The evolution of Minimally Invasive Surgery (MIS) has brought about numerous benefits to patients, including less pain, fewer complications, and shorter hospital stays. But one unintended consequence of laparoscopy and robotic surgery has received less attention than these advantages. The same technological advancements that enable greater precision and reduce invasiveness have also put more distance between the surgeon and patient—not just by creating physical distance, but by reducing the sensory information surgeons have available to make decisions.
Dr. Ed Chekan, the VP of Medical Affairs and Professional Education at Asensus Surgical, gives this example: “Using clamps [in surgery] is much better than using your fingers to stop the bleeding. But you’re also distancing yourself: do you need to clean that clamp? How do you lubricate it? Is it wearing out? Surgery just keeps getting better and better in one sense, but it creates bigger and bigger challenges as we put technology between the surgeon and the patient… there are trade-offs that you didn’t have before. And when they start to pile up, they become problems.”
Because MIS limits the ability to physically feel tissue and changes the view of patient anatomy, surgeons have adapted to operating from a different perspective. In many cases, they’re working with less intuitive information.
So what can we do when surgical advancements appear to put us at a disadvantage? Offset the information gap with digital solutions that substitute for the sensory information surgeons are lacking.
Augmented Intelligence Enhances Decision-Making
The Senhance® Surgical System from Asensus uses an advanced digital tool for soft tissue surgery called Augmented Intelligence. During an MIS procedure, Augmented Intelligence is designed to function as a digital assistant, providing tools for enhanced precision, measurement, and efficiency. These digital tools will soon give way to insights that could compensate for the loss of sensory information that occurs when a surgeon operates in a minimally invasive way.
“The foundation of Augmented Intelligence is image recognition,” says Anthony Fernando, the President and CEO of Asensus. “If you take an image and recognize it, you can take ten thousand images and start to see patterns. Once you see patterns, they can become insights.”
By recognizing and annotating images, Augmented Intelligence could elevate a surgeon’s ability to navigate the surgical view with greater confidence and efficiency. When deciding if tissue is viable for suturing without being able to physically feel it, for instance, Augmented Intelligence would be able to fill in for any lingering uncertainty by comparing the image in question to thousands of other images and immediately informing the surgeon of what it finds.
Setting Guard Rails
In time, Augmented Intelligence will be able to recognize anatomical structures to avoid during a procedure. These areas become “no fly zones'' that surgeons will be cued to move away from if the instruments get too close. This technology could even have the potential to provide haptic feedback when a surgeon navigates too closely to an area that’s off-limits: the controls would slightly vibrate, a tactile reminder to steer clear.
These features will provide peace of mind for both the patient and the surgeon. With all the distractions of the OR and the level of focus required during surgery, Augmented Intelligence could offset the distance technology creates for greater assurance with each move.
Another way that Augmented Intelligence might offset the information gap is through visual assistance. When preparing to make a very precise cut, the technology can highlight target areas on the screen and offer other visual cues to assist.
There are several philosophies on what the ideal sleeve configuration should be with one consistent element being the assessment of the distance from the pylorus to start the resection. A variety of measurement tools are available today to accomplish this measurement task that fall within a wide range in terms of accuracy and precision. However, despite a lack of evidence on what the optimized distance should be, it’s clear a more accurate measurement methodology is needed. While the intent of technology is not necessarily to influence or dictate the preferred philosophy of antrum resection or antrum preservation, having objective measurement data can aid in informing the surgical process.
“Before Minimally Invasive Surgery, you opened the abdomen and took care of the problem—there was no ‘approach.’ It was just an incision,” says Dr. Chekan. “Now we have all different approaches to minimize incision size, and different positionings for [the technology involved]. That in and of itself then creates the possibility that we might miss something.”
During laparoscopic procedures, surgeons carefully check for new pathologies or anything else unexpected. Augmented Intelligence could provide assistance by identifying subtle abnormalities—even those outside of a surgeon’s current field of view. This new level of awareness elevates a surgeon’s capabilities. As a “digital assistant,” Augmented Intelligence would offer a second set of eyes, which offsets the new challenges of physical positioning and distraction presented by having more advanced robotics in the room.
Bridging the Gap
Technology has solved many of the issues surrounding surgery throughout the ages. But even technological innovation comes with side effects.
“We think that medicine [provides us with] all this information—but it’s data overload!” Dr. Chekan says. “As we’re getting digital information, we’re also creating crucial information gaps through some of the things that we’re doing—and that has implications.”
The first step to addressing those implications is acknowledging them. And then? We start leveraging Augmented Intelligence to substitute for the sensory information that has been slipping away as MIS has advanced.
It’s time for a new kind of tech in surgery—advancements that increase the surgeon’s ability to make decisions, not just move instruments.
Learn more about how Augmented Intelligence can bridge the information gap in medicine from our recent whitepaper, “Augmented Intelligence: The Answer to Surgery’s Shortcomings”