement made. In order to reduce the risk associated with hasty movements to a strict minimum, Francisco Chinesta and Domenico Borzacchiello are developing solutions to allow surgeons to match what they see on the screen with what they feel in their hands. In other words, to create a realistic force feedback. Thus, the computer image must behave in the same way as the patient and account for organ distortion (during breathing for example). Given that the acceptable margin of error is 2 millimetres and that predictions have to be made in 0.2 seconds, this implies the capacity to solve complex problems of non-linear deformable solids no less than 500 times per second. This would require calculation methods which are hard to conceive of when the aim is to widen the use of such techniques. It is thus necessary to make very precise calculations in real time on very light computing platforms (embedded systems).

This raises the following question: how can this be done well, quickly and economically? The completely new numerical techniques developed by the Centrale Nantes team, based on model reduction techniques and Proper Generalized Decomposition charts, allow for the development of light-weight simulators which combine efficiency, performance and accuracy.

Another challenge: the tablet.
What is the advantage of a tablet compared to a computer? The answer lies in digital manipulation - a skill well-mastered by surgeons - and easy sterilisation. Domenico Borzacchiello is working on whether such simulations are possible on a tablet, with the same objective of helping surgeons to prepare their operations.