2022-08-18 2022, Volume 2 Issue 3

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  • Andrew A. Gumbs, Frank Alexander, Konrad Karcz, Elie Chouillard, Roland Croner, Jasamine Coles-Black, Belinda de Simone, Michel Gagner, Brice Gayet, Vincent Grasso, Alfredo Illanes, Takeaki Ishizawa, Luca Milone, Mehmet Mahir Özmen, Micaela Piccoli, Stefanie Speidel, Gaya Spolverato, Patricia Sylla, Jaime Vilaça, Mohammad Abu Hilal, Lee L. Swanström
  • Review
    Valentina Mari, Gaya Spolverato, Linda Ferrari

    The aim of this work is to offer a panoramic view on how artificial intelligence (AI) can help to break down gender disparity in enrollment and training of women in surgery. Nowadays, many visible and concealed obstacles still exist for women who pursue a surgical career. Impediments due to gender disparity prevent women from choosing surgical specialties. Furthermore, female surgical trainees have to face many difficulties during their training, such as inequity during the residency selection process, sexual harassment, discrimination in pregnancy experience and parental leave, and work-life balance problems. AI has been successfully employed for several applications in surgery to improve patient management, implement the decision-making process, and support training. AI could represent an effective way to overcome barriers related to gender disparity and overcome the obstacles women face during surgical education and training. Virtual and augmented reality, remote mentoring, and simulators could help female surgeons deal with disparities during their training and could positively impact the choice of women when pursuing a surgical career.

  • Systematic Review
    Mustafa Bektaş, Babs M. Zonderhuis, Henk A. Marquering, Jaime Costa Pereira, George L. Burchell, Donald L. van der Peet

    Aim: The aim of this systematic review was to provide an overview of Machine Learning applications within hepatopancreaticobiliary surgery. The secondary aim was to evaluate the predictive performances of applied Machine Learning models.

    Methods: A systematic search was conducted in PubMed, EMBASE, Cochrane, and Web of Science. Studies were only eligible for inclusion when they described Machine Learning in hepatopancreaticobiliary surgery. The Cochrane and PROBAST risk of bias tools were used to evaluate the quality of studies and included Machine Learning models.

    Results: Out of 1821 articles, 52 studies have met the inclusion criteria. The majority of Machine Learning models were developed to predict the course of disease, and postoperative complications. The course of disease has been predicted with accuracies up to 99%, and postoperative complications with accuracies up to 89%. Most studies had a retrospective study design, in which external validation was absent for Machine Learning models.

    Conclusion: Machine learning models have shown promising accuracies in the prediction of short-term and long-term surgical outcomes after hepatopancreaticobiliary surgery. External validation of Machine Learning models is required to facilitate the clinical introduction of Machine Learning.

  • Systematic Review
    Heba Taher, Vincent Grasso, Sherifa Tawfik, Andrew Gumbs

    Aim: Artificial intelligence (AI) is rapidly evolving in healthcare worldwide, especially in surgery. This article reviews important terms used in machine learning and the challenges of deep learning in surgery.

    Methods: A review of the English literature was carried out focused on the terms “challenges of deep learning” and “surgery” using Medline and PubMed between 2018 and 2022.

    Results: In total, 54 articles discussed the challenges of deep learning in general. We include 25 articles from various surgical specialties discussing challenges corresponding to their respective specialties.

    Conclusion: The increased utilization of AI in surgery is faced with a wide variety of technical, ethical, clinical, and business-related challenges. The best way to expedite its expansion in surgery in the safest and most cost-efficient manner is by ensuring that as many surgeons as possible have a clear understanding of basic AI concepts and how they can be applied to the preoperative, intraoperative, postoperative, and long-term follow-up phases of the surgical patient care.

  • Systematic Review
    Martin Wagner, André Schulze, Michael Haselbeck-Köbler, Pascal Probst, Johanna M. Brandenburg, Eva Kalkum, Ali Majlesara, Ali Ramouz, Rosa Klotz, Felix Nickel, Keno März, Sebastian Bodenstedt, Martin Dugas, Lena Maier-Hein, Arianeb Mehrabi, Stefanie Speidel, Markus W. Büchler, Beat Peter Müller-Stich

    Aim: We systematically review current clinical applications of artificial intelligence (AI) that use machine learning (ML) methods for decision support in surgical oncology with an emphasis on clinical translation.

    Methods: MEDLINE, Web of Science, and CENTRAL were searched on 19 January 2021 for a combination of AI and ML-related terms, decision support, and surgical procedures for abdominal malignancies. Data extraction included study characteristics, description of algorithms and their respective purpose, and description of key steps for scientific validation and clinical translation.

    Results: Out of 8302 articles, 107 studies were included for full-text analysis. Most of the studies were conducted in a retrospective setting (n = 105, 98%), with 45 studies (42%) using data from multiple centers. The most common tumor entities were colorectal cancer (n = 35, 33%), liver cancer (n = 21, 20%), and gastric cancer (n = 17, 16%). The most common prediction task was survival (n = 36, 34%), with artificial neural networks being the most common class of ML algorithms (n = 52, 49%). Key reporting and validation steps included, among others, a complete listing of patient features (n = 95, 89%), training of multiple algorithms (n = 73, 68%), external validation (n = 13, 12%), prospective validation (n = 2, 2%), robustness in terms of cross-validation or resampling (n = 89, 83%), treatment recommendations by ML algorithms (n = 9, 8%), and development of an interface (n = 12, 11%).

    Conclusion: ML for decision support in surgical oncology is receiving increasing attention with promising results, but robust and prospective clinical validation is mostly lacking. Furthermore, the integration of ML into AI applications is necessary to foster clinical translation.

  • Editorial
    Derek A. O’Reilly, Henry A. Pitt