Digital surgery for gastroenterological diseases

Abstract

Advances in machine learning, computer vision and artificial intelligence methods, in combination with those in processing and cloud computing capability, portend the advent of true decision support during interventions in real-time and soon perhaps in automated surgical steps. Such capability, deployed alongside technology intraoperatively, is termed digital surgery and can be delivered without the need for high-end capital robotic investment. An area close to clinical usefulness right now harnesses advances in near infrared endolaparoscopy and fluorescence guidance for tissue characterisation through the use of biophysics-inspired algorithms. This represents a potential synergistic methodology for the deep learning methods currently advancing in ophthalmology, radiology, and recently gastroenterology via colonoscopy. As databanks of more general surgical videos are created, greater analytic insights can be derived across the operative spectrum of gastroenterological disease and operations (including instrumentation and operative step sequencing and recognition, followed over time by surgeon and instrument performance assessment) and linked to value-based outcomes. However, issues of legality, ethics and even morality need consideration, as do the limiting effects of monopolies, cartels and isolated data silos. Furthermore, the role of the surgeon, surgical societies and healthcare institutions in this evolving field needs active deliberation, as the default risks relegation to bystander or passive recipient. This editorial provides insight into this accelerating field by illuminating the near-future and next decade evolutionary steps towards widespread clinical integration for patient and societal benefit.

Keywords: Digital surgery; Artificial intelligence; Gastrointestinal disease; Biophysics; Deep learning; Fluorescence-guided surgery

Core Tip: Here, we introduce the concept of digital surgery and why it is important for everyone involved in the area of gastroenterological disease management. The current state and near-future of the art in this area are discussed, including the use of artificial intelligence methods to provide intraoperative real-time augmented decision making. Moral, ethical and legal challenges pertinent to digital surgery are explored, including the concerns relating to big data in health care and the transitioning role of industry in surgical development, as well as the implications such profound and imminent changes may have on the role of the clinician.