CAN WE MAKE SURGERY

AUTONOMOUSDr Fangde LiuRA@Imperial College London CoFounder@surgicalAI

OUTLINE

0) NEXT CHAPTER OF AI 2) WHY 3) HOW 4) WHY NOT 5) SOME THOUGHT AND COMPROMISE

NEXT CHAPETER OF AI

BIG  IDEA  GREAT POTENTIAL CONVINCING THE PUBLIC

GAME CHANING APPLICATION 1) DRIVERLESS CAR 2) FINACE 3) MEDICINE 4) EDUCATION 5) AGRICUTRUE

MEDICINE AND HEALTHCARE

1)BIG NCD cost 30 Trillion dollars, HEALTHCARE 25% of US GDP2) SHORTAGE70% is Labour cost1/3 doctor shortage in the US3) Evidence /Experience BasedHuman Pattern Recognition

Economic Burden

Mortality

SURGICAL LANDSCAPE:1/3 COST,1/3 DEATHNeurosurgery

Cardiology and cardiovascular

Cancer: Endoscope

DBS

Tumor Resection

?

LANCET

5 BILLIONS PEOPLE HAVE NO ACCESS

TO SAFE SURGERY

SURGICAL AUTONOMY (PROS AND CONS)

2) Controlled Environment1) Narrow AI3) Human for Help

Accuracy And RiskSkill and Art (not science)Time is Critical ValuableEthical Dilemmas

4) Cost Insensitive

SURGICAL AUTONOMY (NOT VERY DIFFERENT FROM DRIVERLESS CAR)TECHNICALLY ACHIEVABLE

Semanticsegmentati

on

Poseestimati

on

Motion plannin

gRobot/US

SURGICAL AUTONOMY (PERCEPTION)

Medical Imaging Processing (Tracking, Segmentation, Registration)

DL makes Medical Images Processing as good as HumanVery Good Results even before DL (statistic shape model)

SURGERY AUTONOMY (PLANNING)

AI Beat Human

THE DARK HISTORY OF SURGICAL AUTONOMY

Full Autonomous, 1997 No Autonomy, 2000 cooperative, 2001

Technology Is Available long beforeSurgeon Hate Them All1) No Partial Solution2) No Complete Solution

Supporting Role

Do Nothing

REASON FOR AI FAILURE

MEDICINE PROBLEM (NO DISCRIMINATIVE BIOMARKER, NOT EFFECTIVE TREATMENT) VS ENGINEERING PROBLEM

EFFICIENCY? VS EFFICIENCYVEHICLE VS DRIVER

Machine Learning can be only as good as Human.Your Problem is usually Surgeons don’t do well.

INFORMATION MISSING VS EFFICIENCY

MY RECIPE (FOR NON-GENIUS)

1) Calculating Not Machine Learning (Beat Human in Accuracy and Speed)Surgeons are bad at maths2) Take Vehicle AdvantageFind a better surgical procedure Impossible for human

3) Machine Learning for Simple job.Not for magic.Do many Simple Job.Reason for Machine Learning is for the autonomy more complete,

4) Don’t Do Anything Intra-operativelythinking three times1) Never Fail2) No Risk3) UsefulDon’t Do cutting!5) Check the

medicine

WHAT CAN WE DO(PATIENT SPECIFIC INSTRUMENTATION)(AI For Autonomous Tool Design)

Patient Specific Rehearsal (AI For VR Content Generation)

Clinician Need VR for Rehearsal (senior surgeons really want)

Most VR Provides Training (senior surgeons don’t care)

Content Generation

AI FOR INTRA-OPERATIVEAI FOR COMMUNICATION /TEAM COORDINATION

CONCLUSION

Medicine is Hard, AI has Great Potential, AI can do many things for MedicineStill Deliver Clinical Impact is Very Hard.

Have the Big Picture is Very Important.For Medical and also for Other Industry

Autonomy: people are looking for something smart enough for any challengeBut stupid enough to take whatever he orders