The Future Points to Performance-Guided Surgery

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New era in surgery leverages augmented intelligence and deep learning capabilities to improve surgical outcomes 

By Anthony Fernando, Asensus Surgical President & Chief Executive Officer

Even before the pandemic fueled society’s digital transformation, every industry has been looking for ways to automate and digitize its processes to increase efficiencies, improve experiences and outcomes, and maintain competitiveness. Digital transformation in healthcare has tremendous potential, especially in surgery, but also faces significant challenges and is not moving at the same pace as in other industries. Given that surgical care accounts for roughly 30% of total healthcare expenditures and 50% of inpatient spending, there is a clear need to accelerate technology innovation with augmented intelligence (AI) and machine learning in the OR to give surgeons and staff the tools and Clinical Intelligence to improve outcomes and reduce costs.

The impending surgeon shortage, pressure to shift to value-based care, and an aging and increasingly complex patient population only further amplifies the need to evolve surgery into a new standard called Performance-Guided Surgery™. This article highlights the market drivers and next-level technology that is driving this new standard forward. 

Opportunity for Continued Progress 

Despite the healthcare industry lagging behind many other sectors in terms of integrating technology, there have been some noteworthy advancements over the past twenty years. From genome sequencing to 3D printing of artificial limbs and blood vessels, to electronic health records and mRNA vaccines, digital transformation has significantly enhanced the overall experience of both healthcare professionals and patients. The one area that has remained somewhat stagnant is surgery.  

Twenty years ago, robotic-assisted surgery (RAS) was introduced, which used computer and software technology to facilitate minimally invasive surgery and assist with complex tasks in confined areas of the body with more precision, flexibility and control than is possible with conventional techniques. Its initial clinical application was in urology and expanded into gynecology, converting open surgery to minimally invasive. For patients, this resulted in smaller incisions, shorter recovery time, and less pain. Eventually RAS expanded into some colorectal and bariatric procedures, however, today robotic surgery accounts for only 4.4% of the market and offers unquantified improvement over traditional laparoscopy.

It wasn’t until 2017 that the interface between the surgeon and patient was digitized (Digital Laparoscopy), providing the benefits of RAS with expanded control and Clinical Intelligence while performing laparoscopy—which is the most common type of surgery. Digital Laparoscopy goes beyond robotics and integrates additional technological advances to help surgery become more instinctive, more responsive, and more focused. In return, this creates an environment for surgeons that is more conducive to perform a greater variety of procedures, reach more patients in more care settings, and lessen the physical toll on surgeons.

We have not yet crossed the digital transformation finish line in surgery. One in five patients undergoing an operation has one or more complications. That can translate to increased length of stay, repeat surgery, additional medical treatment, legal issues, and increased costs. Surgery is also being performed by many different physicians with different levels of skill, experience, and training. This is making consistent outcomes and quality patient care challenging to achieve.

A Clarion Call for Change

While patients’ conditions are becoming more complex and treatment becoming more complicated, the absolute number of patients seeking care is increasing, and many more patients have multiple chronic conditions than was true a generation, or even a decade, ago. 

In the last few years, hospitals worldwide have also experienced a decrease in their budgets, primarily due to declining federal funds. Cost-cutting has resulted in delays in facility upgrades and freezing capital equipment purchases such as high-cost robotic systems. COVID-19 also exposed the shocking financial frailty of the hospital system, as well as capacity and resource constraints. New study findings showed that postponement of nonessential surgical procedures early in the pandemic not only disrupted surgical care but also took away a significant portion of hospitals’ total income. 

However, maintaining access to surgical care is not all about revenue; it’s about how to efficiently manage the needs of patients, surgeon, and staff. Health care systems must make long-term preparations so they can safely provide elective surgical care during future peaks in COVID-19 caseloads and even potential future pandemics. As a result, these pressures will force a new norm in surgery that is better aligned with the principles of value. 

In response to these market factors, a new era of surgery and technology integration has begun. The future of surgery is being driven by a decrease in the price of innovative technologies that are becoming more widely adopted, as well as a decrease in the cost of new innovations such as augmented intelligence and machine vision technologies. 

The technology exists and is building in other industries with AI and computational technology growing exponentially. It’s time to finally bring it to surgery as the future of healthcare requires an acceleration of innovation. 

From Promise to Practice

Surgeons and hospitals are committed to delivering the best patient outcomes possible—every time. Moving forward, surgeons will be able to build upon Digital Laparoscopy with a next-level operating platform that can perceive (computer vision), learn (machine learning), and assist (clinical intelligence) in surgery. The result is improved surgical decision making, enriched collaboration across surgical staff, and enhanced predictability for all procedures. This shifts the promise of consistently superior surgery into practice. This is called Performance-Guided Surgery.  

AI is starting to take root in our society and everyday lives. From Google Maps to chat bots, face recognition to unlock your phone screen to Netflix recommendations, machines are gaining the ability to reason and perform cognitive functions such as problem solving, object recognition, and decision-making. Healthcare has always operated (no pun intended) at the intersection of human judgement and scientific data. Recent AI advancements are bringing those two elements closer than ever, creating positive waves of change in diagnosis, treatment, outcomes, and cost—and surgery can certainly benefit from it. By integrating augmented intelligence and leveraging analytics, decisions can be smarter and faster, which is crucial in the high-pressure, highly variable situations that happen repeatedly during any surgery. This is at the core of driving surgical outcomes and improving patient care. 

To be clear, this partnership between man and machine is not to replace the surgeon but to serve in an assistive role. The surgeon now has access to evidence-based, real-time clinical data to boost her capabilities to perceive complex environments and perform the desired tasks with increased precision, safety, and efficiency.  

With 3D measurement capabilities, surgeons can now measure points in the abdominal cavity and receive instant measurements between those points, down to a few millimeters; whereas surgeons used to have to rely on estimates or inserted sterile measuring tapes, which can provide inaccurate results, to map staple lines or surgical mesh sizes. 

Digital tagging allows surgeons to highlight areas of interest within a patient’s anatomy, making it easier for them to keep track of those areas throughout a procedure. That feature can also be used as a teaching aide, giving surgeons a way to mark up images while guiding trainees through an operation. 

Additional Benefits of Performance-Guided Surgery 

According to data published in June of 2021 by the AAMC (Association of American Medical Colleges), the United States could see an estimated shortage between 15,800 and 30,200 surgeons by 2034, including shortfalls in general surgery, obstetrics and gynecology, and orthopedic surgery.  

Researchers attributed the increased demand for physicians due to population growth and population aging. The U.S. population is expected to grow about 11% between 2019 and 2034, while the population of U.S. seniors aged 75 and older is expected to grow 74% during that time.  

To address this, Performance-Guided Surgery platforms allow the surgeon to be seated in a position that minimizes strain and fatigue to help reduce surgeon burnout, decrease muscular skeletal disorders, and extends surgeon careers to help mitigate the expected surgeon shortage.

Eye-tracking cameras help address the variables that can occur due to team interactions and allow the surgeon to control his or her visualization via an eye-tracking camera instead of having to provide verbal direction to a surgical assistant.  

COVID-19 only accelerated the deepening workforce challenge. While researchers predicted that the overall impact of COVID-19 on physician supply and demand would be small, the impact of COVID-19 on physicians themselves is much greater. 

In Conclusion 

Next-level technology completely changes the idea of what’s possible in surgery. As technology enhances and changes the world we live in, the OR can move beyond inefficiency, unpredictability, and outdated technology. 

By digitizing surgery and building machine learning algorithms and AI, Performance-Guided Surgeries are smarter and more instinctive and result in better patient outcomes. The confluence of all these technologies could be transformative.