Technical skill assessment in minimally invasive surgery using artificial intelligence: a systematic review.
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BORIS DOI
Publisher DOI
PubMed ID
37584774
Description
BACKGROUND
Technical skill assessment in surgery relies on expert opinion. Therefore, it is time-consuming, costly, and often lacks objectivity. Analysis of intraoperative data by artificial intelligence (AI) has the potential for automated technical skill assessment. The aim of this systematic review was to analyze the performance, external validity, and generalizability of AI models for technical skill assessment in minimally invasive surgery.
METHODS
A systematic search of Medline, Embase, Web of Science, and IEEE Xplore was performed to identify original articles reporting the use of AI in the assessment of technical skill in minimally invasive surgery. Risk of bias (RoB) and quality of the included studies were analyzed according to Quality Assessment of Diagnostic Accuracy Studies criteria and the modified Joanna Briggs Institute checklists, respectively. Findings were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.
RESULTS
In total, 1958 articles were identified, 50 articles met eligibility criteria and were analyzed. Motion data extracted from surgical videos (n = 25) or kinematic data from robotic systems or sensors (n = 22) were the most frequent input data for AI. Most studies used deep learning (n = 34) and predicted technical skills using an ordinal assessment scale (n = 36) with good accuracies in simulated settings. However, all proposed models were in development stage, only 4 studies were externally validated and 8 showed a low RoB.
CONCLUSION
AI showed good performance in technical skill assessment in minimally invasive surgery. However, models often lacked external validity and generalizability. Therefore, models should be benchmarked using predefined performance metrics and tested in clinical implementation studies.
Technical skill assessment in surgery relies on expert opinion. Therefore, it is time-consuming, costly, and often lacks objectivity. Analysis of intraoperative data by artificial intelligence (AI) has the potential for automated technical skill assessment. The aim of this systematic review was to analyze the performance, external validity, and generalizability of AI models for technical skill assessment in minimally invasive surgery.
METHODS
A systematic search of Medline, Embase, Web of Science, and IEEE Xplore was performed to identify original articles reporting the use of AI in the assessment of technical skill in minimally invasive surgery. Risk of bias (RoB) and quality of the included studies were analyzed according to Quality Assessment of Diagnostic Accuracy Studies criteria and the modified Joanna Briggs Institute checklists, respectively. Findings were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.
RESULTS
In total, 1958 articles were identified, 50 articles met eligibility criteria and were analyzed. Motion data extracted from surgical videos (n = 25) or kinematic data from robotic systems or sensors (n = 22) were the most frequent input data for AI. Most studies used deep learning (n = 34) and predicted technical skills using an ordinal assessment scale (n = 36) with good accuracies in simulated settings. However, all proposed models were in development stage, only 4 studies were externally validated and 8 showed a low RoB.
CONCLUSION
AI showed good performance in technical skill assessment in minimally invasive surgery. However, models often lacked external validity and generalizability. Therefore, models should be benchmarked using predefined performance metrics and tested in clinical implementation studies.
Date of Publication
2023-10
Publication Type
article
Subject(s)
600 - Technology::610 - Medicine & health
Keyword(s)
Artificial intelligence Minimally invasive surgery Surgical data science Surgical skill assessment Technical skill assessment
Language(s)
en
Contributor(s)
Additional Credits
Universitätsklinik für Viszerale Chirurgie und Medizin - Viszeral- und Transplantationschirurgie
Series
Surgical endoscopy
Publisher
Springer
ISSN
1432-2218
Access(Rights)
open.access