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. 2023 Dec 1;278(6):896-903.
doi: 10.1097/SLA.0000000000005700. Epub 2022 Sep 30.

Intraoperative Applications of Artificial Intelligence in Robotic Surgery: A Scoping Review of Current Development Stages and Levels of Autonomy

Baptiste Vasey  1   2   3 , Karoline A N Lippert  4 , Danyal Z Khan  5   6 , Mudathir Ibrahim  1   7 , Chan Hee Koh  5   6 , Hugo Layard Horsfall  5   6 , Keng Siang Lee  8 , Simon Williams  5   6 , Hani J Marcus  5   6 , Peter McCulloch  1
Affiliations

Intraoperative Applications of Artificial Intelligence in Robotic Surgery: A Scoping Review of Current Development Stages and Levels of Autonomy

Baptiste Vasey et al. Ann Surg. .

Abstract

Objective: A scoping review of the literature was conducted to identify intraoperative artificial intelligence (AI) applications for robotic surgery under development and categorize them by (1) purpose of the applications, (2) level of autonomy, (3) stage of development, and (4) type of measured outcome.

Background: In robotic surgery, AI-based applications have the potential to disrupt a field so far based on a master-slave paradigm. However, there is no available overview about this technology's current stage of development and level of autonomy.

Methods: MEDLINE and EMBASE were searched between January 1, 2010 and May 21, 2022. Abstract screening, full-text review, and data extraction were performed independently by 2 reviewers. The level of autonomy was defined according to the Yang and colleagues' classification and stage of development according to the Idea, Development, Evaluation, Assessment, and Long-term follow-up framework.

Results: One hundred twenty-nine studies were included in the review. Ninety-seven studies (75%) described applications providing Robot Assistance (autonomy level 1), 30 studies (23%) application enabling Task Autonomy (autonomy level 2), and 2 studies (2%) application achieving Conditional autonomy (autonomy level 3). All studies were at Idea, Development, Evaluation, Assessment, and Long-term follow-up stage 0 and no clinical investigations on humans were found. One hundred sixteen (90%) conducted in silico or ex vivo experiments on inorganic material, 9 (7%) ex vivo experiments on organic material, and 4 (3%) performed in vivo experiments in porcine models.

Conclusions: Clinical evaluation of intraoperative AI applications for robotic surgery is still in its infancy and most applications have a low level of autonomy. With increasing levels of autonomy, the evaluation focus seems to shift from AI-specific metrics to process outcomes, although common standards are needed to allow comparison between systems.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
PRISMA flowchart. Other sources include reference lists from similar reviews and expert recommendations.
FIGURE 2
FIGURE 2
Studies published over time, stratified by level of autonomy of the AI-augmented robotic system studied.
FIGURE 3
FIGURE 3
Numbers of studies per the level of autonomy of the AI-augmented robotic system studied.
FIGURE 4
FIGURE 4
A-C, Stacked bar chart of outcome categories against application of AI, stratified by each level of autonomy.
See this image and copyright information in PMC

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