By MIKE MAGEE
When you talk to consultants about AI in medicine, it’s full throttle. GenAI assistants, “upskilling” the workforce, redesigning customer service, new roles supported by reallocation of budgets, and always with “the dark side” in mind.
But one area that has been relatively quiet is surgery. What’s happening there? In June 2023, the American College of Surgeons (ACS) came forward with a report that largely stated the obvious. They wrote: “The daily barrage of news about artificial intelligence (AI) shows that this groundbreaking technology is here to stay and is poised to revolutionize surgical care.”
Their summary self-analysis was cautious, stating: “By highlighting tools, monitoring operations, and sending alerts, AI-based surgical systems can design an approach to each patient’s surgical needs and control and optimize surgical procedures.” AI is particularly effective in laparoscopic and robotic surgery, where a video screen can display AI information or guidance during surgery.”
So the ACS does not expect an invasion by robots. This is understandable in many ways. The operating room does not reward exaggeration or flashy performances. In an environment where risk is palpable and simple shocks at the wrong time and place can be fatal, surgeons are well rehearsed and trained to remain calm, conservative and alert as members of the “surgical team.”
MedTech, the AI surgery division of Johnson & Johnson, describes surgeons as “high-performance athletes” who continually train and learn, but are also “busy surgeons” under time pressure. The leaders of its AI business unit say they want to “make healthcare smarter, less invasive, more personalized and more connected.” As a business unit, they decided to focus heavily on surgical training. “By combining a wealth of data from surgical procedures and increasingly sophisticated AI technologies, we can transform the experience of patients, doctors and hospitals alike. . . When we use AI, it is always with a purpose.”
The operating room is no stranger to technology. In recent decades, lasers, laparoscopic devices, microscopes, embedded imaging, all kinds of alarms and warnings, and robotic workstations on the wearer’s side have become commonplace. It’s not like mAI is ACS’s first tech rodeo.
Mass surgeon Jennifer Eckoff, MD, sees the movement in broad terms. “Unsurprisingly, the biggest impact of technology is on diagnostic specialties such as radiology, pathology and dermatology.” Danielle Walsh, a surgeon at the University of Kentucky, also decided to look at other departments. “AI should not replace radiologists. – it’s designed to help them find the needle in the haystack.” But make no mistake, surgeons are aware that changes are on the way. Christopher Tignanelli, a surgeon at the University of Minnesota, believes the future is now. He says: “AI will analyze surgeries as they are performed and potentially provide decision support to surgeons during the operation.”
Most believe that AI robotics as a challenger to their surgical role is pure science fiction. But as a companion and team member, most are seeing the increasing role of AI in the OR, and quickly. The greater the complexity, the greater the need. Mass General’s Eckoff says, “Simultaneously processing large amounts of multimodal data, particularly imaging data, and incorporating diverse surgical expertise will be the greatest benefit AI brings to medicine.” . Based on review of millions of surgical videos, AI is able to predict the next 15 to 30 seconds of surgery and provide additional control during surgery.”
As a powerful profit center for most hospitals, the dollars are likely to keep pace with the vision as long as the “dark side of AI” is kept in check. These include “guidelines and guardrails” as outlined by new, rapidly forming elite academic AI collaborations such as the Coalition for Health AI. Quality control, assumption of liability and personal responsibility, and patient trust are prerequisites. But the rewards of diagnostics, real-time safety feedback, precision and shake-free engineering, speed and efficient execution, and improved results are likely to more than offset the investment in time, training, and money.
Mike Magee MD is a medical historian and a regular contributor to THCB. He is the author of CODE BLUE: Inside the Medical Industrial Complex (Grove/2020)