Rethinking Autonomous Surgery: Focusing on Enhancement over Autonomy

A surgical activity model of laparoscopic cholecystectomy for co-operation with collaborative robots

BACKGROUND

Laparoscopic cholecystectomy is a very frequent surgical procedure. However, in an ageing society, less surgical staff will need to perform surgery on patients. Collaborative surgical robots (cobots) could address surgical staff shortages and workload. To achieve context-awareness for surgeon-robot collaboration, the intraoperative action workflow recognition is a key challenge.

METHODS

A surgical process model was developed for intraoperative surgical activities including actor, instrument, action and target in laparoscopic cholecystectomy (excluding camera guidance). These activities, as well as instrument presence and surgical phases were annotated in videos of laparoscopic cholecystectomy performed on human patients (n = 10) and on explanted porcine livers (n = 10). The machine learning algorithm Distilled-Swin was trained on our own annotated dataset and the CholecT45 dataset. The validation of the model was conducted using a fivefold cross-validation approach.

RESULTS

In total, 22,351 activities were annotated with a cumulative duration of 24.9 h of video segments. The machine learning algorithm trained and validated on our own dataset scored a mean average precision (mAP) of 25.7% and a top K = 5 accuracy of 85.3%. With training and validation on our dataset and CholecT45, the algorithm scored a mAP of 37.9%.

CONCLUSIONS

An activity model was developed and applied for the fine-granular annotation of laparoscopic cholecystectomies in two surgical settings. A machine recognition algorithm trained on our own annotated dataset and CholecT45 achieved a higher performance than training only on CholecT45 and can recognize frequently occurring activities well, but not infrequent activities. The analysis of an annotated dataset allowed for the quantification of the potential of collaborative surgical robots to address the workload of surgical staff. If collaborative surgical robots could grasp and hold tissue, up to 83.5% of the assistant's tissue interacting tasks (i.e. excluding camera guidance) could be performed by robots.

Robotic Assistance in Percutaneous Liver Ablation Therapies: A Systematic Review and Meta-Analysis

Objective

The aim of this systematic review and meta-analysis is to identify current robotic assistance systems for percutaneous liver ablations, compare approaches, and determine how to achieve standardization of procedural concepts for optimized ablation outcomes.

Background

Image-guided surgical approaches are increasingly common. Assistance by navigation and robotic systems allows to optimize procedural accuracy, with the aim to consistently obtain adequate ablation volumes.

Methods

Several databases (PubMed/MEDLINE, ProQuest, Science Direct, Research Rabbit, and IEEE Xplore) were systematically searched for robotic preclinical and clinical percutaneous liver ablation studies, and relevant original manuscripts were included according to the Preferred Reporting items for Systematic Reviews and Meta-Analyses guidelines. The endpoints were the type of device, insertion technique (freehand or robotic), planning, execution, and confirmation of the procedure. A meta-analysis was performed, including comparative studies of freehand and robotic techniques in terms of radiation dose, accuracy, and Euclidean error.

Results

The inclusion criteria were met by 33/755 studies. There were 24 robotic devices reported for percutaneous liver surgery. The most used were the MAXIO robot (8/33; 24.2%), Zerobot, and AcuBot (each 2/33, 6.1%). The most common tracking system was optical (25/33, 75.8%). In the meta-analysis, the robotic approach was superior to the freehand technique in terms of individual radiation (0.5582, 95% confidence interval [CI] = 0.0167-1.0996, dose-length product range 79-2216 mGy.cm), accuracy (0.6260, 95% CI = 0.1423-1.1097), and Euclidean error (0.8189, 95% CI = -0.1020 to 1.7399).

Conclusions

Robotic assistance in percutaneous ablation for liver tumors achieves superior results and reduces errors compared with manual applicator insertion. Standardization of concepts and reporting is necessary and suggested to facilitate the comparison of the different parameters used to measure liver ablation results. The increasing use of image-guided surgery has encouraged robotic assistance for percutaneous liver ablations. This systematic review analyzed 33 studies and identified 24 robotic devices, with optical tracking prevailing. The meta-analysis favored robotic assessment, showing increased accuracy and reduced errors compared with freehand technique, emphasizing the need for conceptual standardization.

Configurations of human-centered AI at work: seven actor-structure engagements in organizations

Purpose

The discourse on the human-centricity of AI at work needs contextualization. The aim of this study is to distinguish prevalent criteria of human-centricity for AI applications in the scientific discourse and to relate them to the work contexts for which they are specifically intended. This leads to configurations of actor-structure engagements that foster human-centricity in the workplace.

Theoretical foundation

The study applies configurational theory to sociotechnical systems' analysis of work settings. The assumption is that different approaches to promote human-centricity coexist, depending on the stakeholders responsible for their application.

Method

The exploration of criteria indicating human-centricity and their synthesis into configurations is based on a cross-disciplinary literature review following a systematic search strategy and a deductive-inductive qualitative content analysis of 101 research articles.

Results

The article outlines eight criteria of human-centricity, two of which face challenges of human-centered technology development (trustworthiness and explainability), three challenges of human-centered employee development (prevention of job loss, health, and human agency and augmentation), and three challenges of human-centered organizational development (compensation of systems' weaknesses, integration of user-domain knowledge, accountability, and safety culture). The configurational theory allows contextualization of these criteria from a higher-order perspective and leads to seven configurations of actor-structure engagements in terms of engagement for (1) data and technostructure, (2) operational process optimization, (3) operators' employment, (4) employees' wellbeing, (5) proficiency, (6) accountability, and (7) interactive cross-domain design. Each has one criterion of human-centricity in the foreground. Trustworthiness does not build its own configuration but is proposed to be a necessary condition in all seven configurations.

Discussion

The article contextualizes the overall debate on human-centricity and allows us to specify stakeholder-related engagements and how these complement each other. This is of high value for practitioners bringing human-centricity to the workplace and allows them to compare which criteria are considered in transnational declarations, international norms and standards, or company guidelines.

In the Hands of a Robot, From the Operating Room to the Courtroom: The Medicolegal Considerations of Robotic Surgery

Robotic surgery has rapidly evolved as a groundbreaking field in medicine, revolutionizing surgical practices across various specialties. Despite its numerous benefits, the adoption of robotic surgery faces significant medicolegal challenges. This article delves into the underexplored legal implications of robotic surgery and identifies three distinct medicolegal problems. First, the lack of standardized training and credentialing for robotic surgery poses potential risks to patient safety and surgeon competence. Second, informed consent processes require additional considerations to ensure patients are fully aware of the technology's capabilities and potential risks. Finally, the issue of legal liability becomes complex due to the involvement of multiple stakeholders in the functioning of robotic systems. The article highlights the need for comprehensive guidelines, regulations, and training programs to navigate the medicolegal aspects of robotic surgery effectively, thereby unlocking its full potential for the future..

Recognition and Prediction of Surgical Gestures and Trajectories Using Transformer Models in Robot-Assisted Surgery

Surgical activity recognition and prediction can help provide important context in many Robot-Assisted Surgery (RAS) applications, for example, surgical progress monitoring and estimation, surgical skill evaluation, and shared control strategies during teleoperation. Transformer models were first developed for Natural Language Processing (NLP) to model word sequences and soon the method gained popularity for general sequence modeling tasks. In this paper, we propose the novel use of a Transformer model for three tasks: gesture recognition, gesture prediction, and trajectory prediction during RAS. We modify the original Transformer architecture to be able to generate the current gesture sequence, future gesture sequence, and future trajectory sequence estimations using only the current kinematic data of the surgical robot end-effectors. We evaluate our proposed models on the JHU-ISI Gesture and Skill Assessment Working Set (JIGSAWS) and use Leave-One-User-Out (LOUO) cross validation to ensure generalizability of our results. Our models achieve up to 89.3% gesture recognition accuracy, 84.6% gesture prediction accuracy (1 second ahead) and 2.71mm trajectory prediction error (1 second ahead). Our models are comparable to and able to outperform state-of-the-art methods while using only the kinematic data channel. This approach can enabling near-real time surgical activity recognition and prediction.

[Image-based supportive measures for future application in surgery]

BACKGROUND

The development of assistive technologies will become of increasing importance in the coming years and not only in surgery. The comprehensive perception of the actual situation is the basis of every autonomous action. Different sensor systems can be used for this purpose, of which video-based systems have a special potential.

METHOD

Based on the available literature and on own research projects, central aspects of image-based support systems for surgery are presented. In this context, not only the potential but also the limitations of the methods are explained.

RESULTS

An established application is the phase detection of surgical interventions, for which surgical videos are analyzed using neural networks. Through a time-based and transformative analysis the results of the prediction could only recently be significantly improved. Robotic camera guidance systems will also use image data to autonomously navigate laparoscopes in the near future. The reliability of the systems needs to be adapted to the high requirements in surgery by means of additional information. A comparable multimodal approach has already been implemented for navigation and localization during laparoscopic procedures. For this purpose, video data are analyzed using various methods and these data are fused with other sensor modalities.

DISCUSSION

Image-based supportive methods are already available for various tasks and will become an important aspect for the surgery of the future; however, in order to be able to be reliably implemented for autonomous functions, they must be embedded in multimodal approaches in the future in order to provide the necessary security.

U-Hack Med Gap Year-A Virtual Undergraduate Internship Program in Computer-Assisted Healthcare and Biomedical Research

The COVID-19 healthcare crisis dramatically changed educational opportunities for undergraduate students. To overcome the lack of exposure to lab research and provide an alternative to cancelled classes and online lectures, the Lyda Hill Department of Bioinformatics at UT Southwestern Medical Center established an innovative, fully remote and paid "U-Hack Med Gap Year" internship program. At the core of the internship program were dedicated biomedical research projects spanning nine months in fields as diverse as computational microscopy, bioimage analysis, genome sequence analysis and establishment of a surgical skill analysis platform. To complement the project work, a biweekly Gap Year lab meeting was devised with opportunities to develop important skills in presenting, data sharing and analysis of new research. Despite a challenging year, all selected students completed the full internship period and over 30% will continue their project remotely after the end of the program.