New trends in digestive surgery Guillaume Meurette, Emmanuel coron

A history of surgery

Ambroise Paré

Surgeon of the village (XVIIth)

A practice based on experience and pragmatism

Lesson of Pr Velpeau (XIXth)

Nowadays…

What has changed ?

The patient

Improvement in medical care « Surgery is a step in the medical history»

Preoperative explorations

Technology And Devices

Improvement in postoperative management (Fast-track programs)

Future direction

• Teaching and training surgery • Development of new devices to

decrease invasiveness – transanal endoscopic microsurgery – Robotic-assisted surgery

• Improve the tools involved into diagnosis and gut exploration – Confocal Endomicroscopy

Mantoo et al. Colorectal Dis 2013 Wong et al. Dis colon Rectum 2011

An example: The TEM

Pre-clinical model as a new tool to overcome challenges

• LGA: porcine plateform

SNS in experimental colitis Methods:

1. Endoscopic and confocal endomicroscopy and

histology

1. Functional approach of the barrier: Permeability and motricity

Bregeon J, Cordeiro A personal data

SNS in experimental colitis 0.09

T0 SHAM – T24H SNS – T24H

Endoscopy

T0

SH

AM

T

24H

S

NS

T2

4H

* *

Endomicroscopy

Bregeon J, Cordeiro A personal data

Conclusion

• Future management in gut diseases is – Bright – Targetting lesions – Adapted to each case – Curing sickness – Saving function