HJBR Jul/Aug 2024

HEALTHCARE JOURNAL OF BATON ROUGE  I  JUL / AUG 2024 53 Mo Al Efishat, MD, FSSO Surgical Oncologist and Pancreatic and Hepatobiliary Surgeon Our Lady of the Lake Regional Medical Center and Cancer Institute massive potential to revolutionize health- care, improve diagnostic accuracy, bridge the gap in workforce shortage, and make healthcare more efficient and potentially less costly. However, data privacy con- cerns, bias, and lack of accountability are legitimate issues. Thus, safe and effective implementation into clinical medicine re- quires the collaboration of healthcare pro- viders with AI developers. Learning about AI is critical for today’s clinicians, as AI lit- eracy will allow for a safer and smarter uti- lization of this revolutionary technology. How can AI improve robotic- assisted surgery? The most widely used and advanced robotic surgical platform is the da Vinci platform by Intuitive Surgical, which has recently launched its fifth and AI-com- patible “da Vinci 5” machine. It will likely replace most of the previous model ma- chines once production surpasses the de- mand. This new platform has the potential to gradually integrate AI into the practice of surgery. In fact, the platform already offers AI-generated intraoperative assess- ment and feedback of the surgeon’s per- formance (e.g., economy of motions and efficient use of instruments) and provides simulation exercises designed to improve any deficiency or inefficiency a surgeon may have demonstrated. When it comes to AI in robotic surgery, what immediately comes to mind is the question of “robotic autonomy,” in which the robot is capable of performing a part or most of a complex surgical procedure. This is not only unfeasible with the current technology, and many decades away from us, but also it is not within the current vi- sion of implementing this technology. AI is expected to create a data-driven, safe envi- ronment that allows for enhanced perfor- mance through image guidance, augment- ed reality rendering like 3D modeling of a tumor location, real-time image enhance- ment to identify critical anatomical struc- tures, and integration of the patient’s data with intraoperative instrument kinematics and robotic sensors to provide invaluable feedback for the surgeon during and after surgery, making it safer and more efficient. Additionally, AI has promising potential in the field of surgical oncology and assess- ing the surgical margins. In these surgeries, certain instruments can be AI-trained to recognize tumor location based on a heat- map, fiber-based fluorescence imaging, or multiparametric MRI augmented reality 3D model, which helps the surgeon locate the tumor and define the surgical margin. What is the future role of AI in robotic-assisted surgery? Some of it is already here, but the impact AI can have on improving robotic surgery is immense, and certainly the best is yet to come. As mentioned above, AI model- ing can provide integrated information and advanced metrics to guide surgeons when making intraoperative decisions, identifying critical anatomical structures, and notifying the surgeon of an imminent error based on kinematics data. It will also allow a more objective way of evaluating the competency of young surgical trainees’ performance via video feedback and skills assessment and will likely become one of the methods surgical boards use to evalu- ate the competency of their graduates and diplomates.. Conclusion In summary, AI is a powerful tool that is here to stay and will inevitably be part of daily patient care in the future, and that future is fast approaching. One of the most exciting aspects of AI in robotic-as- sisted surgery is the potential to provide live intraoperative assessment, automat- ed feedback, and surgical skills improve- ment tasks, making robotic-assisted sur- gery even more safe and efficient for our patients. That said, we must be aware of enchanted determinism; AI is not limitless and is only as good as we regulate it to be. The proper adoption and risk mitigation of AI is of utmost importance, but don’t wor- ry. The AI-augmented robot will never take over the role of your surgeon, just like the autopilot in every plane would never re- place the captain!. n REFERENCES Hashimoto, D.A.; Rosman, G.; Rus, D.; Meireles, O.R. “Artificial Intelligence in Surgery: Promises andPerils.”AnnalsofSurgery268,no.1(July2018): 70-76. doi: 10.1097/SLA.0000000000002693 Knudsen, J.E.; Ghaffar, U.; Ma, R.; Hung, A.J. “Clin- ical applications of artificial intelligence in robot- ic surgery.” Journal of Robotic Surgery 18, no. 1 (March 1, 2024): 102. doi: 10.1007/s11701-024- 01867-0 Bianchi, L.; Chessa, F.; Angiolini, A.; et al.“The Use of Augmented Reality to Guide the Intraoperative Frozen Section During Robot-Assisted Radical Prostatectomy.” European Urology 80, no. 4 (October 2021): 480–488. doi: 10.1016/j. eururo.2021.06.020 As part of the Surgeons Group of Baton Rouge at Our Lady of the Lake Regional Medical Center and Cancer Institute,MohammadAl Efishat,MD, is a surgical on- cologist and pancreatic and hepatobiliary surgeon, treating conditions of the pancreas, liver,gallbladder, and bile duct. He also treats abdominal tumors, in- cluding those with peritoneal carcinomatosis, sar- coma, melanoma, and breast cancer. Al Efishat is a clinical assistant professor at LSUSchool of Medicine.