Artificial intelligence tools, such as 3D mapping, can assist vascular surgeons by reducing radiation exposure by 50% and decreasing procedure time, while also reducing administrative burden.
Surgery is a scientific craftsmanship that combines technical skills, creativity, dexterity, and empathy to treat the patient as a whole and not just the disease. Similar to an elite athlete, a vascular surgeon needs precise skills, mental resilience, intense physical stamina, and coordinated actions with the team members. Vascular surgery is a high-stakes contact sport wherein, even though it is a team effort, the onus of the patient outcome predominantly lies on the shoulders of the surgeon. Being the team leader, very often apart from operative work, the surgeon spends time in administrative and bureaucratic tasks that lead to a significant increase in workload. Initially, it starts with fatigue that becomes a chronic issue, eventually leading to burnout and an increased attrition rate of surgeons.1 Surgical fatigue, surgical loneliness, and burnout are all part of the same epidemic that the current healthcare system is facing globally. This is not an individual failure, but it is actually a failure of the entire complex healthcare system. Surgeon fatigue and burnout will impair cognitive and motor function. This will affect alertness and decision-making capacity and will adversely affect patient outcomes.2 Artificial Intelligence (AI) is rapidly transforming health care by analyzing data, recognizing patterns, and predicting outcomes. Use of machine learning, natural language processing, artificial neural networks, computer vision, and large language models (LLMs) in vascular surgery will assist vascular surgeons to focus better on patient care. There is a difference between AI and assisted intelligence. AI uses algorithms to perform actions, i.e., an autonomous system completes the tasks and has minimal or no need for human input. However, vascular surgery involves crucial steps right from diagnosis to operative procedures that have a significant effect on the life and limb of patients; hence, human input is mandatory at every step. For vascular surgeons, assisted/augmented intelligence is vital because this AI will enhance human capabilities and improve existing workflow patterns. Assisted intelligence will act as a copilot before, during, and after surgery. This second pair of eyes will reduce mundane administrative tasks, enhance precision, decrease cognitive load, and eventually improve patient safety, ensuring the surgeon is no longer left alone. APPLICATION OF MACHINE LEARNING MODEL To identify fatigue and take necessary action Wearable sensors and machine learning models have been combined to automatically detect the state of cognitive fatigue using wearable near-infrared spectroscopy sensors.3 Using computer vision and facial recognition algorithms that detect subtle changes such as drooping eyelids, reduced blink rate, or prolonged eye closure, intraoperative surgeon fatigue can be identified. Use of methods to identify surgeon fatigue can help the surgeons and operative team to integrate fatigue management strategies in the operating room, thereby increasing operative efficiency and patient safety.4 Imaging and predicting outcome Deep learning and convolutional neural networks can process imaging data (color Doppler, magnetic resonance, and computed tomography) and correlate with patient clinical details. This image analysis is used in vascular surgery for disease classification, severity prediction, objective identification, semantic segmentation, and instance segmentation.5 Machine learning models can predict outcomes following open or endovascular intervention and guide perioperative risk mitigation strategies to improve outcomes. This form of assisted intelligence will help the patient, the patient’s family, and the surgeon in the process of decision-making.6 Intraoperative guidance: Third hand or copilot Machine learning copilots are advanced AI-driven surgical guidance systems that have the potential to assist vascular surgeons intraoperatively to enhance precision, identify anatomical structures at risk, and help in preoperative planning of complex procedures. Cydar three-dimensional (3D) mapping: AI-based technology that creates patient-specific 3D maps of their anatomy for procedure planning, image-guided navigation, and postoperative review. It can identify the weaker, anatomically challenging blood vessels and their benefits for both the patient and surgeon to treat complex vascular procedures. Additional benefits include 50% less radiation exposure to the patient and clinical team and significantly reduced procedure time ORBEYE™ 4K 3D exoscope: High magnification surgical imaging system with zero latency that provides real-time images on large monitors, thereby enhancing visualization, ergonomics, and teamwork. It is being used in complex carotid endarterectomy surgeries and to do supermicrosurgery, like lymphovenous anastomosis. The ORBEYE exoscope has been integrated with machine learning algorithms to detect predictive signs of thrombus formation during vascular anastomosis.7 APPLICATION OF NATURAL LANGUAGE PROCESSING AND LARGE LANGUAGE MODELS Reduce documentation and administrative burden Artificial intelligence-powered digital scribes Specialized ambient clinical intelligence that is designed to listen, transcribe, and summarize patient–clinician conversations in real time. There is a significant reduction in time spent in entering electronic health records (EHRs), which reduces the “Pajama time” (unpaid hours clinicians spend on EHR tasks after work), improves clinician–patient engagement, and minimizes surgeon burnout. AI scribe solutions available for global and/or local use include Freed, Nuance DAX, Copilot (Microsoft), Abridge, Suki AI, Heidi Health, Eka Scribe, Talk to write, Sunoh.ai, and DeepScribe. Academic writing and research activities LLMs can combine audio, visual, and text data to draft manuscripts, write literature reviews, paraphrase text, manage citations, and generate entire scientific papers. However, there are risks of having potential hallucinations due to fabricated data and the inability of AI to take responsibility for the content. The commonly available research companion AI tools are Paperpal, SciSpace, NoteGPT, NyxGen AI, and Jenni AI, which increase academic efficiency and save the time involved in scientific research paper writing. Diagnostics and predictive clinical decision-making As a subset of Generative AI, LLM and advanced neural networks are used to complete complex tasks with higher speed, efficiency, and accuracy. The system combines different data types (text, audio, image, and video) and creates an outcome that assists in making predictive analysis and clinical decision-making. Thereby, to some extent, there is some relief from the burden of decision-making, especially in complex procedures associated with high mortality and morbidity. Chung et al. used the aneurysm prognosis classifier (APC) model using patient-specific images and clinical data to predict patient outcome, identify high-risk abdominal aortic aneurysm (AAA), and provide a reliable, noninvasive, objective clinical decision support tool for AAA management.8 Platforms such as NextGenAi, VASC.AI, and vascBUDDY are specifically designed for processing data and generating human-like responses, thereby assisting in enhancing medical education, patient care, and clinical decision-making.9 CONCLUSION “The only constant is change,” and “Intelligence is the ability to adapt to change.” AI has revolutionized health care, ushering in an era of personalized and proactive vascular care. To lead this shift, vascular surgeons must understand the rationale behind AI technology, learn to trust and integrate these tools into clinical practice, and understand the ethical and legal limitations of this technology.10 The word “companion” derives from the Latin companio, meaning “one who shares bread.” By embracing assisted intelligence as a trusted associate – a true companion in our high-stakes surgical field – we can improve patient outcomes while better sustaining our own well-being.
Pritee Sharma (Wed,) conducted a review in Vascular surgery. Artificial Intelligence was evaluated. Artificial intelligence tools, such as 3D mapping, can assist vascular surgeons by reducing radiation exposure by 50% and decreasing procedure time, while also reducing administrative burden.