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By Dr. Sanjay Purkayastha, BSc, MBBS, MD, FRCS, Laparoscopic, General and Bariatric Surgeon, Imperial College, London, United Kingdom
One Welbeck, Digestive Health and digestive surgery
The rise of machine learning and Artificial Intelligence (AI) technology has significantly transformed clinician training, and holds the potential to make an even greater impact in the future. This article will explore how technology has enhanced clinician training, how skeptics may feel about it, and the importance of better training for clinicians and patients alike.
Consider the field of surgery. As a laparoscopic general and bariatric surgeon for my public and private practice, (Imperial College NHS Healthcare Trust, London General Surgery Clinic, One Welbeck digestive surgery and King Edward VII’s Hospital, London), I have spent more than a decade gathering experiences since residency.
Prior to the advent of recent technology, in order to observe their own techniques, surgeons had to record all of their own operations with the approval of their patients and watch them back. This was originally data that had to be “burned” on to CD or DVD formats. Many surgical residents likely experienced what I did: after extensive self analysis, I could see that what I thought I was doing in the operating room (OR) in real time was not necessarily what I was actually doing. My trainers at the end of my training were not the sort that had the time to go over my videos and did not utilize video capture as part of their armamentarium to deliver more highly trained future surgeons. With my videos though, in the cold light of day, I was able to see that a different technique may have been a better choice for the patient.
Interestingly enough, this concept is not much different than professional athlete training. For example, some elite athletes record themselves to watch how they perform and work with experts to improve their form and technique. While athletes are focused on training for track or football, surgeons are training for surgery. Yet the surgeons’ work occurs in a different stadium – an operating theater.
Recording thousands of surgeries on CDs and DVDs took countless hours. Even as technology progressed to hard drives and flash drives, it still took a great deal of time to upload videos onto a laptop and then edit them.
Fortunately, technology now exists that streamlines this process. For example, the Touch Surgery™ Enterprise platform features the first smart surgical video recorder — the DS1 computer — to use AI-driven anonymization of sensitive surgical video frames.
Depending on where algorithms are for a team’s learning curve (for me, the AI has already learned all the basic procedures for bariatrics) the system will watch a clinician’s operation, and upload it at the end of the surgery onto a mobile device. It will then segment the surgery into the various steps and after the operation, clinicians will have a video that they can watch back.
The system also automatically anonymizes the case to protect patient privacy, and the different segments of the surgery can be tagged for easy identification of specific anatomy or processes. For example, a surgeon can click on stapling to look at what parts of the surgery involved stapling.
The lengths of these different sections are recorded and compared to the length of time that the sections typically take, and surgeons can create notes in a given section. For example, a surgeon can annotate where there were complications in the surgery that may explain why certain parts of the procedure took longer than usual when comparing to other videos in the library.
In the end, surgeons can have thousands of data sets of standardized, segmented procedures that their peers can watch on the Touch Surgery™ app on their mobile phones to train their brains on what to do, and what not to do, during surgery. This is an enormous feat when remembering that merely transferring one full surgery onto a laptop that only one person could see used to take hours, whereas this vast pool of organized data takes a matter of minutes to collect, edit and share with other clinicians.
This concept of digital, remote training, or “tele-mentoring” is not just important for honestly reflecting on one’s surgical methods after a real time surgery. It’s also exceptionally relevant right now as facilities continue to combat the COVID-19 virus, which limits the number of people who can be in the same room. For example, after a procedure, surgeons can maximize training opportunities by reviewing the procedure video together on a video call without being in the same room. Likewise, it opens up the door for training on a global scale. A surgeon in the United States can upload videos of their cataract surgery or cleft lip pallet surgery performances, which physicians in Africa and the Philippines can then watch on their phones and learn from. Now, recording and sharing surgeries with a broad network of surgeons truly knows no bounds.
Improving Patient Outcomes with Digital Files and Training
The idea of recording surgeries can seem intimidating — most likely, clinicians will immediately express concern about litigation. However, as caregivers, clinicians have a responsibility to be accountable for their surgeries and to continue to progress in their specialties. Recording surgery is really no different than automobile technology that exists to monitor one’s driving for a year in order to adjust insurance premiums. Transparency is the future of health care. We should be sharing what happens in the operating room and not hiding in there.
In fact, recording surgery can actually help avoid oversights.
For example, during a gastric bypass procedure, one of my needles broke off of the suture and instantly disappeared into the operative field. When my staff members and I reversed the recording in slow motion — during the case — we could see exactly where the needle went and were able to remove it without any adverse events. We called it a needle in a haystack. At the time, there was no protocol for how to find a needle if it disappears, and now with the capabilities this technology offers, we have developed practices to help identify other sources of intraoperative complications.
Final Takeaways and Future Outlook
In conclusion, digitizing surgery, especially using AI, brings important opportunities to the OR for clinicians and their patients. It’s clear that advancements in technology can really help enhance training for clinicians, which is crucial for successful outcomes.
The surgical experience is only one example of many that showcases the importance of quality training and how technology can support it. Technology will only continue to advance, putting the entire health care field on the precipice of exciting new ways to improve clinician and patient experiences.
Note: Dr. Purkayastha was involved in the development of the Touch Surgery™ training app and continues to be an early adopter of the technology. Touch Surgery™ Enterprise is not intended to direct surgery, or aid in diagnosis or treatment of a disease or condition.