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The challenges of deep learning in artificial intelligence and autonomous actions in surgery: a literature review 深度学习在人工智能和手术自主行动中的挑战:文献综述
Pub Date : 2022-01-01 DOI: 10.20517/ais.2022.11
H. Taher, Vincent Grasso, Sherifa Tawfik, ANDREW GUMBS
Aim: Artificial intelligence (AI) is rapidly evolving in healthcare worldwide, especially in surgery. This article reviews important terms used in machine learning and the challenges of deep learning in surgery. Methods: A review of the English literature was carried out focused on the terms “challenges of deep learning” and “surgery” using Medline and PubMed between 2018 and 2022. Results: In total, 54 articles discussed the challenges of deep learning in general. We include 25 articles from various surgical specialties discussing challenges corresponding to their respective specialties. Conclusion: The increased utilization of AI in surgery is faced with a wide variety of technical, ethical, clinical, and business-related challenges. The best way to expedite its expansion in surgery in the safest and most cost-efficient manner is by ensuring that as many surgeons as possible have a clear understanding of basic AI concepts and how they can be applied to the preoperative, intraoperative, postoperative, and long-term follow-up phases of the surgical patient care.
目的:人工智能(AI)在全球医疗保健领域迅速发展,尤其是在外科领域。本文回顾了机器学习中使用的重要术语以及深度学习在外科手术中的挑战。方法:使用Medline和PubMed检索2018年至2022年期间的英文文献,重点分析“深度学习的挑战”和“手术”这两个术语。结果:总共有54篇文章讨论了深度学习的挑战。我们收录了来自不同外科专业的25篇文章,讨论了各自专业所面临的挑战。结论:人工智能在外科手术中的应用日益增加,面临着各种各样的技术、伦理、临床和商业方面的挑战。以最安全和最具成本效益的方式加速其在外科手术中的扩展的最佳方法是确保尽可能多的外科医生清楚地了解基本的人工智能概念,以及如何将它们应用于手术患者护理的术前、术中、术后和长期随访阶段。
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引用次数: 29
White paper: definitions of artificial intelligence and autonomous actions in clinical surgery 白皮书:人工智能的定义和临床手术中的自主行动
Pub Date : 2022-01-01 DOI: 10.20517/ais.2022.10
ANDREW GUMBS, Frank Alexander, K. Karcz, E. Chouillard, R. Croner, J. Coles-Black, B. De Simone, M. Gagner, B. Gayet, Vincent Grasso, A. Illanes, T. Ishizawa, L. Milone, Mehmet Mahir Özmen, M. Piccoli, Stefanie Spiedel, G. Spolverato, P. Sylla, Jaime Vilaça, L. Swanström
This white paper documents the consensus opinion of the expert members of the Editorial Board of Artificial Intelligence Surgery regarding the definitions of artificial intelligence and autonomy in regards to surgery and how the digital evolution of surgery is interrelated with the various forms of robotic-assisted surgery. It was derived from a series of video conference discussions, and the survey and results were subsequently revised and approved by all authors.
本白皮书记录了《人工智能外科》编辑委员会专家成员关于外科手术中人工智能和自主的定义以及外科手术的数字化发展如何与各种形式的机器人辅助手术相关联的共识意见。它来源于一系列视频会议讨论,调查和结果随后经过所有作者的修改和批准。
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引用次数: 11
Operative difficulty in laparoscopic cholecystectomy: considering the role of machine learning platforms in clinical practice 腹腔镜胆囊切除术的手术难度:考虑机器学习平台在临床实践中的作用
Pub Date : 2022-01-01 DOI: 10.20517/ais.2022.01
Isaac Tranter-Entwistle, T. Eglinton, S. Connor, T. Hugh
Aim: Computer vision is a subset of machine learning (ML) technology that allows automated analysis of large operative video datasets. The aim of this study was to use a commercially available ML-driven platform to evaluate a subjective grading of operative difficulty in laparoscopic cholecystectomy (LC). Methods: Patients undergoing LC prospectively consented, and their operations were recorded. The intra-operative findings were prospectively graded (1-4) based on intraoperative gallbladder appearance assessments. Deidentified videos were uploaded to Touch SurgeryTMand run through the platform’s algorithm, providing automated analytics including the total operative length and operative phase length. The rate of critical view of safety (CVS) achievement was also included in the analysis. Results: 206 LC were included. 27 LC were excluded due to incomplete video recording and were therefore not amenable to the final data analysis. Grade 1 and 2 patients had significantly shorter operative time than grade 3 and 4 patients [17min and 53s (IQR 15min and 24s- 21min and 38s) vs. 25 min and 49s (IQR 20min and 12s-38min and 38s) (P < 0.010)]. The operative phases for each step were significantly longer in patients with gallbladders graded 3 or 4 compared to those patients graded 1 or 2 (P < 0.043). The CVS was achieved in 94% of grade 1 patients, 88% of grade 2 patients, 85% of grade 3 patients and 73% of grade 4 patients (P = 0.177). Conclusion: Increased operative time and decreased ability to achieve the CVS with more difficult intraoperative findings supports the utility of the proposed grading system. ML in surgery is a nascent field, but this study demonstrates the potential of commercially available platforms for use in operative analytics, documentation, audit and training of future surgeons.
目的:计算机视觉是机器学习(ML)技术的一个子集,它允许对大型操作视频数据集进行自动分析。本研究的目的是使用市售的机器学习驱动平台来评估腹腔镜胆囊切除术(LC)手术难度的主观评分。方法:前瞻性同意行LC的患者,记录其手术情况。术中发现根据术中胆囊外观评估进行前瞻性分级(1-4)。经过识别的视频被上传到Touch surgical tmd,并通过平台的算法运行,提供包括总手术长度和手术阶段长度在内的自动分析。安全评价(CVS)完成率也包括在分析中。结果:共纳入206个LC。27个LC因视频记录不完整而被排除,因此无法进行最终数据分析。1级和2级患者的手术时间明显短于3级和4级患者[17min和53s (IQR 15min和24s- 21min和38s)比25min和49s (IQR 20min和12s-38min和38s),差异有统计学意义(P < 0.010)]。胆囊分级为3级或4级的患者比分级为1级或2级的患者每一步的手术期均明显延长(P < 0.043)。94%的1级患者、88%的2级患者、85%的3级患者和73%的4级患者达到了CVS (P = 0.177)。结论:手术时间的增加和达到CVS的能力的下降以及术中更困难的发现支持了所提出的分级系统的实用性。机器学习在外科手术中是一个新兴领域,但这项研究证明了商业平台在手术分析、文件记录、审计和培训未来外科医生方面的潜力。
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引用次数: 5
Artificial intelligence in laparoscopic cholecystectomy: does computer vision outperform human vision? 人工智能在腹腔镜胆囊切除术中的应用:计算机视觉是否优于人类视觉?
Pub Date : 2022-01-01 DOI: 10.20517/ais.2022.04
Runwen Liu, Jingjing An, Ziyao Wang, Jingye Guan, Jie Liu, Jingwen Jiang, Zhimin Chen, Hai Li, B. Peng, Xin Wang
Background: The occurrence of biliary duct injury (BDI) after laparoscopic cholecystectomy (LC) remains 0.2-1.5%, which is largely caused by anatomic misidentifications. To solve this problem, we developed an artificial intelligence model, SurgSmart, and preliminarily verified its potential surgical guidance ability by comparing its performance with surgeons. Methods: We prospectively collected 60 LC videos from November 2019 to August 2020 and enrolled 41 videos into the model establishment. Four important anatomic regions, namely cystic duct, cystic artery, common bile duct, and cystic plate, were annotated, and YOLOv3 (You Look Only Once), an object detection algorithm, was applied to develop the model SurgSmart. To further evaluate its performance, comparisons were made among SurgSmart, trainees, and seniors (surgical experience in LC > 100). Results: In total, 101,863 frames were extracted from videos, and 5533 video frames were selected, annotated, and used in model training. The mean average precision (mAP) of SurgSmart was 0.710. Comparative results show SurgSmart had significantly higher intersection-over-union (IoU) and accuracy (IoU ≥ 0.5) in anatomy detection than those of seniors (n = 36) and trainees (n = 32) despite the existence of severe inflammation. Additionally, SurgSmart tended to correctly identify anatomic regions in earlier surgical phases than most of the seniors and trainees (P < 0.001). Conclusions: SurgSmart is not only capable of accurately detecting and positioning anatomic regions in LC but also has better performance than that of the trainees and seniors in terms of individual still images and the whole set.
背景:腹腔镜胆囊切除术(LC)后胆管损伤(BDI)的发生率仍为0.2-1.5%,这主要是由于解剖上的误诊造成的。为了解决这一问题,我们开发了一个人工智能模型SurgSmart,并通过与外科医生的性能对比,初步验证了其潜在的手术指导能力。方法:前瞻性收集2019年11月至2020年8月的60个LC视频,并将41个视频纳入模型建立。对胆囊管、胆囊动脉、胆总管、胆囊板四个重要解剖区域进行标注,并应用YOLOv3 (You Look Only Once)目标检测算法开发模型SurgSmart。为了进一步评估其性能,对SurgSmart、学员和老年人(LC bbbb100的手术经验)进行了比较。结果:共从视频中提取了101,863帧,并选择了5533帧视频帧进行标注,用于模型训练。SurgSmart的平均精度(mAP)为0.710。对比结果显示,尽管存在严重炎症,但与老年人(n = 36)和练习生(n = 32)相比,SurgSmart在解剖检测中的IoU和准确性(IoU≥0.5)均显著高于老年人(n = 36)和实习生(n = 32)。此外,与大多数老年人和实习生相比,SurgSmart倾向于在手术早期正确识别解剖区域(P < 0.001)。结论:SurgSmart不仅能够准确地检测和定位LC的解剖区域,而且在单个静止图像和整套图像上都优于学员和高年级学生。
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引用次数: 10
The cassandra paradox: looking into the crystal Ball of radiomics in thoracic surgery 卡桑德拉悖论:透视胸外科放射组学的水晶球
Pub Date : 2022-01-01 DOI: 10.20517/ais.2022.05
J. Decker, J. Sesti, Amber L. Turner, S. Paul
and tuberculomas ( P < 0.0001). Other were able to identify radiomic features specific for EGFR mutant vs. wild type groups and K-ras mutations an application designed to stratify lung adenocarcinoma into aggressive and minimally uses nine representative characteristics to identify the histopathology standardized uptake value (SUV), maximum standardized uptake significantly T N stage.
和结核瘤(P < 0.0001)。其他能够确定EGFR突变体与野生型组和K-ras突变的放射学特征,该应用旨在将肺腺癌分层为侵袭性和最低限度,使用9个代表性特征来确定组织病理学标准化摄取值(SUV),最大标准化摄取显著T N阶段。
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引用次数: 2
Applications of machine learning in surgery: ethical considerations 机器学习在外科手术中的应用:伦理考虑
Pub Date : 2022-01-01 DOI: 10.20517/ais.2021.13
N. Rashidian, M. Hilal
© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
©作者2022。开放获取本文遵循知识共享署名4.0国际许可协议(https://creativecommons.org/licenses/by/4.0/),该协议允许不受限制地使用、共享、改编、分发和复制,以任何媒介或格式,用于任何目的,甚至商业目的,只要您适当地注明原作者和来源,提供知识共享许可协议的链接,并注明是否进行了更改。
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引用次数: 1
The potential of artificial intelligence as an equalizer of gender disparity in surgical training and education 人工智能在外科培训和教育中平衡性别差异的潜力
Pub Date : 2022-01-01 DOI: 10.20517/ais.2022.12
V. Mari, G. Spolverato, L. Ferrari
The aim of this work is to offer a panoramic view on how artificial intelligence (AI) can help to break down gender disparity in enrollment and training of women in surgery. Nowadays, many visible and concealed obstacles still exist for women who pursue a surgical career. Impediments due to gender disparity prevent women from choosing surgical specialties. Furthermore, female surgical trainees have to face many difficulties during their training, such as inequity during the residency selection process, sexual harassment, discrimination in pregnancy experience and parental leave, and work-life balance problems. AI has been successfully employed for several applications in surgery to improve patient management, implement the decision-making process, and support training. AI could represent an effective way to overcome barriers related to gender disparity and overcome the obstacles women face during surgical education and training. Virtual and augmented reality, remote mentoring, and simulators could help female surgeons deal with disparities during their training and could positively impact the choice of women when pursuing a surgical career.
这项工作的目的是提供一个全景视图,人工智能(AI)如何帮助打破女性手术入学和培训中的性别差异。如今,对于追求外科事业的女性来说,仍然存在许多可见和隐藏的障碍。性别差异造成的障碍阻碍了女性选择外科专科。此外,女性外科实习生在培训过程中还面临着许多困难,如住院医师选择过程中的不平等、性骚扰、怀孕经历和育儿假的歧视、工作与生活的平衡问题等。人工智能已经成功地应用于手术中,以改善患者管理,实施决策过程,并支持培训。人工智能可能是克服与性别差异有关的障碍,克服女性在外科教育和培训中面临的障碍的有效途径。虚拟和增强现实、远程指导和模拟器可以帮助女性外科医生处理培训过程中的差异,并可能对女性在追求外科职业时的选择产生积极影响。
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引用次数: 0
Leveraging artificial intelligence for resident recruitment: can the dream of holistic review be realized? 利用人工智能进行驻地招聘:能否实现整体评审的梦想?
Pub Date : 2022-01-01 DOI: 10.20517/ais.2022.24
A. S. John, S. Kavic
Aim: The purpose of this study was to investigate if principles of Artificial Intelligence (AI), specifically Natural Language Processing (NLP), could be applied to the personal statements of general surgery residency applicants in order to gain valuable insight into the candidates and facilitate a more comprehensive assessment. Methods: The personal statements from individuals applying for a general surgery residency position during the 2021/22 application cycle (n = 1792) were analyzed using AI technology. Comparison groups were drawn from a database of documents from the general population and the personal statements of current general surgery residents (n = 64) at a single academic center. The study was conducted in collaboration with a leading language psychology and natural language processing organization. Results: Applicants exhibited a language-based personality that was highly self-assured (P < 0.0001) and trusting (P < 0.0001), and less stress-prone (P < 0.0001) and impulsive (P < 0.0001) than that of the general population. Compared to the general applicant pool, current residents were significantly more emotionally aware (P < 0.001) and organized (P < 0.001) and less self-assured (P < 0.001) and less driven by power (P < 0.001). Conclusion: Natural language processing technology can be utilized to assess the unique characteristics of general surgery resident applicants based on the content of their personal statements. In addition, candidates who successfully gain admission to a single academic program display different language-based personalities and drives compared to the general applicant pool. Incorporating these principles of artificial intelligence into the residency selection process could facilitate a more holistic evaluation of candidates.
目的:本研究的目的是探讨人工智能(AI)的原理,特别是自然语言处理(NLP),是否可以应用于普通外科住院医师申请人的个人陈述,以获得对候选人的有价值的见解,并促进更全面的评估。方法:采用人工智能技术对2021/22年申请普外科住院医师职位的申请人(n = 1792)的个人陈述进行分析。比较组从一个单一学术中心的普通人群和当前普通外科住院医生(n = 64)的个人陈述的文件数据库中抽取。这项研究是与一家领先的语言心理学和自然语言处理组织合作进行的。结果:应征者表现出高度自信(P < 0.0001)、信任(P < 0.0001)、压力倾向(P < 0.0001)和冲动(P < 0.0001)的语言型人格。与一般申请人群体相比,当前居民的情感意识(P < 0.001)和组织能力(P < 0.001)显著提高,自信(P < 0.001)和受权力驱动的程度(P < 0.001)显著降低。结论:自然语言处理技术可用于评估普外科住院医师申请人个人陈述内容的独特特征。此外,与普通申请人相比,成功获得单一学术课程入学资格的候选人表现出不同的语言个性和动力。将这些人工智能原则纳入住院医师选择过程,可以促进对候选人进行更全面的评估。
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引用次数: 0
The importance of machine learning in autonomous actions for surgical decision making 机器学习在自主手术决策中的重要性
Pub Date : 2022-01-01 DOI: 10.20517/ais.2022.02
M. Wagner, S. Bodenstedt, M. Daum, A. Schulze, Rayan Younis, Johanna M. Brandenburg, F. Kolbinger, M. Distler, L. Maier-Hein, J. Weitz, B. Müller-Stich, S. Speidel
Surgery faces a paradigm shift since it has developed rapidly in recent decades, becoming a high-tech discipline. Increasingly powerful technological developments such as modern operating rooms, featuring digital and interconnected equipment and novel imaging as well as robotic procedures, provide several data sources resulting in a huge potential to improve patient therapy and surgical outcome by means of Surgical Data Science. The emerging field of Surgical Data Science aims to improve the quality of surgery through acquisition, organization, analysis, and modeling of data, in particular using machine learning (ML). An integral part of surgical data science is to analyze the available data along the surgical treatment path and provide a context-aware autonomous action by means of ML methods. Autonomous actions related to surgical decision-making include preoperative decision support, intraoperative assistance functions, as well as robot-assisted actions. The goal is to democratize surgical skills and enhance the collaboration between surgeons and cyber-physical systems by quantifying surgical experience and making it accessible to machines, thereby improving patient therapy and outcome. The article introduces basic ML concepts as enablers for autonomous actions in surgery, highlighting examples for such actions along the surgical treatment path.
外科手术近几十年来发展迅速,成为一门高科技学科,面临着范式转变。越来越强大的技术发展,如现代手术室,具有数字化和互联设备,新型成像以及机器人程序,提供了几个数据源,从而通过外科数据科学改善患者治疗和手术结果的巨大潜力。外科数据科学这一新兴领域旨在通过数据的获取、组织、分析和建模来提高手术质量,特别是使用机器学习(ML)。外科数据科学的一个组成部分是分析手术治疗路径上的可用数据,并通过ML方法提供上下文感知的自主行动。与手术决策相关的自主行动包括术前决策支持、术中辅助功能以及机器人辅助行动。目标是通过量化手术经验并使其可被机器访问,从而改善患者治疗和结果,使手术技能民主化,加强外科医生和网络物理系统之间的协作。本文介绍了基本的机器学习概念,作为手术中自主动作的推动者,并突出了手术治疗路径中此类动作的示例。
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引用次数: 6
Mentorship and early career mentorship 指导和早期职业指导
Pub Date : 2022-01-01 DOI: 10.20517/ais.2022.16
L. Ferrari, V. Mari, G. Capelli, G. Spolverato
Mentorship is important for the personal and professional development of a surgeon. Surgical mentoring includes technical and non-technical skills necessary for clinical activities, career improvement, leadership acquisition and research development. Mentors are important in different phases of surgical career, conferring various forms of support. The most delicate period for a surgeon is the transition between the role of trainee and physician, and the first few years are crucial to the trajectory of future career. While in the past, the main limitation for mentorship opportunities was the lack of available mentors at a single institution, more recently, long-distance mentorship opportunities have overcome this barrier. This is of particular importance for women and underrepresented minorities in surgery, who benefit the most from same gender and same ethnicity role model. Furthermore, having the opportunity to establish productive relationships with mentors from other institutions and/or countries will prevent the possibility of leading to dependence between mentee and mentor within a single institution. This review aims to investigate different forms of mentorships, with a specific interest in early career support, long-distance mentorship and opportunities for underrepresented minorities in surgery.
指导对外科医生的个人和专业发展都很重要。外科指导包括临床活动、职业发展、领导力获取和研究发展所需的技术和非技术技能。导师在手术生涯的不同阶段都很重要,可以提供各种形式的支持。对于外科医生来说,最微妙的时期是实习生和医生角色之间的过渡,头几年对未来职业生涯的轨迹至关重要。在过去,指导机会的主要限制是单个机构缺乏可用的导师,最近,远程指导机会克服了这一障碍。这对女性和在外科领域未被充分代表的少数群体尤其重要,因为她们从同性别、同种族的榜样中获益最多。此外,有机会与来自其他机构和/或国家的导师建立富有成效的关系将防止在单一机构内导致被徒弟和导师之间依赖的可能性。本综述旨在调查不同形式的师徒关系,特别关注早期职业支持、远程师徒关系和手术中代表性不足的少数群体的机会。
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引用次数: 0
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Artificial intelligence surgery
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