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Collins JW, Marcus HJ, Ghazi A, Sridhar A, Hashimoto D, Hager G, Arezzo A, Jannin P, Maier-Hein L, Marz K, Valdastri P, Mori K, Elson D, Giannarou S, Slack M, Hares L, Beaulieu Y, Levy J, Laplante G, Ramadorai A, Jarc A, Andrews B, Garcia P, Neemuchwala H, Andrusaite A, Kimpe T, Hawkes D, Kelly JD, Stoyanov D. Ethical implications of AI in robotic surgical training: A Delphi consensus statement. Eur Urol Focus 2021; 8:613-622. [PMID: 33941503 DOI: 10.1016/j.euf.2021.04.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/02/2021] [Accepted: 04/08/2021] [Indexed: 12/12/2022]
Abstract
CONTEXT As the role of AI in healthcare continues to expand there is increasing awareness of the potential pitfalls of AI and the need for guidance to avoid them. OBJECTIVES To provide ethical guidance on developing narrow AI applications for surgical training curricula. We define standardised approaches to developing AI driven applications in surgical training that address current recognised ethical implications of utilising AI on surgical data. We aim to describe an ethical approach based on the current evidence, understanding of AI and available technologies, by seeking consensus from an expert committee. EVIDENCE ACQUISITION The project was carried out in 3 phases: (1) A steering group was formed to review the literature and summarize current evidence. (2) A larger expert panel convened and discussed the ethical implications of AI application based on the current evidence. A survey was created, with input from panel members. (3) Thirdly, panel-based consensus findings were determined using an online Delphi process to formulate guidance. 30 experts in AI implementation and/or training including clinicians, academics and industry contributed. The Delphi process underwent 3 rounds. Additions to the second and third-round surveys were formulated based on the answers and comments from previous rounds. Consensus opinion was defined as ≥ 80% agreement. EVIDENCE SYNTHESIS There was 100% response from all 3 rounds. The resulting formulated guidance showed good internal consistency, with a Cronbach alpha of >0.8. There was 100% consensus that there is currently a lack of guidance on the utilisation of AI in the setting of robotic surgical training. Consensus was reached in multiple areas, including: 1. Data protection and privacy; 2. Reproducibility and transparency; 3. Predictive analytics; 4. Inherent biases; 5. Areas of training most likely to benefit from AI. CONCLUSIONS Using the Delphi methodology, we achieved international consensus among experts to develop and reach content validation for guidance on ethical implications of AI in surgical training. Providing an ethical foundation for launching narrow AI applications in surgical training. This guidance will require further validation. PATIENT SUMMARY As the role of AI in healthcare continues to expand there is increasing awareness of the potential pitfalls of AI and the need for guidance to avoid them.In this paper we provide guidance on ethical implications of AI in surgical training.
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Affiliation(s)
- Justin W Collins
- University College London, Division of Surgery and Interventional Science, Research Department of Targeted Intervention; Wellcome/ESPRC Centre for Interventional and Surgical Sciences (WEISS), University College London; University College London Hospital, Division of Uro-oncology.
| | - Hani J Marcus
- Wellcome/ESPRC Centre for Interventional and Surgical Sciences (WEISS), University College London
| | - Ahmed Ghazi
- Simulation Innovation Laboratory, University of Rochester, USA
| | - Ashwin Sridhar
- University College London, Division of Surgery and Interventional Science, Research Department of Targeted Intervention; University College London Hospital, Division of Uro-oncology
| | - Daniel Hashimoto
- Surgical Artificial Intelligence and Innovation Laboratory, Massachusetts General Hospital, USA
| | - Gregory Hager
- Malone Center for engineering in healthcare, Department of Computer Science, John Hopkins University, Baltimore, USA
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Italy
| | | | - Lena Maier-Hein
- Deutsches Krebsforschungszentrum, Division of Computer Assisted Medical Interventions, Heidelberg, Germany
| | - Keno Marz
- Deutsches Krebsforschungszentrum, Division of Computer Assisted Medical Interventions, Heidelberg, Germany
| | - Pietro Valdastri
- STORM Lab, School of Electronic and Electrical Engineering, University of Leeds, Leeds, UK
| | - Kensaku Mori
- Director of Information Technology Center, Nagoya University, Japan
| | - Daniel Elson
- Hamlyn Centre for robotic surgery, Department of Surgery and cancer, Imperial College London, UK
| | - Stamatia Giannarou
- Hamlyn Centre for robotic surgery, Department of Surgery and cancer, Imperial College London, UK
| | - Mark Slack
- Honorary Senior Lecturer, University of Cambridge, Cambridge UK; CMO CMR Surgical, Cambridge, UK
| | - Luke Hares
- Chief technology director, CMR Surgical, Cambridge, UK
| | - Yanick Beaulieu
- Division of Cardiology and Critical Care, Sacré-Coeur Hospital, University of Montreal, Montreal, Canada
| | - Jeff Levy
- Institute for Surgical Excellence, Philadelphia, USA
| | - Guy Laplante
- Director, Global Medical Affairs at Medtronic Minimally Invasive Therapies, Brampton, Canada
| | - Arvind Ramadorai
- Director, Digital-Assisted Surgery (DAS), Medtronic Surgical Robotics, North Haven, CT, USA
| | - Anthony Jarc
- Applied Research, Intuitive Surgical, Inc., Sunnyvale, CA, USA
| | - Ben Andrews
- Strategy, Intuitive Surgical, Inc., Sunnyvale, CA, USA
| | | | | | | | - Tom Kimpe
- BARCO NV - Healthcare division, Kortrijk, Belgium
| | - David Hawkes
- Wellcome/ESPRC Centre for Interventional and Surgical Sciences (WEISS), University College London
| | - John D Kelly
- University College London, Division of Surgery and Interventional Science, Research Department of Targeted Intervention; Wellcome/ESPRC Centre for Interventional and Surgical Sciences (WEISS), University College London; University College London Hospital, Division of Uro-oncology
| | - Danail Stoyanov
- Wellcome/ESPRC Centre for Interventional and Surgical Sciences (WEISS), University College London
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Nirvikalpa N, Narayanan V, Wahab A, Ramadorai A. Comparison between the classical and a modified trans-septal technique of alar cinching for Le Fort I osteotomies: a prospective randomized controlled trial. Int J Oral Maxillofac Surg 2012; 42:49-54. [PMID: 22771085 DOI: 10.1016/j.ijom.2012.05.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 03/22/2012] [Accepted: 05/24/2012] [Indexed: 11/19/2022]
Abstract
The aim of this prospective randomized control trial was to analyse the efficacy of a new trans-septal alar base cinch suture in controlling alar width in patients undergoing maxillary intrusion and setback by comparing it with the traditional cinch suture. Statistical evaluation was carried out in 62 of 76 patients. Group I (31 patients) received the traditional alar base cinch suture, and group II (31 patients) received the alar base cinch suture with an anchoring bite taken through the nasal septum 10mm behind its anterior edge. In both groups the accurate identification of alar fibroareolar tissue was facilitated by an 18 gauge green needle passed extra orally. Alar base width was measured before and 6 months after surgery using Vernier callipers. Preoperative alar base width for group I was 29.76 mm (1.901SD) and for group II 29.79 mm (3.141SD); the postoperative values were 32.42 mm (1.858SD) and 29.94 mm (2.568SD), respectively. Mean alar base widening was 2.661 mm (0.800SD) in group I and 0.145 mm (2.050) in group II. The difference in alar widening was statistically significant (p<0.001). In conclusion, the trans-septal modified alar cinch suture offers better control of alar base architecture in maxillary intrusion and setback.
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Affiliation(s)
- N Nirvikalpa
- Department of Oral & Maxillofacial Surgery, Saveetha Dental College & Hospital, Chennai, India.
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