The Future of Surgery is More Than Robots
September 22, 2023
Countless players in the healthcare technology space want to build a better robot for Minimally Invasive Surgery (MIS). After all, surgical robotics companies have seen great success enhancing mechanical manipulation and producing instruments that can navigate with extreme precision in tight spaces. But the real question is whether these robots have improved patient outcomes compared with traditional MIS — and the data is inconsistent at best.
Augmented Intelligence has the potential to provide a standard of care beyond what mechanical manipulation alone is capable of. During surgery, it has the potential to function as a digital assistant, a second set of eyes offering recommendations, suggestions, and enhanced visual direction. Augmented Intelligence is used today in Asensus’ Senhance® Surgical System. In the near future, this technology could provide surgeons with real-time insights, analyzed and extracted from past procedures around the world.
Is this digital surgery technology what’s next for the OR? Let’s take a closer look at what it can do right now and what it has the potential to become.
Enhancing, not Replacing
The term “Augmented Intelligence” is easily confused with “artificial intelligence,” but the key difference between these two is that Augmented Intelligence is designed to enhance human abilities rather than replace them. While artificial intelligence typically takes over tedious or repetitive tasks so that a human doesn’t have to manage them, Augmented Intelligence requires active participation.
“We are walking a very robust line not to take away the final decision of the surgeon,” says Anthony Fernando, President and CEO of Asensus Surgical. “It’s a bit like flying a commercial airplane—there are two pilots, and they have the ability to override anything if the need arises. But if not, they just keep accepting the next step.”
Augmented Intelligence is a tool to reduce mental burden and provide peace of mind, but the presence and judgment of a surgeon is necessary to review and accept its suggestions. The OR is a stressful work environment, and surgeons put in long hours on the days they operate. Having the technology to reduce fatigue also means reducing the risk of complications when the stakes are high — an appealing prospect for surgeons, patients, and hospitals alike.
According to Fernando, artificial intelligence in surgery isn’t impossible, but it is “relatively far away.”
“I do not believe we will see artificial intelligence at play anytime soon, because there’s someone’s life on the other side,” he says. “No one’s going to take that risk. Augmented Intelligence can be implemented today.”
Asensus is currently the only company with FDA and CE approval to use Augmented Intelligence during surgery. Other companies may have the capability to use this technology before and after a procedure, but this doesn’t create the same potential to impact patient outcomes.
So, what does having a real time “digital assistant” accomplish, and what would change if it were adopted more broadly? This leads us to consider a few more questions.
What if We Could Increase Efficiency and Reduce Waste?
A surgeon needs to suture the right amount of mesh to repair a hernia defect. Too little could result in recurrence, too much could result in bulging or shifting. For the best possible outcome, exactly the right amount of material is required.
Augmented Intelligence tools have the potential to measure the defect more efficiently, helping surgeons to determine the correct amount of mesh to use. While using more mesh than necessary is a relatively small example of inefficiency, Augmented Intelligence could reduce both waste and operative time. By providing anatomical measurements and digital tagging features, Augmented Intelligence would be able to create efficiencies that many surgeons and hospitals aren’t considering today.
What if We Could Increase Standardization?
Gallbladder surgery is one of the most common MIS procedures. During surgery, one of the complications that can occur is inadvertent injury to a common bile duct. One of the features to prevent this complication is critical anatomy identification to highlight the bile duct and avoid potential injury. This is one example of how Augmented Intelligence would be able to bridge gaps in experience, leading to a higher level of predictability and standardization overall.
Another example comes from bariatric surgery: digital tools would be able to automatically measure the point of resection for a sleeve, thereby standardizing and optimizing sleeve gastrectomy. As this technology continues to evolve, standardized approaches to increasingly varied, complex procedures could lead to improved outcomes for more patients.
What if We Could Help Avoid Complications?
During gynecology or lower pelvic procedures, surgeons carefully avoid damaging the ureter. And as mentioned previously, care must be taken when dissecting around the cystic duct and cystic artery during a cholecystectomy. But human error is always a possibility. One potential feature of Augmented Intelligence is the ability to automatically identify critical structures of anatomy, as well as allow surgeons to manually set up “no fly zones.” Once these areas are identified, the instrument handles can vibrate slightly when they’re brought too close, cueing the surgeon to move away. This is similar to how cars with collision avoidance systems will beep when the driver comes too close to backing into a wall.
This safety feature would elevate the practice of surgery beyond where robotics alone has taken us, affecting not just how, but where the instruments move. By reducing the possibility of error, Augmented Intelligence could create a layer of protection that surgery hasn’t seen yet on a larger scale.
The Missing Piece
While surgical robots are becoming more commonplace, surgery is still performed by people. No matter how impressive robotic systems may be in terms of dexterity or precision, they do little to address what causes complications, waste, and inefficiency. Only by reducing the ambiguity of surgery and making operations more predictable can we expect advanced robotics systems to become innovative solutions for better care. This is exactly what Augmented Intelligence sets out to accomplish.
“Robotic surgery as we know it today is going to go away,” Anthony Fernando says. “The future is going to be digital surgery. Yes, there will be robotic manipulation, but it’ll have intelligence built in.”
An engineer by training, Fernando has observed what generally happens when technological advancements are introduced: quality and productivity go up while cost goes down. Only in surgery, with the addition of surgical robotics, did he observe a reversal of those trends: cost goes up, quality doesn’t improve, and it takes more time to perform the same procedure. By layering in Augmented Intelligence, hospitals and surgeons may soon see the same changes to surgery that are affected by technology in other industries. Augmented Intelligence has powerful potential to be the most patient-centric, cost-effective, responsible, and forward-thinking option for MIS.
“Technology didn’t help the [patient’s] outcome,” Fernando says. “That doesn’t mean it's bad technology. The missing piece is, you’re still limited to the surgeon’s ability to perform the surgery. All humans have limitations and mental capacities—but a computer does not. That’s why digitizing is the next frontier.”
Learn more about the potential of Augmented Intelligence in our recent whitepaper: “Augmented Intelligence: The Answer to Surgery’s Shortcomings”