Authors: Zheng Minhua, Ma Junjun, Dai Kefan, Li Shuchun
Source: Chinese Journal of Digestive Surgery, 2024, 23(4)
summary
After nearly 40 years of development, minimally invasive techniques have been widely used in radical resection of various tumors, and its safety and efficacy have been fully verified. With the continuous update and iteration of related medical devices and equipment, the convenience and accuracy of surgery have been significantly improved, and the development of minimally invasive surgery has entered a high plateau. With the rapid development of information technology, researchers have gradually entered the era of smart medicine, and the integration of artificial intelligence and other technologies will inject new vitality into the development of minimally invasive surgery. Based on the most cutting-edge research trends, the author deeply analyzes the unique role of artificial intelligence in the key links of minimally invasive surgery, such as preoperative assessment and planning, intraoperative monitoring and early warning, and postoperative comprehensive management. At the same time, the author also discusses how to use these innovative technologies to further promote the reform of medical education, and looks forward to the development of telemedicine services. In the era of smart medicine, the development of minimally invasive surgery should follow the principle of "bold innovation and careful practice" and adhere to the concept of "people-oriented" as the guide. By continuously promoting interdisciplinary cooperation between medical and engineering disciplines, we will accelerate the transformation of scientific and technological achievements into clinical practice to ensure that minimally invasive surgical technology can better serve the health and well-being of the people.
The successful development of the world's first LC in 1987 was the first year of the development of minimally invasive surgery. In the following years, the theme of how to expand the scope of laparoscopic surgery and how to popularize it became the theme. In the early 90s of the 20th century, the exploration of minimally invasive surgery in the field of malignant tumors began. After 2000, the development of minimally invasive technology and related equipment and instruments has advanced by leaps and bounds, and the key word has become the development of various micro-innovative technologies, such as robot-assisted surgery, dual-mirror combined surgery, 3D, 4K laparoscopy, etc. At present, we have entered the era of smart medicine, and precision medicine, especially AI-enabled minimally invasive technology, has developed rapidly. In 2024, AI will become the only keyword for scientific and technological development, and AI is expected to replace 95% of human jobs in the future, which will bring great changes to human health care, medical education, medical research, medical equipment, medical models, and surgical techniques. In this context, the future development of minimally invasive surgery has also attracted everyone's attention and needs to be further discussed. Based on the most cutting-edge research trends, the author deeply analyzes the unique role of AI in key aspects of minimally invasive surgery, such as preoperative assessment and planning, intraoperative monitoring and early warning, and postoperative comprehensive management. At the same time, the author also discusses how to use these innovative technologies to further promote the reform of medical education, and looks forward to the development of telemedicine services.
First, the rise of the era of smart medicine
Smart medicine is a recent rise of proprietary medical terms, is a set of integration of the Internet of Things, cloud computing and other technologies, patient data as the center of the medical service model, which uses the Internet of Things technology to achieve the interaction between patients and medical staff, medical institutions, medical equipment, and with the help of digitalization, visualization mode, so that limited medical resources can be shared to more patients. At present, the application scenarios of smart medicine in mainland China are very extensive, mainly including remote consultation, remote surgery, remote examination, emergency rescue and other telemedicine applications; In addition, there are also in-hospital application scenarios such as smart guidance, smart hospital management, mobile medical care, and AI-assisted diagnosis and treatment. In the smart medicine or smart medical system, disease prevention and health management can be carried out in clinics, pharmacies or even patients' homes, simple disease diagnosis and treatment operations can be undertaken by clinics or primary hospitals, and auxiliary examinations, such as imaging examinations and laboratory index tests, can be undertaken by third-party institutions. In most mature markets, the core services of smart hospitals will focus on surgical treatment, intensive care, and diagnosis and treatment of difficult diseases, mainly with minimally invasive technology as the mainstay. In mainland China, limited by the capacity of primary care, the evolution of the role of smart hospitals is different from that of mature markets. The author predicts that in the next 10 years, domestic hospitals will still play the most important role in the medical service system, taking into account both outpatient and inpatient tasks, leading grassroots institutions to form a medical alliance/medical community, and jointly undertake the health management of residents in the region.
2. Smart medicine and minimally invasive surgery
Taking the development of minimally invasive surgery as an example, in the past, researchers usually paid more attention to the research at the level of pure surgical technology, but now they need to pay more attention to the accurate diagnosis and preoperative surgical planning at the front end, to the accurate recognition and precise anatomy of surgical images during surgery, to the all-round postoperative management, follow-up diagnosis and treatment plan formulation and prognosis evaluation, etc., The AI smart medical platform based on clinical big data will participate in the whole process management of the perioperative period and create a new model of smart surgery.
(1) Preoperative planning and accurate diagnosis
AI-empowered decision-making based on powerful computing power can accurately diagnose patients before minimally invasive surgery, accurately assess the difficulty of surgery, and plan surgical plans in detail. For example, based on the patient's CT-enhanced examination images, combined with AI-enabled 3D liver reconstruction technology, the location of intrahepatic lesions and their relationship with important blood vessels can be displayed in a full-dimensional perspective, and the remaining liver volume after surgery can be accurately estimated through AI-assisted measurement and calculation, so as to determine the safe scope of surgical resection, ensure the radical curability and tumor safety, and reduce the risk of postoperative liver failure. In addition, for some standard procedures, videos of previous minimally invasive surgeries can provide rich training data for the training of surgery-related AI models. Japanese scholars reported that the complexity of surgery can be assessed through artificial intelligence analysis of patients' clinical data and robotic surgical videos, and the corresponding model has a high accuracy in assessing surgical complexity, with an area under the receiver operating characteristic curve of 0.913. This can guide the prediction and prevention of surgical risks.
With the exploration and application of technologies such as virtual reality, augmented reality and mixed reality in the field of minimally invasive surgery, these technologies are gradually being applied to scenarios such as simulation training, surgical plan planning, preoperative conversation and intraoperative visual navigation. It is expected to provide more auxiliary information for surgery by fusing it with preoperative CT, MRI and other imaging data. Previously, Ryu et al. reported that in laparoscopic left hemicolectomy, the Microsoft Hololens2 wearable mixed reality device was used for intraoperative 3D holographic navigation to assist colon vascular root ligation and lymph node dissection, and the system achieved good results in showing colonic vascular variation and assisting lymph node dissection. However, due to the susceptibility of the organs in the abdominal cavity to factors such as respiration, pneumoperitoneum, body position, and intraoperative traction, the superposition of the 3D model reconstructed by imaging data and the laparoscopic direct view image often has relative displacement, which affects the positioning accuracy. Therefore, the author believes that there are still many problems to be solved urgently in the large-scale application of visual assistive technologies such as distance augmented reality in clinical practice.
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Progress and prospect of minimally invasive surgery in the era of smart medicine
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