Artificial Intelligence Surgery: How Do We Get to Autonomous Actions in Surgery?

Abstract

Most surgeons are skeptical as to the feasibility of autonomous actions in surgery. Interestingly, many examples of autonomous actions already exist and have been around for years. Since the beginning of this millennium, the field of artificial intelligence (AI) has grown exponentially with the development of machine learning (ML), deep learning (DL), computer vision (CV) and natural language processing (NLP). All of these facets of AI will be fundamental to the development of more autonomous actions in surgery, unfortunately, only a limited number of surgeons have or seek expertise in this rapidly evolving field. As opposed to AI in medicine, AI surgery (AIS) involves autonomous movements. Fortuitously, as the field of robotics in surgery has improved, more surgeons are becoming interested in technology and the potential of autonomous actions in procedures such as interventional radiology, endoscopy and surgery. The lack of haptics, or the sensation of touch, has hindered the wider adoption of robotics by many surgeons; however, now that the true potential of robotics can be comprehended, the embracing of AI by the surgical community is more important than ever before. Although current complete surgical systems are mainly only examples of tele-manipulation, for surgeons to get to more autonomously functioning robots, haptics is perhaps not the most important aspect. If the goal is for robots to ultimately become more and more independent, perhaps research should not focus on the concept of haptics as it is perceived by humans, and the focus should be on haptics as it is perceived by robots/computers. This article will discuss aspects of ML, DL, CV and NLP as they pertain to the modern practice of surgery, with a focus on current AI issues and advances that will enable us to get to more autonomous actions in surgery. Ultimately, there may be a paradigm shift that needs to occur in the surgical community as more surgeons with expertise in AI may be needed to fully unlock the potential of AIS in a safe, efficacious and timely manner.

Knowledge, Attitude and Practice of ARtificial Intelligence in Emergency and Trauma Surgery, the ARIES Project: An international web-based survey

“…Several studies have shown that robotic surgery is safe and feasible in the emergency setting. The main obstacle to its adoption is the lack of training and accessibility [15][16][17]. The current study clearly shows that trauma and acute care surgeons are enthusiasts and supportive of the use of AI in their clinical practice.…”

Knowledge, attitude, and practice of artificial intelligence in emergency and trauma surgery, the ARIES project: an international web-based survey

“…Several studies have shown that robotic surgery is safe and feasible in the emergency setting. The main obstacle to its adoption is the lack of training and accessibility [ 15 – 17 ]. The current study clearly shows that trauma and acute care surgeons are enthusiasts and supportive of the use of AI in their clinical practice.…”

The Advances in Computer Vision That Are Enabling More Autonomous Actions in Surgery: A Systematic Review of the Literature

“…Although robots and computers may be able to effectively "see" through traditional concepts of CV such as instrument priors and motion analysis to create the third dimension, non-visual data points such as the interpretation of audio signals and light intensity readings may also be used. This review is a follow-up to a previously published article that, in addition to CV, also expanded upon the other pillars of AI such as machine learning (ML), deep learning (DP) and natural language processing as they pertain to autonomous actions in surgery [3].…”