The Future of Surgery? 🤖 3 Ways AI is Changing the OR

EDITOR’S NOTE

Dear Nanobiters,

Imagine this: You are lying on an operating table, about to undergo surgery for endometriosis.

But there's a twist – the surgeon isn't even in the same room! He's miles away, expertly guiding robotic arms with the precision of a maestro conducting a symphony.

This, my friends, is the reality of robotic surgery, a cutting-edge technology transforming the medical landscape.

In this issue of Nanobits Industry Focus, we'll explore the impact of AI in Robotic Surgery, its current applications, its challenges, and its potential to shape the future of healthcare.

But more importantly, we'll examine the potential of RAS (Robotic Assisted Surgery) to transform healthcare, offering less invasive procedures, faster recovery times, and improved patient outcomes worldwide.

Buckle up because the future of surgery is here, and it's nothing short of extraordinary! 😷 ✂️ 

In Today’s Newsletter:

• Robots Make History with the First Fully Robotic Heart Transplant in Saudia Arabia

• SSI Mantra Robotic System Ushering a New Era of Pediatric Surgical Care

• Beyond the Scalpel: The Cutting Edge of AI in Robotic Surgery

TOP NEWS
Teen Gets World's First Fully Robotic Heart Transplant

Surgeons at King Faisal Specialist Hospital and Research Center in Saudi Arabia have performed the world's first fully robotic heart transplant. This groundbreaking procedure lasted two and a half hours and marked a significant milestone in robotic surgery.

Why is it relevant?
AI-powered robotic surgery is transforming the industry, offering patients faster recovery times, reduced complication risks, and improved quality of life. This innovative procedure demonstrates the potential of robotic surgery to transform the way complex surgeries are performed, paving the way for new possibilities in healthcare services and elevating the quality of life for patients globally. Read More

TOP NEWS
Tiny Tot Gets Kidney Fix with Made-in-India Robot Surgeon

The SSI Mantra Surgical Robotic System has successfully performed a urology procedure on a one-year-old infant with a kidney condition in Hyderabad, India. This marks a significant milestone in pediatric robotic surgery and demonstrates the capabilities of the Made-in-India robotic system.

Why is it relevant?
This achievement highlights the potential of indigenous Indian innovation to transform surgical care, making it safe, precise, and affordable for all. The SSI Mantra System's cost-effectiveness and accessibility make it a game-changer for the healthcare industry, particularly in developing countries with limited access to advanced medical care. This success story marks the beginning of a new era in Indian medical surgery, where innovation meets affordability and accessibility to redefine surgical excellence. Read More.

NANOBITS RESEARCH
The Rise of the Robot Surgeons: AI is Scrubbing In!

The global AI-based surgical robots market is expected to grow from $7.5 billion in 2023 to $25.2 billion by 2030 at a CAGR of 18.9%.2032. That's a huge jump, with an expected CAGR of ~24% over the next decade.

Key Drivers of Growth of AI in Robotic Surgery

This explosive growth can be attributed to the following reasons:

Increasing prevalence of chronic disorders globally: As the number of people suffering from chronic diseases rises, the demand for surgical interventions also increases. This, in turn, drives the need for more efficient and precise surgical techniques, such as those offered by AI-based surgical robots.

Technological advancements in automated robotic surgeries: The continuous development and refinement of AI algorithms and robotic systems have led to significant improvements in the capabilities and performance of surgical robots. These advancements make the procedures more precise, less invasive, and safer for patients.

Increased efficiency and success rate of robotic surgery: AI-based surgical robots offer several advantages over traditional surgical methods. They allow for greater precision and control, leading to better surgical outcomes and faster recovery times. These benefits contribute to the growing popularity of robotic surgery.

Rising trend of using minimally invasive medical devices: Minimally invasive surgery is becoming increasingly popular due to its reduced trauma, shorter hospital stays, and fewer complications. AI-based surgical robots are well-suited for minimally invasive procedures, contributing to the market's growth.

The growing integration of AI in automated robotic surgeries for clinical decision-making: AI algorithms can analyze vast amounts of data and provide real-time insights to surgeons during surgery. This can aid decision-making, improve surgical planning, and enhance overall surgical performance.

AI and robotics being preferred by surgeons worldwide: Surgeons are increasingly recognizing the benefits of AI-based surgical robots. The minimally invasive nature of these procedures and the enhanced precision and control offered by AI make them a preferred choice for many surgical specialties.

Quick recovery and less blood loss than standard procedures: AI-based robotic surgeries typically involve smaller incisions and less tissue damage, resulting in faster recovery and reduced patient blood loss.

AI-assisted surgical robots help surgeons with decision-making, speech recognition, and problem-solving: AI algorithms can assist surgeons in various tasks during surgery. They can analyze images and data, provide real-time guidance, and even understand and respond to voice commands. This assistance can enhance surgical efficiency and accuracy.

There is growing concern about the shortage of medical professionals globally. The demand for surgical procedures is increasing, while the number of qualified surgeons remains limited. AI-based surgical robots can help address this shortage by assisting surgeons and allowing them to perform more procedures.

Increasing trend to practice medical procedures using technology-based approaches: There is a growing trend towards incorporating technology into healthcare practices. AI-based surgical robots represent a significant advancement in this direction, driving market growth.

Upsurge in adopting AI-based robotic instruments for various applications: AI-based robots are finding applications beyond traditional surgical procedures. They are being used for tasks such as cancer detection, scan analysis, and instrument positioning. This wider adoption further fuels market growth.

Increase in strategic activities by manufacturers, such as acquisitions, mergers, partnerships, and technological advancements: Leading companies in the surgical robotics market are actively engaged in strategic initiatives to strengthen their position and expand their product offerings. These activities include acquisitions, mergers, partnerships, and investments in research and development.

Growing prevalence of chronic diseases and increasing preference for robot-assist procedures: As the burden of chronic diseases continues to rise, the demand for robotic-assisted surgeries, which are often more precise and less invasive, is expected to increase.

Technological advancements and increased adoption of AI-equipped surgical robots: Continued advancements in AI and robotics drive the development of more sophisticated and capable surgical robots, leading to their wider adoption in healthcare institutions.

Shifting towards robot-assisted surgeries to clear the pending backlog of elective surgeries: After the disruptions caused by the COVID-19 pandemic, hospitals are increasingly turning to robotic-assisted surgeries to address the backlog of elective procedures.

Increase in preference for robotic surgery in the post-pandemic period due to its advantages: The advantages of robotic surgery, such as reduced need for manpower and lower chances of disease transmission, have become more prominent in the wake of the pandemic, further boosting its adoption.

Applications of AI in Robotic Surgery

The following figure illustrates the predicted applications of AI in surgery.

Here is a breakdown of the various AI applications across different surgical domains  spanning the entire patient journey from screening to follow-up:

Preoperative Stage:

• Population Screening: AI can transform population-wide screening strategies by analyzing medical images, such as mammograms, for early and accurate cancer detection. AI-powered tools can also triage clinical data into risk categories, enabling clinicians to prioritize high-risk cases and streamline data processing.

• Diagnosis of Symptomatic Patients: AI algorithms, particularly those leveraging deep learning techniques, analyze medical images to diagnose various surgical conditions. These include diagnosing retinal disease in ophthalmology, detecting colorectal polyps during colonoscopy, and identifying fractures, prostate cancer, intracranial hemorrhages, and thyroid cancer, among others. AI can also analyze patient-physician consultations using NLP, extracting and summarizing information to support diagnostic workflows.

• Preoperative Risk Prediction: AI can improve the accuracy of preoperative risk assessment tools by analyzing large and diverse datasets to model non-linear relationships between variables. This allows for more personalized risk prediction based on patient characteristics and operative factors, enhancing surgical planning and informed consent.

Intraoperative Stage:

• Intraoperative Guidance: AI-powered computer vision algorithms are being developed to analyze surgical videos, providing real-time guidance to surgeons during procedures. While still in the early stages, this technology can improve surgical accuracy and safety, especially in challenging operations.

• Operative Robotics: AI is being integrated into robotic surgery to enhance its capabilities further, such as motion analysis, instrument recognition, improved haptic feedback, and task completion. This highlights AI's potential to enable truly autonomous operative robots, although significant ethical and practical considerations remain.

• AI in Surgical Training: AI has massive potential to transform surgical education and training. The abundance of operative videos can be leveraged for AI-powered analysis, providing students and trainees with detailed insights into procedures, anatomical landmarks, and potential errors.

Postoperative Stage:

• Postoperative Care: AI can predict and manage postoperative complications by analyzing pre- and intraoperative data. AI algorithms are being developed to predict anastomotic leaks, surgical site infections, bleeding, and complications following bariatric and liver surgery.

• Effective Discharge Planning: AI can assist in optimizing discharge planning by predicting the optimal timing for safe discharge, potentially reducing inpatient stays and improving patient flow.

• Patient Follow-Up: AI-assisted systems are being explored to automate patient follow-up, collect feedback on recovery progress, answer queries, and triage concerns with clinicians.

Top Tech Companies Pioneering the AI Revolution in Robotic Surgery:

Robotic surgery involves a collaborative effort between the surgeon and the machine. Sophisticated surgical robots comprise interconnected components – instruments, sensors, and software – working together to provide real-time feedback and data that can enhance a surgeon's decision-making during minimally invasive procedures.

Intuitive's Da Vinci Platform includes a console and interconnected systems, software, and instruments. It allows surgeons to perform minimally invasive procedures with enhanced dexterity, magnified 3D visualization, and the ability to collect and analyze data.

A groundbreaking achievement in AI robotic surgery occurred in Barranquilla, Colombia, where a robot dentist, developed by US-based company Perceptive, successfully performed the world's first fully automated dental procedure on a human.

The procedure involved using a robotic arm, artificial intelligence, and 3D imaging. The technology scanned the patient's mouth, analyzed the collected data, and then used a series of specialized tools to complete the dental work.

Although the company anticipates a multi-year wait for US regulatory approval, it claims its technology can significantly reduce the time required for crown placement, completing the procedure in approximately 15 minutes versus the typical two hours.

Vicarious Surgical's Robotic System: This system allows precise operations using tiny human-like arms. These arms have multiple sensors for accurate movement replication and allow small incisions, minimizing patient trauma.

Japan's first surgical robot is the Hinotori, a robotic-assisted surgery system produced by Medicaroid. As of 2022, it has won approval for use in prostate, stomach, colon, and uterus cancers.

Asensus Surgical's Senhance Surgical System: This system uses an eye-controlled camera, alerts for excessive pressure or tension, and reusable equipment for a cost-effective surgical option.

The two leading companies developing surgical robots for cataract/IOL (intraocular) surgery are ForSight Robotics and Horizon Surgical Systems.

Stryker Corporation’s MAKO Surgical Robotic Arm: This robotic arm is designed for hip and knee replacements and has been widely adopted by surgeons for joint replacement surgeries.

The PLA General Hospital's urology team used a remote surgical robot to perform a minimally invasive surgery during a conference in Rome. This surgery, facilitated by AI, was conducted across a significant distance and showcased the integration of robotics, remote communication, and AI in surgical practice.

Caresyntax offers a "surgical intelligence platform" that uses AI to collect and analyze data during surgeries, improving surgical outcomes and efficiency. This platform, which can connect to various robotic surgery tools and operating room equipment, gathers information from patient details to surgical videos. Caresyntax aims to become the "Android of robotic surgery" by creating an open ecosystem that enhances surgical practices through AI insights.

Medtronic's Mazor X Stealth Robotic Platform improves the accuracy and safety of procedures in spine surgery.

Medtronic's new Live Stream function enables secure live streaming of surgical procedures, using AI to transform these videos into actionable insights for surgeons. 

It is part of the Touch Surgery ecosystem and aims to create a virtual learning environment for surgeons and trainees while giving them access to expert techniques.

India's adoption of robotic-assisted surgery (RAS) dates back to the early 2000s, with Intuitive's da Vinci system dominating the market.

Gastroenterology, urology, and gynecology are among the specialties where RAS is frequently employed, though its use has also extended to certain spinal and cardiothoracic procedures.

Recent estimates value the Indian RAS market at approximately $300 million.

Intuitive India's general manager and vice president noted a huge demand for RAS post-COVID; some are coming from standalone hospitals and hospitals outside tier-1 cities that are also looking to benefit from its shorter recovery times.

Several public and private hospitals are establishing RAS units and surgical theatres using different robotic surgery systems, including da Vinci, Renaissance Robotic Technology, Hugo RAS System, CMR Surgical's Versius System, and CORI Surgical System by Smith+Nephew.

Dr. Sudhir Srivastava, a cardiologist with experience on the da Vinci system, has developed the SSI Mantra, a more affordable robotic surgical system produced domestically.  Launched in 2021, the SSI Mantra aims to increase accessibility to robotic surgery and has already been installed in five Indian hospitals, with plans to manufacture and sell over 1,000 units by 2030.

Doctors from Rajiv Gandhi Cancer Institute and Research Centre in Rohini, New Delhi, performed the first telesurgery using the indigenous surgical robot SSI Mantra for a patient with urinary bladder cancer. The procedure was conducted remotely from Gurgaon (Haryana), 40 km away, with the surgeon controlling the robotic instruments through a console.

Misso is an AI-powered surgical robot developed by Meril Life Sciences specifically for knee replacement surgeries. This robot assists surgeons with personalized pre-operative planning and precise cutting during the procedure, using 3D CT scans and AI-based segmentation to create individualized surgical plans. Misso aims to improve the precision, safety, and affordability (reduce cost by 66% compared to imported technologies) of knee replacement surgeries in India.

Kne3wiz (founded in Ahmedabad, India) is a company that created Robo3wiz Roboalign Hololens 2, an AI-powered system that uses smart glasses to enhance the precision of joint replacement surgeries. This system overlays 3D models of the patient's anatomy, virtual incision guides, and real-time data about implant positioning directly onto the surgeon's field of vision, improving accuracy in complex knee, hip, and shoulder replacements.

In a ground-breaking development that is set to transform the field of joint replacement surgery, renowned surgeon Dr. Aashish Arbat from Pune has launched a first-of-its-kind AI-powered innovation in robotic joint replacement surgery in August this year.

Integrating AI in robotic surgery offers significant opportunities but has several risks that must be carefully managed.

Here are some of the key risks and mitigation strategies:

Ethical Dilemmas and Decision-Making:

• Risk: AI-powered risk prediction tools offer valuable support for surgical decision-making but can also create ethical challenges. For example, if a surgeon chooses to disregard a tool's recommendation, questions of responsibility and liability arise in case of complications.

• Mitigation: Establish robust guidelines and frameworks to guide clinicians using AI tools. AI should be viewed as one of several factors informing clinical judgment, and clear protocols should be in place to address potential conflicts between AI recommendations and a surgeon's clinical assessment.

Data Bias and Drift:

• Risk: AI algorithms are susceptible to bias stemming from the data they are trained on. This can lead to inaccurate predictions and potentially exacerbate healthcare inequalities, particularly for underserved populations. Data drift, the divergence between training data and real-world data, also challenges the accuracy and reliability of AI systems.

• Mitigation: Implement bias and drift mitigation strategies at various AI development and deployment stages. This includes carefully considering data sources, population representation in training datasets, and ongoing monitoring of model performance in real-world settings.

Cybersecurity and Data Privacy:

• Risk: Widespread adoption of AI in surgery necessitates handling large volumes of sensitive patient data. This creates vulnerabilities to cybersecurity breaches, potentially leading to data leaks, corruption, or loss of privacy.

• Mitigation: Build robust data governance frameworks and secure data environments to protect patient information. Data de-identification and strict adherence to privacy regulations are crucial for maintaining patient trust and ensuring responsible data management.

Patient Safety:

• Risk: While AI offers the potential to improve patient outcomes, its improper implementation can pose risks to patient safety. Overreliance on AI systems without appropriate human oversight or a lack of understanding of their limitations can lead to errors and adverse events.

• Mitigation: There is an urgent need for rigorous testing and validation of AI systems before clinical deployment. Integrating AI research and implementation within established patient safety models like the Donabedian model or the Systems Engineering Initiative for Patient Safety (SEIPS) model can help evaluate the impact on patient safety and mitigate potential risks.

Transparency and Explainability:

• Risk: The "black box" nature of some AI algorithms, where the reasoning behind their predictions is unclear, can create challenges for clinicians in understanding and trusting their recommendations.

• Mitigation: Reporting guidelines and quality assessment standards for AI research, such as SPIRIT-AI, CONSORT-AI, and DECIDE-AI, are being developed. These frameworks aim to improve transparency and ensure the reporting of essential information, enabling better evaluation of the safety and effectiveness of AI interventions.

Future Trends of AI in Robotic Surgery

The future of AI in robotic surgery is poised for a dramatic evolution, moving from a supportive role to potentially taking the lead in surgical procedures.

BrainBridge has released a concept video of its planned system that uses robotics, AI and precise imaging to perform head transplants.

Here's what we can expect:  

Near Future:

• AI as a surgical assistant: AI will continue to augment surgeons' capabilities, providing real-time insights, improving precision, and aiding in decision-making during operations. This collaborative approach enhances safety and efficiency.  

• AI-driven diagnostics and consultations: Conversational AI models will interact with patients, analyze their conditions, and recommend treatment plans, all while providing empathetic and human-like interaction.

Distant Future:

• Autonomous surgical robots: Advanced robots with sophisticated AI could perform complex surgeries independently, particularly in remote or high-risk environments. This would transform healthcare access in underserved areas.  

• Surgeon-controlled humanoids: Surgeons may operate remotely through advanced interfaces, controlling robotic humanoids or swarms of microbots to perform intricate procedures with enhanced dexterity and precision.

• AI exceeding human capability: As AI evolves, it may eventually surpass human surgeons in skill and decision-making, potentially becoming the gold standard for surgical care.

This future is closer than we think.

Major healthcare and technology players are investing heavily in AI, integrating it into everything from administrative tasks to performing surgeries.

As AI technology continues to evolve, we can expect even more groundbreaking innovations that will redefine robotic surgery and the overall medical robot landscape and shape the future of healthcare.