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White paper: ethics and trustworthiness of artificial intelligence in clinical surgery 白皮书:人工智能在临床手术中的伦理与可信度
Pub Date : 2023-01-01 DOI: 10.20517/ais.2023.04
G. Capelli, Daunia Verdi, I. Frigerio, Niki Rashidian, Antonella Ficorilli, Vincent Grasso, D. Majidi, ANDREW GUMBS, G. Spolverato
This white paper documents the consensus opinion of the Artificial Intelligence Surgery (AIS) task force on Artificial Intelligence (AI) Ethics and the AIS Editorial Board Study Group on Ethics on the ethical considerations and current trustworthiness of artificial intelligence and autonomous actions in surgery. The ethics were divided into 6 topics defined by the Task Force: Reliability of robotic and AI systems; Respect for privacy and sensitive data; Use of complete and representative (i.e., unbiased) data; Transparencies and uncertainties in AI; Fairness: are we exacerbating inequalities in access to healthcare?; Technology as an equalizer in surgical education. Task Force members were asked to research a topic, draft a section, and come up with several potential consensus statements. These were voted on by members of the Task Force and the Study Group, and all proposals that received > 75 % agreement were adopted and included in the White Paper.
本白皮书记录了人工智能外科(AIS)人工智能(AI)伦理工作组和AIS编辑委员会伦理研究小组关于人工智能和手术自主行为的伦理考虑和当前可信度的共识意见。伦理被分为6个主题,由工作组定义:机器人和人工智能系统的可靠性;尊重私隐及敏感资料;使用完整和具有代表性(即无偏)的数据;人工智能的透明度和不确定性;公平:我们是否加剧了获得医疗服务的不平等?技术在外科教育中的平衡作用。工作组成员被要求研究一个主题,起草一个章节,并提出几个潜在的共识声明。这些建议由工作组和研究小组的成员投票表决,所有获得75%以上同意的建议被采纳并纳入白皮书。
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引用次数: 2
Introduction to AI-driven surgical robots 介绍人工智能驱动的手术机器人
Pub Date : 2023-01-01 DOI: 10.20517/ais.2023.14
Z. Nawrat
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引用次数: 1
Machine learning for prediction of postoperative complications after hepato-biliary and pancreatic surgery 机器学习在肝胆胰手术后并发症预测中的应用
Pub Date : 2023-01-01 DOI: 10.20517/ais.2022.31
I. Shapey, Mustafa Sultan
Machine Learning (ML) relates to the use of computer-derived algorithms and systems to enhance knowledge in order to facilitate decision making. In surgery, ML has the potential to shape clinical decision making and the management of postoperative complications in three ways: (a) by using the predicted probability of postoperative complications or survival to determine and guide optimal treatment; (b) by identifying anomalous data and patterns representing high-risk physiological states during the perioperative period and taking measures to minimise the impact of the existing risks; (c) to facilitate post-hoc identification of physiological trends, phenotypic patient characteristics, morphological characteristics of diseases, and human factors that may help alert surgeons to relevant risk factors in future patients. The accuracy, validity and integrity of data that are input into ML predictive models are central to its future success. ML could reduce errors by drawing attention to known risks of complications through supervised learning, and gain greater insights by identifying previously under-appreciated aspects of care through unsupervised learning. The success of ML in enhancing patient care will be determined by the human potential to incorporate data science techniques into daily clinical practice.
机器学习(ML)涉及使用计算机派生的算法和系统来增强知识,以促进决策。在手术中,机器学习有可能通过三种方式影响临床决策和术后并发症的管理:(a)通过预测术后并发症或生存的概率来确定和指导最佳治疗;(b)识别围手术期高危生理状态的异常数据和模式,并采取措施尽量减少现有风险的影响;(c)方便事后识别生理趋势、病人的表型特征、疾病的形态学特征,以及可能有助于提醒外科医生注意未来病人的相关风险因素的人为因素。输入到机器学习预测模型中的数据的准确性、有效性和完整性是其未来成功的关键。机器学习可以通过监督学习来引起对已知并发症风险的关注,从而减少错误,并通过无监督学习来识别以前被低估的护理方面,从而获得更大的见解。机器学习在增强患者护理方面的成功将取决于人类将数据科学技术纳入日常临床实践的潜力。
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引用次数: 0
Potential of artificial intelligence in the risk stratification for and early detection of pancreatic cancer. 人工智能在胰腺癌风险分层和早期检测中的潜力。
Pub Date : 2023-01-01 Epub Date: 2023-03-20 DOI: 10.20517/ais.2022.38
Daniela R Tovar, Michael H Rosenthal, Anirban Maitra, Eugene J Koay

Pancreatic ductal adenocarcinoma (PDAC) is the third most lethal cancer in the United States, with a 5-year life expectancy of 11%. Most symptoms manifest at an advanced stage of the disease when surgery is no longer appropriate. The dire prognosis of PDAC warrants new strategies to improve the outcomes of patients, and early detection has garnered significant attention. However, early detection of PDAC is most often incidental, emphasizing the importance of developing new early detection screening strategies. Due to the low incidence of the disease in the general population, much of the focus for screening has turned to individuals at high risk of PDAC. This enriches the screening population and balances the risks associated with pancreas interventions. The cancers that are found in these high-risk individuals by MRI and/or EUS screening show favorable 73% 5-year overall survival. Even with the emphasis on screening in enriched high-risk populations, only a minority of incident cancers are detected this way. One strategy to improve early detection outcomes is to integrate artificial intelligence (AI) into biomarker discovery and risk models. This expert review summarizes recent publications that have developed AI algorithms for the applications of risk stratification of PDAC using radiomics and electronic health records. Furthermore, this review illustrates the current uses of radiomics and biomarkers in AI for early detection of PDAC. Finally, various challenges and potential solutions are highlighted regarding the use of AI in medicine for early detection purposes.

胰腺导管腺癌(PDAC)是美国致死率第三高的癌症,5 年预期寿命仅为 11%。大多数症状出现在疾病晚期,此时手术已不再合适。PDAC 的预后十分严重,因此需要采取新的策略来改善患者的预后,而早期检测已引起人们的极大关注。然而,PDAC 的早期发现往往是偶然的,这就强调了制定新的早期发现筛查策略的重要性。由于该病在普通人群中的发病率较低,筛查的重点主要转向 PDAC 的高危人群。这既丰富了筛查人群,又平衡了与胰腺干预相关的风险。通过 MRI 和/或 EUS 筛查在这些高危人群中发现的癌症显示出 73% 的 5 年总生存率。即使强调在富集的高危人群中进行筛查,通过这种方式发现的偶发癌症也只占少数。改善早期检测结果的策略之一是将人工智能(AI)整合到生物标记物发现和风险模型中。本专家综述总结了最近发表的利用放射组学和电子健康记录开发人工智能算法用于 PDAC 风险分层的文章。此外,本综述还说明了目前在人工智能中使用放射组学和生物标记物进行 PDAC 早期检测的情况。最后,重点介绍了在医学中使用人工智能进行早期检测所面临的各种挑战和潜在解决方案。
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引用次数: 0
Applying artificial intelligence to big data in hepatopancreatic and biliary surgery: a scoping review 人工智能在肝胆外科大数据中的应用综述
Pub Date : 2023-01-01 DOI: 10.20517/ais.2022.39
Kieran G. McGivern, T. Drake, S. Knight, J. Lucocq, M. Bernabeu, Neil Clark, C. Fairfield, R. Pius, Catherine A Shaw, S. Seth, E. Harrison, M. Prof.Ewen, Harrison, H. Pitt, ANDREW GUMBS
Aim: Artificial Intelligence (AI) and its applications in healthcare are rapidly developing. The healthcare industry generates ever-increasing volumes of data that should be used to improve patient care. This review aims to examine the use of AI and its applications in hepatopancreatic and biliary (HPB) surgery, highlighting studies leveraging large datasets. Methods: A PRISMA-ScR compliant scoping review using Medline and Google Scholar databases was performed (5th August 2022). Studies focusing on the development and application of AI to HPB surgery were eligible for inclusion. We undertook a conceptual mapping exercise to identify key areas where AI is under active development for use in HPB surgery. We considered studies and concepts in the context of patient pathways - before surgery (including diagnostics), around the time of surgery (supporting interventions) and after surgery (including prognostication). Results: 98 studies were included. Most studies were performed in China or the USA (n = 45). Liver surgery was the most common area studied (n = 51). Research into AI in HPB surgery has increased rapidly in recent years, with almost two-thirds published since 2019 (61/98). Of these studies, 11 have focused on using “big data” to develop and apply AI models. Nine of these studies came from the USA and nearly all focused on the application of Natural Language Processing. We identified several critical conceptual areas where AI is under active development, including improving preoperative optimization, image guidance and sensor fusion-assisted surgery, surgical planning and simulation, natural language processing of clinical reports for deep phenotyping and prediction, and image-based machine learning. Conclusion: Applications of AI in HPB surgery primarily focus on image analysis and computer vision to address diagnostic and prognostic uncertainties. Virtual 3D and augmented reality models to support complex HPB interventions are also under active development and likely to be used in surgical planning and education. In addition, natural language processing may be helpful in the annotation and phenotyping of disease, leading to new scientific insights.
目的:人工智能(AI)及其在医疗保健领域的应用正在迅速发展。医疗保健行业产生的数据量不断增加,这些数据应用于改善患者护理。本综述旨在研究人工智能及其在肝胆外科(HPB)手术中的应用,重点介绍利用大数据集的研究。方法:使用Medline和谷歌Scholar数据库进行符合PRISMA-ScR标准的范围审查(2022年8月5日)。关注人工智能在HPB手术中的发展和应用的研究符合纳入标准。我们进行了概念映射练习,以确定人工智能正在积极开发用于HPB手术的关键领域。我们考虑了患者路径背景下的研究和概念——术前(包括诊断)、手术前后(支持干预)和术后(包括预后)。结果:共纳入98项研究。大多数研究在中国或美国进行(n = 45)。肝脏手术是最常见的研究领域(n = 51)。近年来,人工智能在HPB手术中的研究迅速增加,近三分之二的研究自2019年以来发表(61/98)。在这些研究中,有11项研究侧重于利用“大数据”开发和应用人工智能模型。其中9项研究来自美国,几乎都集中在自然语言处理的应用上。我们确定了人工智能正在积极发展的几个关键概念领域,包括改进术前优化,图像引导和传感器融合辅助手术,手术计划和模拟,用于深度表型和预测的临床报告的自然语言处理,以及基于图像的机器学习。结论:人工智能在HPB手术中的应用主要集中在图像分析和计算机视觉方面,以解决诊断和预后的不确定性。支持复杂HPB干预的虚拟3D和增强现实模型也在积极开发中,可能用于手术计划和教育。此外,自然语言处理可能有助于疾病的注释和表型,从而产生新的科学见解。
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引用次数: 1
Artificial intelligence for equity 公平的人工智能
Pub Date : 2023-01-01 DOI: 10.20517/ais.2023.22
I. Frigerio, Niki Rashidian
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引用次数: 0
Robotic Pancreatoduodenectomy - how I do it: tips, tricks and pitfalls to standardize the technique to reduce postoperative morbidity and mortality 机器人胰十二指肠切除术-我是怎么做的:技巧,技巧和陷阱标准化的技术,以减少术后发病率和死亡率
Pub Date : 2023-01-01 DOI: 10.20517/ais.2023.03
L. Jiao, R. Vellaisamy, T. Gall
benefits of minimally invasive surgery and equivalent oncological outcomes compared with conventional open PD (OPD). When LPD and RPD are compared, RPD offers better precision with 3D vision and advanced instrumentation. Although the learning curve for RPD is long with a longer operating time compared with OPD, this can be reduced to a duration similar to that for OPD through standardization of techniques and case numbers.Perioperative outcomes such as length of stay, blood loss, and transfusion requirement are significantly improved compared to OPD and fewer cases require conversion to open than LPD. In this article, we describe our approach to RPD through standardizing PD techniques along with tips and tricks for the benefit of surgeons interested in learning robotic pancreatic surgery.
与传统的开放式PD (OPD)相比,微创手术的益处和等效的肿瘤预后。当LPD和RPD进行比较时,RPD具有更高的3D视觉精度和先进的仪器。尽管与OPD相比,RPD的学习曲线很长,操作时间也更长,但通过技术和病例数的标准化,可以将其缩短到与OPD相似的持续时间。围手术期预后,如住院时间、出血量和输血需求,与OPD相比有显著改善,并且需要转开的病例比LPD少。在这篇文章中,我们通过标准化PD技术以及对学习机器人胰腺手术感兴趣的外科医生的提示和技巧来描述我们的RPD方法。
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引用次数: 0
Women surgeons fighting for work-life balance: how technology might help close the gender gap 女外科医生为工作与生活的平衡而战:科技如何帮助缩小性别差距
Pub Date : 2023-01-01 DOI: 10.20517/ais.2022.40
G. Capelli, Dajana Glavas, L. Ferrari, Daunia Verdi, G. Spolverato
Despite a growing number of women choosing to pursue surgical specialties, surgery is still perceived as a woman-unfriendly career. The difficulties of conciliating a demanding career with the requirements of both personal and family life for women surgeons have been investigated by several authors. The current study aims to summarize existing evidence on the issue of work-life balance for women surgeons, particularly focusing on possible strategies to improve it. Artificial intelligence (AI) has been investigated as a possible means to close the gender gap, acting as an equalizer for women surgeons. Female surgeons have been reported to be unmarried or to have married later in life at a higher rate than their male colleagues; many of them also choose not to have children or to have fewer and to have them later in life. These disparities are partly due to the issues connected to invisible work (e.g. household management), the difficulties of managing pregnancy during surgical residency, the challenges women face when returning to work following maternity leave, and the lack of a supportive environment. Flexible work schedules, implementation of childcare facilities, introduction and encouragement of paternity leave for surgeons, and enforcement of mentorship and sponsorship for female surgeons are some of the proposed solutions for building a fair and equitable work culture for all surgeons and overthrowing old, conventional ideas concerning gender roles. Moreover, technology has been advocated as a possible solution to gender discrimination in surgical departments; technology could facilitate an objective assessment of surgical performances and advanced training for surgeons unable to attend in-person education. A healthy, thriving, organized, supportive, and culturally transformed work environment could benefit surgeon and staff productivity and ultimately improve patient care.
尽管越来越多的女性选择从事外科专业,但外科仍然被认为是对女性不友好的职业。几位作者调查了女外科医生在协调高要求的职业与个人和家庭生活的要求方面的困难。目前的研究旨在总结关于女性外科医生工作与生活平衡问题的现有证据,特别是关注可能的改善策略。人工智能(AI)已被研究作为缩小性别差距的可能手段,作为女性外科医生的平衡器。据报道,女外科医生未婚或晚婚的比例高于她们的男同事;他们中的许多人还选择不生孩子,或者少生,晚生。造成这些差异的部分原因是与无形工作相关的问题(如家务管理)、外科住院医师期间妊娠管理的困难、妇女在产假后重返工作岗位时面临的挑战以及缺乏支持性环境。为为所有外科医生建立公平和公平的工作文化,推翻关于性别角色的旧的传统观念,提出了一些解决办法,其中包括灵活的工作时间表、实施儿童保育设施、为外科医生引入和鼓励陪产假,以及对女外科医生实施指导和赞助。此外,技术一直被提倡作为解决外科性别歧视的可能方案;技术可以促进对手术效果的客观评估,并为无法参加现场教育的外科医生提供高级培训。一个健康的、繁荣的、有组织的、支持性的、文化转型的工作环境可以提高外科医生和工作人员的工作效率,并最终改善病人的护理。
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引用次数: 1
The preliminary stage in developing an artificial intelligence algorithm: a study of the inter- and intra-individual variability of phase annotations in internal fixation of distal radius fracture videos 开发人工智能算法的初步阶段:研究桡骨远端骨折视频内固定中相位注释的个体间和个体内变异性
Pub Date : 2023-01-01 DOI: 10.20517/ais.2023.12
Camille Graëff, T. Lampert, J. Mazellier, N. Padoy, Laëla El Amiri, P. Liverneaux
Aim: As a preliminary stage in the development of an artificial intelligence (AI) algorithm for surgery, this work aimed to study the inter- and intra-individual variability of phase annotations in videos of minimally invasive plate osteosynthesis of distal radius fractures (MIPO). The main hypothesis was that the inter-individual variability was almost perfect if Cohen's kappa coefficient (k) was ≥ 81% overall; the secondary hypothesis was that the intra-individual variability was almost perfect if the F1-score (F1) was ≥ 81%. Methods: The material comprised 9 annotators and three annotated MIPO videos with 5 phases and 4 sub-phases. Each video was presented 3 times to each annotator. The method involved analysing the inter-individual variability of annotations by computing k and F1 from a reference annotator. The intra-individual variability of annotations was analysed by computing F1. Results: Annotation anomalies were noticed: either absences or differences in phase and sub-phase annotations. Regarding the inter-individual variability, an almost perfect agreement between annotators was observed because k ≥ 81% for the three videos. Regarding the intra-individual variability, F1 ≥ 81% for most phases and sub-phases with the nine annotators. Conclusion: The homogeneity of annotations must be as high as possible to develop an AI algorithm in surgery. Therefore, it is necessary to identify the least efficient annotators (measurement of the intra-individual variability) to provide them with individual training and a personalised annotation rhythm. It is also important to optimise the definition of the phases, improve the annotation protocol and choose suitable training videos.
目的:作为人工智能(AI)手术算法开发的初步阶段,本研究旨在研究桡骨远端骨折微创钢板内固定(MIPO)视频中相位注释的个体间和个体内变异性。主要假设:当Cohen’s kappa系数(k)总体≥81%时,个体间变异性接近完美;次要假设是,如果F1评分(F1)≥81%,则个体内变异几乎是完美的。方法:材料由9个注释者和3个注释的MIPO视频组成,分为5个阶段和4个子阶段。每个视频向每个注释者展示3次。该方法通过计算参考注释器的k和F1来分析注释的个体间可变性。通过计算F1来分析注释的个体内变异。结果:注意到注释异常:阶段和亚阶段注释缺失或差异。关于个体间变异,注释者之间几乎完全一致,因为三个视频的k≥81%。在个体内变异方面,9个注释者的大部分阶段和子阶段的F1≥81%。结论:开发手术人工智能算法必须尽可能提高注释的同质性。因此,有必要识别效率最低的注释者(测量个体内部可变性),为他们提供个性化的培训和个性化的注释节奏。优化阶段定义、改进标注协议和选择合适的训练视频也很重要。
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引用次数: 0
Artificial intelligence-based technology for enhancing the quality of simulation, navigation, and outcome prediction for hepatectomy 基于人工智能的技术,用于提高肝切除术的模拟、导航和结果预测的质量
Pub Date : 2023-01-01 DOI: 10.20517/ais.2022.37
H. Shinkawa, T. Ishizawa
In the past decade, artificial intelligence (AI)-based technology has been applied to develop a simulation and navigation system and a model for predicting surgical outcomes in hepatobiliary surgery. To identify the intrahepatic vascular structure and accurate liver segmentation and volumetry, AI technology has been applied in three-dimensional (3D) simulation software. Recently, 3D and 4D printing have been used as innovative technologies for tissue and organ fabrication, medical education, and preoperative planning. AI can empower 3D and 4D printing technologies. Attempts have been made to use AI technology in augmented reality for navigating and performing intraoperative ultrasound. To predict surgical outcomes and postoperative early recurrence in patients with hepatocellular carcinoma, a deep learning model can be useful. Indocyanine green fluorescence imaging is used in hepatobiliary surgery to visualize the anatomy of the bile duct, hepatic tumors, and hepatic segmental areas. AI technology was applied to fuse intraoperative near-infrared fluorescence and visible images. Preoperative simulation, intraoperative navigation, and models to predict surgical outcomes using AI technology can be clinically applied in hepatobiliary surgery. As shown in reliable and robust clinical studies, AI can be a useful tool in clinical practice to improve the safety and efficacy of hepatobiliary surgery.
在过去的十年中,基于人工智能(AI)的技术已被应用于开发肝胆手术的模拟和导航系统以及预测手术结果的模型。为了识别肝内血管结构和准确的肝脏分割和体积测量,在三维(3D)仿真软件中应用了AI技术。最近,3D和4D打印已被用作组织和器官制造、医学教育和术前规划的创新技术。人工智能可以增强3D和4D打印技术。已经尝试在增强现实中使用人工智能技术来导航和执行术中超声。为了预测肝细胞癌患者的手术结果和术后早期复发,深度学习模型可能是有用的。吲哚菁绿荧光成像在肝胆外科手术中用于显示胆管、肝脏肿瘤和肝节段区域的解剖结构。采用人工智能技术融合术中近红外荧光与可见光图像。利用人工智能技术进行术前模拟、术中导航、建立手术预后预测模型等,可在肝胆手术中得到临床应用。可靠而有力的临床研究表明,人工智能可以成为临床实践中提高肝胆手术安全性和有效性的有用工具。
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引用次数: 2
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Artificial intelligence surgery
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