538 Using AI and surgical gestures to predict outcomes- Dr Andrew J Hung

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This video is being presented at the Humans at the Cutting Edge of Robotic Surgery Symposium 2024, Jaipur, India. It was produced by Dr Umar Gaffar & Dr Andrew J Hung. Cedars Sinai Medical Center
Abstract:
Using AI and surgical gestures to predict outcomes
Abstract
Introduction
How well a surgery is performed impacts a patient’s outcomes. However, objective
quantification of performance remains an unsolved challenge. Deconstructing a
procedure into discrete instrument-tissue 'gestures' is an emerging way to understand
surgery. Our objective is to establish this paradigm, particularly for the nerve-sparing
step of prostatectomy, where performance is the most important factor for patient
outcomes.
Methods
We identified 34,323 individual gestures performed in 80 nerve-sparing robot-assisted
radical prostatectomies from two international medical centers. Gestures were classified
into nine distinct dissection gestures (e.g., hot cut) and four supporting gestures (e.g.,
retraction). Our primary outcome was to identify factors impacting a patient’s 1-year
erectile function (EF) recovery after radical prostatectomy.
Results
We found that less use of hot cut and more use of peel/push was statistically associated
with better chance of 1-year EF recovery. Our results also show interactions between
surgeon experience and gesture types—similar gesture selection resulted in different
EF recovery rates dependent on surgeon experience. Furthermore, two teams
independently constructed machine learning models using gesture sequences vs.
traditional clinical features to predict 1-year EF. Gesture sequences were able to better
predict 1-year EF (Team-1: AUC 0.77, 95% CI 0.73–0.81; Team-2: AUC 0.68, 95% CI
0.66–0.70) than traditional clinical features (Team-1: AUC 0.69, 95% CI 0.65–0.73;
Team-2: AUC 0.65, 95% CI 0.62–0.68).
Conclusions
Gestures provide a granular method to objectively indicate surgical performance and
outcomes. Application of this methodology to other surgeries may lead to discoveries on
methods to improve surgery.

See more at: http://vattikutifoundation.com/
Category
Urology
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