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Intraoperative Applications of Artificial Intelligence in Robotic Surgery: A Scoping Review of Current Development Stages and Levels of Autonomy

Vasey, Baptiste; Lippert, Karoline AN; Khan, Danyal Z; Ibrahim, Mudathir; Koh, CH; Layard Horsfall, Hugo; Lee, Keng S; ... McCulloch, Peter; + view all (2022) Intraoperative Applications of Artificial Intelligence in Robotic Surgery: A Scoping Review of Current Development Stages and Levels of Autonomy. Annals of Surgery 10.1097/sla.0000000000005700. (In press). Green open access

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Abstract

OBJECTIVE: A scoping review of the literature was conducted to identify intraoperative AI applications for robotic surgery under development and categorise them by 1) purpose of the applications, 2) level of autonomy, 3) stage of development, and 4) type of measured outcome. BACKGROUND: In robotic surgery, artificial intelligence (AI) based applications have the potential to disrupt a field so far based on a master-slave paradigm. However, there is no available overview about this technology’s current stage of development and level of autonomy. METHODS: MEDLINE and EMBASE were searched between January 1st 2010 and May 21st 2022. Abstract screening, full text review and data extraction were performed independently by two reviewers. Level of autonomy was defined according to the Yang et al classification and stage of development according to the IDEAL framework. RESULTS: 129 studies were included in the review. 97 studies (75%) described applications providing Robot Assistance (autonomy level 1), 30 studies (23%) application enabling Task Autonomy (autonomy level 2), and two studies (2%) application achieving Conditional autonomy (autonomy level 3). All studies were at IDEAL stage 0 and no clinical investigations on humans were found. 116 (90%) conducted in silico or ex-vivo experiments on inorganic material, 9 (7%) ex-vivo experiments on organic material, and 4 (3%) performed in vivo experiments in porcine models. CONCLUSION: Clinical evaluation of intraoperative AI applications for robotic surgery is still in its infancy and most applications have a low level of autonomy. With increasing levels of autonomy, the evaluation focus seems to shift from AI-specific metrics to process outcomes, although common standards are needed to allow comparison between systems.

Type: Article
Title: Intraoperative Applications of Artificial Intelligence in Robotic Surgery: A Scoping Review of Current Development Stages and Levels of Autonomy
Open access status: An open access version is available from UCL Discovery
DOI: 10.1097/sla.0000000000005700
Publisher version: http://doi.org/10.1097/sla.0000000000005700
Language: English
Additional information: Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
Keywords: Artificial intelligence, machine learning, surgery, robotic, intraoperative, IDEAL, evaluation, autonomy, performance, outcomes
UCL classification: UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL
URI: https://discovery.ucl.ac.uk/id/eprint/10156813
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