Gynecological Surgery:
In surgery, the application of physical AI has been utilized more than
virtual AI. Virtual AI uses established patient factors, repetitive
patterns, and treatment algorithms to predict the outcome, as opposed to
the surgical field, which has many independent variables. Some of these
variables are the consistency of different tissues, the skills of each
surgeon, changes are done in the surgical field while operating, and
unique differences between patients and their pathology; ultimately
these unique factors make it challenging to create an algorithm
[27].
Areas in which AI has assisted gynecological surgery include those
related to imaging and spatial awareness. AI can aid the surgeon by
providing better imaging before and during surgery. The creation of
three-dimensional printing (3DP) that replicates the surgical site is
far superior to its 2D counterpart, as it represents a more precise
version of the actual model [28,29]. This allows a more accurate
preoperative plan, hence diminishing error in the operating room. 3DP
can also provide different materials that can resemble the tissues that
would be encountered, thus providing realistic practice for trainees and
unprecedented preoperative planning [29]. Ultimately a 3DP image
helps navigate the surgical field and increase awareness of the area
involved and so protect its surrounding structures. This has proved
useful in one case report for deep infiltrating endometriosis (DIE)
[27,29]. A 3DP model was derived from a preoperative MRI then later
compared retrospectively with the surgical findings. The surgeons agreed
the 3DP image assisted in planning to calculate depth, extent, and
involvement of adjacent structures and how to proceed accordingly. These
models can potentially serve as adjuncts for preoperative planning where
depth and spatial relationships are challenging to analyze by the
standard 2D image alone.
AI has also helped decrease operative time and accuracy, which
subsequently decreases operative complications [27]. This has been
done via the utilization of augmented reality. Augmented reality
consists of a computer that can reconstruct objects taken from the
real-world and enhance them virtually to create a more informative
visual image [30,31]. One review of augmented reality in surgery
summarizes some of the shortcomings of this technology such as increased
cost; concern for a latency of the system; and that the head-mounted
display is heavy and impractical for long surgeries [32].
Furthermore, augmented reality might cause nausea and vomiting due to
“simulator sickness” which would be less than ideal during surgery.
Augmented reality might also demonstrate too much information and
increase clutter thus, distracting the surgeon from the task on hand,
and is most helpful in an immobile structure, so mobile organs like the
uterus are not ideal for this technology. Despite certain disadvantages,
the authors of the review conclude that overall there are positive
benefits to augmented reality, such as increased precision, safety, and
a time reduction in performing procedures [28]. Nonetheless, further
studies and improvements still need to be done to take full advantage of
its potential benefits [31].
Other examples of computer systems assisting in surgery are evident in
robotics and computer-assisted platforms. With the help of these
platforms, the possibility to opt for a minimally invasive route during
surgery becomes feasible, and can help reduce invasive surgeries, their
associated risks and reduce operative times. Some robotics can even
decrease tremors to promote accuracy [27]. Additionally, the
introduction of instruments, such as three-dimensional laparoscopic
surgery, which aid in-depth visibility, have the potential to provide
better surgical outcomes [32].
AI has aided in enhancing spatial awareness, cautioning surgeons if
certain vessels or structures of importance are concealed, identifying
them in a timely matter, and being able to protect vital structures. An
example is isolating the ureters during gynecological surgery. A study
was done using an endoscope system based on AI using algorithms to
estimate the depth and location of the ureters, which proved to enhance
accuracy and safety [33].