The Future of Surgery: Transforming Operating Theatres with AI

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This post is based on the presentation on this topic by AI expert Dr. Giota Antonakaki.

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As the world faces an increasing shortage of skilled surgeons and the growing complexity of surgical procedures, the demand for innovative solutions has never been greater. The introduction of AI into surgical theatres offers a transformative potential that could redefine the future of surgery.

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Addressing the Shortage of Surgeons

One of the most pressing issues facing healthcare today is the shortage of surgeons. According to a report by the American Association of Medical Colleges, by 2036, the United States alone could face a shortage of 10,000 to 20,000 surgeons across various specialties. This shortage is not merely a result of insufficient medical school graduates; it is compounded by the lengthy and costly education required to become a surgeon. A surgeon's journey from medical school to independent practice can span more than a decade, encompassing rigorous training and years of hands-on experience.

This shortage of surgeons has far-reaching implications. Overcrowded and overburdened surgical theatres lead to inefficiencies and increase the likelihood of errors. However, many tasks within the surgical environment are repetitive and mundane, such as passing instruments, monitoring vital signs, and maintaining a sterile environment. These are precisely the tasks that can be optimised through the integration of AI.

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The Rise of Robotic Assistance in Surgery

Robotic assistance in surgery is not a new concept. As early as 1985, medical computer scientists began experimenting with converting industrial robots into surgical devices. Today, surgical robots are commonplace in operating theatres around the world. They assist in a wide range of operations, from general surgery to specialised oncological procedures.

One of the most well-known examples of surgical robotics is the Da Vinci surgical system, which gained fame for its precision by delicately stitching a grape. More recently, Sony's microsurgery assistant robot has garnered attention for its ability to enable surgeons to operate on a scale up to one-tenth the size achievable by the human hand. These robotic systems are designed to augment human capabilities, improving precision, increasing endurance, and reducing the risk of errors due to hand tremors.

The idea of using robots for medical purposes originated with the US Defence Advanced Research Projects Agency (DARPA) in the 1990s. Although the communication networks of that time were not advanced enough to fully realise the concept, today, robotic systems are increasingly used for remote surgeries. A notable example occurred in 2014 when a surgeon in Canada performed a precise operation on a patient in another part of the country using a remotely controlled robot.

Robotic assistance is now becoming the norm rather than the exception in many surgical procedures. Energy delivery robots are transforming cancer treatment by using predefined treatment plans to deliver focused energy that destroys tumours within the body. Similarly, orthopaedic and dental implant robots act as assistive guides, ensuring that human actions align with pre-operational digital plans, thereby avoiding deviations that could lead to suboptimal treatment.

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Enhancing AI Capabilities in Surgery

The integration of AI into surgical procedures has the potential to significantly enhance surgical precision, reduce errors, and optimise patient recovery. However, one of the key challenges in realising this potential is data acquisition. AI systems require vast amounts of high-quality, complex data to be effectively trained. In the highly regulated field of healthcare, data acquisition is often hindered by concerns about patient trust, safety, privacy, and informed consent.

Robust data governance is crucial for successful data acquisition and the wider adoption of AI in surgery. A recent success story in this domain involved a collaboration between Deeper Insights and Smith and Nephew. Despite challenges such as a lack of annotated data, data complexity, and strict acquisition protocols, Deeper Insights successfully developed a trained AI model to enhance knee replacement surgeries. This achievement demonstrates that overcoming data-related challenges is possible and paves the way for broader AI adoption in the surgical field.

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The Future of AI in Operating Theatres

Looking to the future, the potential of AI in surgery extends far beyond the current capabilities of robotic assistance. Imagine an AI system that functions as the brain of the entire operating theatre, orchestrating every aspect of the surgical process like a master conductor. Although this technology is not yet fully realised, advancements in AI and large language models could eventually make it possible.

This overarching AI system could manage nearly every aspect of surgery, from confirming patient identity using biometrics to cross-referencing medication allergies, thoroughly scanning patient records, summarising medical histories, and assisting in formulating pre-operative plans. During surgery, the AI could control task-specific robots to perform routine tasks and even provide real-time consultation to assist surgeons in overcoming emergencies more quickly and safely. All of this would be facilitated through natural language interfaces and enhanced human-robot interaction.

Autonomous agents, a concept that is gaining traction in AI development, could also play a significant role in the future of surgery. These agents are capable of acting independently to achieve specific goals, using powerful language models to understand questions, make decisions, and choose the appropriate tools for the task at hand. Autonomous agents could perform repetitive tasks with consistent accuracy, ensuring that these tasks are completed efficiently and reliably.

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Challenges and Ethical Considerations

While the future of AI in surgery is promising, significant challenges remain. Data acquisition and privacy concerns, algorithmic biases that could influence the treatment of different minority groups, and the generation of irrelevant or inconsistent content are just a few of the hurdles that must be overcome. Additionally, there is the potential for serious harm if these technologies are not integrated responsibly into surgical systems.

To address these challenges, it is crucial to implement practices that ensure the responsible use of AI in surgery. This includes clearly defining the problem that needs to be solved and the goals that need to be met before deciding on the solution and the tools to be used. Protecting sensitive patient information with cutting-edge encryption, anonymisation, and secure storage solutions is essential. AI systems must comply with legal and regulatory requirements, and their decisions must be explainable and transparent.

Safety protocols and fail-safe mechanisms should be in place to help AI systems handle errors or anomalies safely. Extensive testing and validation are necessary to meet safety and performance standards and to identify potential issues before deployment. Medical professionals should have the ability to override AI decisions to prevent potential harm and ensure patient safety. Regular monitoring of AI systems for performance and biases is also critical to maintaining fairness and accuracy over time.

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Final Thoughts

As the world moves towards a future where AI plays an increasingly central role in surgery, the potential benefits are immense. AI-powered operating theatres could transform the surgical landscape, empowering surgeons to perform their tasks more efficiently and with greater precision. Overcrowded theatres could become a thing of the past as AI-enhanced systems streamline procedures and improve patient outcomes.

The journey towards this new era in surgery is still underway, and many challenges remain to be addressed. However, each step forward brings us closer to a world where surgeries are safer, operations are more efficient, and patient care is harmonious. AI-powered surgical systems are not just a dream but a reality within reach.