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].