Moving to the future: Artificial intelligence in surgery

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Published: 31 Jan 2023
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Dr Maria João Cardoso - Champalimaud Cancer Centre, Lisbon, Portugal

Dr Maria João Cardoso speaks to ecancer at BGICC 2023 about the advancements of artificial intelligence in surgery.

She outlines several technological developments where artificial intelligence and augmented reality are being used in surgery, such as using specialist cameras to create an avatar of a patient to better view their tumour.

Dr João Cardoso also highlights a future CINDERELLA trial which will use artificial intelligence and deep learning to show breast cancer patients how the results will look after surgery.

Artificial intelligence has flooded us in every aspect of day-to-day life; it’s something that we need to deal with. It has become a frightening aspect for many doctors because they think they will be replaced by the computer to do many things so they are afraid of that, although they are curious about what can be done with artificial intelligence. In fact, artificial intelligence is exactly what the name states – the computer can do certain tasks better or identical as our brain does. So it replaces our way of thinking, usually in something that can be repeated. So, for instance, if you have to categorise shirts or trousers it’s easily done by a computer and it doesn’t take your time to do that. There are many things that can be done in medicine like that.

We have several aspects that can be done in medicine but applied to surgery we have several new things that use both artificial intelligence and also what we call augmented reality and virtual reality. Everybody knows about the headsets of Google glasses and Microsoft glasses that permit you, allow you, to have a complete view and different view of the world made of an imaginary world, and you have the augmented reality that you can recall with a Pokémon Go game, for instance. You have your phone, you have the street that you are walking on and then you see a little monster popping up; this is called augmented reality. We can use this to see better our field of surgery, meaning if I want to see a tumour on the breast of a patient I can use imaging that the patient has before going to surgery and put a clip on the tumour and then go to surgery and then take the tumour, have an X-ray of the piece of breast that I have, confirm that the clip is there and then wait for the rest. But what would happen if I could have and see the patient live on the table and can see the tumour inside the breast of the patient, how can we do this with augmented reality? So, we can use the images of the patient and using several Microsoft cameras in the OR transform our patient into an avatar with a tumour inside and then we can operate on the patient. This is something that we are working on for a long time and it’s very enthusiastic for all people because it not only allows you to see the tumour better but it allows you to operate on the patient without having a new biopsy, putting the clip on, doing that and having false negatives. So it’s a very, very impressive area for the future of breast surgery.

The other thing that we are doing, and I’m talking about this, is called the CINDERELLA trial that is going to start this year in June. It’s using artificial intelligence to show the patients how they will be after surgery. So we have a problem – 30% of our patients have low expectations regarding the results of surgery. So they know that they are going to have a mastectomy or breast conservation but the result is something that they don’t understand very well. Nowadays we have several options and sometimes we ask the patient to choose, which is very difficult because they don’t understand the things. So we give leaflets, we show videos, but we have a form of showing the patient in a more realistic way using artificial intelligence and virtual reality how she will become. So we have a very large repository of images of women that have been previously treated with surgery of the breast, so mastectomy, breast conservation etc. In this trial we are going to include patients that are going to be submitted to breast surgery. We take a photograph and with this photograph, using artificial intelligence and deep machine learning, we are going to search the database for the best matching picture for the result of this surgery the woman is going to have. If we don’t find the picture because of race, because of height, because whatever, we have something that is called torso morphometry. We can change the image to adapt to this result and the patient can look at the results and see what pleases her better. She can discuss with her family and our aim is to compare this with the conventional approach and see if doing it this way we can match better the expectations before and after. So this is called the CINDERELLA trial and is something that we are really looking for the results to see how it is going to work.

Another thing that we are going through also is transforming the way to teach about surgery. We use avatars of our doctors and we use virtual reality rooms to show students and young surgeons how to perform a certain surgery. So usually we do this by real training or workshops or real-time videos of surgeries. With this setting we can prepare the videos and do this with avatars and real video-times of surgery to show and demonstrate the cases. So there are so many uses in surgery and I think this is going to be the future whether you want it or not.