Last year, an unmanned machine observed for 17 hours worth of surgical footage before successfully removing the gallbladder by itself. The event was a breakthrough, marking the first step towards a more prominent role of AI technology within the operating room—and not as an assistant. However, what makes it a breakthrough, and why does AI have anything to do with surgeries but the act of slicing?
For most people, a surgery doesn't even begin with the first cut or end when the patient leaves the operating room after being stitched back together. Rather, it may start with a painful knee joint, a fall, or worse still—a radiology result. This is followed by a whole host of decisions: whether to go for surgery at all, whom to choose to perform the procedure on oneself, etc. Furthermore, there is a period following recovery characterized by physical treatment, scars and the aggravating featherline of healing. This is where AI can revolutionize the process of conducting surgery.
As has been established in a large number of other fields of medicine, AI has already started affecting patient care. Almost 80 percent of the nation's physicians report using artificial intelligence as a tool that assists in diagnosing, determining the proper drug dosage, dictating notes and interpreting medical scans and tests. Other new technologies help clinicians to make decisions on practical questions, automate administrative tasks and summarize information.
The situation for surgery is different.
Over 4 million people die within a month of surgery every year. Post-surgery mortality remains the number one cause of death around the world. Pre-surgery complications may arise from factors such as high glucose level, lack of proper nutrition, or too much stress and anxiety. Complications during the lengthy period of recovery may occur when, for example, physical therapy appointments are missed or discharge instructions go unread. AI capable of supporting both patients and professionals throughout the process will have greater value for surgeons than anything ever designed to assist them in the operating theater.
Fortunately, we are starting to witness the benefits of artificial intelligence in addressing such problems. Algorithms are already available to identify those patients who are most vulnerable to developing complications during the operation. Another piece of AI technology is able to monitor the speed of movement in the weeks following hip or knee replacement surgery and notify a patient's physician if their recovery process falls behind schedule. More than 2 million robotic-assisted operations are done annually in the United States alone, while AI-driven simulators are revolutionizing the education process of future surgeons.
We can come up with many uses for AI within this field. Our number-one request would be an AI system helping to choose the right surgeon and procedure and giving objective guidance on their advantages and disadvantages. Other tools of AI might be used to make the experience less stressful for a patient and provide conversational assistance both before and after the surgery. Surgery is a procedure of long-term impact and great physical exertion, not to mention being irreversible. Its results will depend upon caregivers, physical therapists, case managers, home-health aides, and even the patient themselves.
However, we need to proceed cautiously. According to a 2024 study, AI suggested different types of testing depending on the race and gender of patients. In surgery, such a bias means more than differences in diagnostic procedures – it determines the patients who will be eligible for surgery in the first place, which kind of surgery will be proposed, the extent of follow-up, and whether patients will recover independently or not.
Of course, there are still many other issues to consider. In case an AI software makes a mistake, who is accountable for it? Currently, AI is capable of observing the performance and skills of surgeons working remotely via robotic surgeries; however, should that information be released publicly? What does the increased use of AI mean for future generations of surgeons when most of the tasks are delegated to machines?
Engineers and healthcare organizations developing the next-generation surgical AI should avoid focusing solely on the obvious, i.e., the ability of the device to perform autonomous robotic surgery. Another task that requires much attention is the period of time before and after surgeries. Even preventing a third of current complications would save thousands of lives and billions of dollars.
However, the next revolution of AI in surgery may not be as sensational as the previous one, involving robots performing surgery. In this case, it will be the patients who prevent complications during surgery or those who have completed their therapy due to their application detecting problems. If you multiply this by 300 million operations per year, then it becomes obvious where the future is lying.
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