Digital Surgery Group Versus Traditional Experience Group in Head and Neck Reconstruction: A Retrospective Controlled Study to Analyse Clinical Value and Time-Economic-Social Effect

Objective: Explore the application value of digital surgical technology in the reconstruction of head and neck defects after tumor resection, and comprehensively evaluate the operation time and cost-effectiveness.Methods: Retrospective analysis of head and neck cancer patients who underwent reconstruction in head and neck surgery of Sichuan cancer hospital from January 2015 to January 2021. According to the inclusion and exclusion criteria, a total of 52 cases were included, including 25 cases in the digital surgery (DS) group and 27 cases in the conventional surgery (CS) group. The clinical pathological characteristics, postoperative complications, functional and aesthetic evaluation indexes and time-cost-satisfaction evaluation indexes of the two groups were compared and statistically analyzed. Typical cases of digital surgery assisted surgery were shared.Results: There was no significant difference between the two groups in the defect size, pathological type and other major clinicopathological features and operation related indicators (P > 0.05). There was comparability between the two groups, and there was no significant difference in survival outcome and follow-up time between the two groups (P > 0.05). The incidence of titanium plate displacement, deformation or exposure and facial scar deformity in DS group was significantly lower than that in CS group (P < 0.05). However, there was no significant difference in other short-term or long-term complications (P > 0.05). The incidence of dysphagia and eating disorders in DS group was significantly reduced (P < 0.05), and the speech and social functions were improved, but there was no significant difference (P > 0.05). Meanwhile, there was no significant difference in the evaluation index of facial aesthetics in this study (P > 0.05). At the same time, the total operation time, preparation time of donor site bone flap, osteotomy time and reconstruction time in DS group were significantly lower than those in traditional operation group (P < 0.05), but the plastic time and vascular anastomosis time of recipient area could not be shortened (P > 0.05). In addition, there was no significant difference in total hospitalization days between DS group and CS group (P > 0.05), but the time of ICU treatment and postoperative intravenous nutrition support in DS group was shorter than that in CS group (P < 0.05). In particular, the preoperative doctor-patient communication of DS group was more effective, and the treatment satisfaction of patients and their families was higher (P < 0.05).Conclusion: Comprehensive application of digital surgical technology in reconstruction of head and neck after tumor resection is feasible in clinical practice, which can improve the accuracy of repair, decrease some surgical complications, preserve better and improve the patient's diet and speech function, reduce the operation and hospitalization time, but also increase the treatment cost. Futhermore, it is conducive to doctor-patient communication and improve patient satisfaction.

The evolution of surgical education

Surgery is constantly evolving along the history. Surgery has seen an impressive evolution due to advances in anesthesia, basic research, means of exploration, immunology, genetics, pharmacology and especially in artificial intelligence. Surgery has evolved from open surgery to minimally invasive surgery, then to robotic surgery and in future to digital surgery. The five pillars of digital surgery are: (1) robotics, (2) advanced instrumentation, (3) enhanced visualization, (4) connectivity, and (5) data analytics and machine learning. Surgical education has evolved from Halsted's model (one see, one do, one teach) to special training programs such as the Rasmussen model in 3 stages: skill based behavior, ruled based behavior, knowledge based behavior. Digital technologies are changing surgical education. New terms appear such as: Massive open online courses, Flipped classrooms, Digital badges, Virtual anatomy, Medical holograms. Artificial intelligence can improve surgical education. It can bring transparency to the operating room and accelerate surgical education. Digital Mentoring provides the next generation of the digital platform with the transfer of surgical knowledge from an expert to a practitioner and allows surgeons to evolve to achieve the best results. In addition, all members of the operative team can benefit from training using augmented virtual reality. Establishing an infrastructure that allows the perfect integration of robotics, artificial intelligence, advanced instrumentation, advanced training methods, educational programs will allow the rapid development of innovation and surgical progress. In this way, digital surgery will provide globally advanced surgical care in continuous improvement. The classical methods still remain valid in the training of young surgeons. The most important aspect remains the training in the operating room. The new methods do not exclude the classic training that gave good results, but they complement and make general surgery more attractive for the new generation. In the desire to reform surgical education we have actually lost the purpose of training - the surgical patient, which is real, not virtual. The most important aspect that must be transmitted to young surgeons is the humanism of our profession, which for the time being cannot take the digital form.

Robotic-Assisted Minimally Invasive Surgery in Children

Currently, minimally invasive surgery (MIS) includes conventional laparo-thoracoscopic surgery and robot-assisted surgery (RAS) or robotic surgery. Robotic surgery is performed with robotic devices, for example the Da Vinci system from Intuitive Surgical, which has a miniaturized camera capable of image magnification, a three-dimensional image of the surgical field, and the instruments are articulated with 7 degrees of freedom of movement, and the surgeon operates in a sitting position at a surgical console near the patient. Robotic surgery has gained an enormous surge in use on adults, but it has been slowly accepted for children, although it offers important advantages in complex surgeries. The areas of application of robotic surgery in the pediatric population include urological, general surgery, thoracic, oncological, and otorhinolaryngology, the largest application has been in urological surgery. There is evidence that robotic surgery in children is safe and it is important to offer its benefits. Intraoperative complications are rare, and the frequency of postoperative complications ranges from 0–15%. Recommendations for the implementation of a pediatric robotic surgery program are included. The future will be fascinating with upcoming advancements in robotic surgical systems, the use of artificial intelligence, and digital surgery.

Investigating the Ethical and Data Governance Issues of Artificial Intelligence in Surgery: Protocol for a Delphi Study

Background The rapid uptake of digital technology into the operating room has the potential to improve patient outcomes, increase efficiency of the use of operating rooms, and allow surgeons to progress quickly up learning curves. These technologies are, however, dependent on huge amounts of data, and the consequences of their mismanagement are significant. While the field of artificial intelligence ethics is able to provide a broad framework for those designing and implementing these technologies into the operating room, there is a need to determine and address the ethical and data governance challenges of using digital technology in this unique environment. Objective The objectives of this study are to define the term digital surgery and gain expert consensus on the key ethical and data governance issues, barriers, and future research goals of the use of artificial intelligence in surgery. Methods Experts from the fields of surgery, ethics and law, policy, artificial intelligence, and industry will be invited to participate in a 4-round consensus Delphi exercise. In the first round, participants will supply free-text responses across 4 key domains: ethics, data governance, barriers, and future research goals. They will also be asked to provide their understanding of the term digital surgery. In subsequent rounds, statements will be grouped, and participants will be asked to rate the importance of each issue on a 9-point Likert scale ranging from 1 (not at all important) to 9 (critically important). Consensus is defined a priori as a score of 7 to 9 by 70% of respondents and 1 to 3 by less than 30% of respondents. A final online meeting round will be held to discuss inclusion of statements and draft a consensus document. Results Full ethical approval has been obtained for the study by the local research ethics committee at Imperial College, London (20IC6136). We anticipate round 1 to commence in January 2021. Conclusions The results of this study will define the term digital surgery, identify the key issues and barriers, and shape future research in this area. International Registered Report Identifier (IRRID) PRR1-10.2196/26552

Involvement of medical students in a surgery congress: impact on learning motivation, decision-making for a career in surgery, and educational curriculum

SummaryDuring the preclinical period of medical school, the clinical relevance of theoretical knowledge is given little attention. Medical students of the second year were invited to participate in an interdisciplinary congress for robot-assisted and digital surgery. The students had to evaluate the impact of the congress on their learning motivation, decision-making for a career in surgery, and relevance for their educational curriculum. Participation in the congress increased their learning motivation for preclinical subjects, and significantly increased their interest in a surgical career. Most students considered active involvement in medical congresses a valuable supplement to the medical curriculum. Congress participation during the preclinical period was ranked positively by medical students. Greater learning motivation and enthusiasm for the pilot teaching project as well as for surgical disciplines were registered. Thus, early involvement of medical students in scientific congresses should be an integral part of their educational curriculum.