The Advent of Artificial Intelligence… and the Farewell of Print Media!
by Adrian G. Dan, MD, FACS, FASMBS
Dr. Dan is Medical Director, Weight Management Institute at Summa Health in Akron, Ohio, and Associate Professor of Surgery at Northeastern Ohio Medical University (NEOMED) in Rootstown, Ohio.
Bariatric Times. 2023;20(7–12):8–10.
Funding: No funding was provided.
Disclosures: The authors have no conflicts of interest relevant to the content of this article.
The esteemed Dr. Walter Pories, a guiding figure to many in the realm of metabolic and bariatric surgery, has generously imparted a wealth of wisdom to me over the years. About four years ago, when I approached him in Washington D.C. to co-author the inaugural edition of “Perspectives,” he responded with, “I am delighted to do it, but columns can be quite challenging to write because you eventually run out of topics to explore.” Regrettably, and I emphasize that it is only this one instance, Walter was mistaken.
It seems only fitting that as I reflect upon our journey as co-authors in this, the final installment of our “Perspectives” column, we also bid adieu to our beloved Bariatric Times (BT). Over the past four years, I’ve had the honor of contributing a total of 16 columns and two articles, many of which appeared next to Walter’s cartoon corner. These pieces have revolved around topics that hold significance for surgeons and other medical professionals who offer surgical care to individuals battling the disease of obesity. Numerous thought leaders have graced us with their insights, and yet the list of unexplored topics still remains extensive. Many of you were slated to share your own expertise in our rapidly evolving field, which is rapidly advancing into its bright future.
For decades, periodicals have stood as an invaluable platform for introducing and exchanging fresh ideas, fostering critical discussions within various medical specialties. BT has been the staunch media partner of the American Society for Metabolic and Bariatric Surgery (ASMBS). However, akin to clinical guidelines and surgical techniques, the landscape of print media has also undergone a transformation. New platforms have emerged, gained prominence, while others have faded into obscurity. In the current milieu, media companies find it increasingly challenging to sustain the financial support necessary for traditional print publications. Regrettably, BT will be releasing its final digital issue November 20, 2023.
Our last column, initially slated to delve into the emergence of artificial intelligence (AI) in the realm of metabolic and bariatric surgery, ironically aligns with this transitional period. We were set to explore the advantages, challenges, and potential applications of this technology in our specialty. Initially, I pondered whether it was worth writing one more column as the periodical takes its final bow. However, I felt compelled to see this journey through and to contribute to this farewell issue with one last story. As we bid adieu to one platform—print media, we venture into the realm of possibilities offered by another—AI.
Joining me this month to discuss the advent of AI in metabolic and bariatric surgery are two distinguished co-authors. One of them is a friend of many decades, with shared clinical experiences dating back to our time training at the Cleveland Clinic. Dr. Matt Kroh, the Chair of the ASMBS task force on AI, is a recognized global leader in surgical innovation.
The other is a newer acquaintance who has been the hot topic of conversation, and goes by the name of Chat…ChatGPT.
Guest Perspective
by Matt Kroh, MD, FACS, FASMBS, FASGE
Dr. Kroh is Vice Chair, Innovation and Technology, Digestive Disease Institute; Section Head, Foregut Surgery and Surgical Endoscopy; Professor of Surgery, Cleveland Clinic Lerner College of Medicine in Cleveland, Ohio.
Metabolic surgery is the most dynamic subspecialty in general surgery. Over the past few decades, with a combination of the worldwide obesity epidemic, improved technological approaches in laparoscopy, and better understanding of obesity as a disease, the field has advanced immensely. Currently, we are at another critical intersection of our specialty. As we delve into the intersection of artificial intelligence (AI) and digital surgery within the realm of metabolic and bariatric surgery, we are at the point of a pending medical revolution. The promise of these technologies extends beyond the operating room, bearing the potential to reshape the entire continuum of care for those with obesity and its related complications.
Improved Access to Surgical Care
These technologies hold promise for the potential of increased accessibility. With AI’s advanced algorithms, we can predict heterogeneous regional needs and thus potentially distribute healthcare resources more efficiently. The advent of telemedicine, increasingly augmented with AI, can bridge the physical and resource distance between patients and specialized care centers, enabling more people to undergo evaluations without the burden of travel.1 This is particularly transformative for patients in rural or underserved areas, who can now receive expert consultation and follow-up, ensuring continuity of care and adherence to postoperative guidelines.
Better Patient Selection and Risk Stratification
The emerging role of AI in patient selection and risk stratification is likely to be the most important early application of this technology. By analyzing large datasets, AI can help us identify not just who will benefit from surgery, but also the nuances of their preoperative risk. Such approaches can go beyond traditional regression statistical methods, incorporating a wider array of variables, including social determinants of health, to provide a more holistic assessment. As a result, we may be better equipped to tailor surgical interventions to the individual, optimizing outcomes and minimizing risks.
Decreased Complication Rates
Our field has dramatically changed, with continuous improvement and references to national and international standards. Though low, surgical complications are a persistent concern, and here, AI provides an additional layer of insight. Machine learning models are being developed to predict complications before they occur, allowing for preemptive interventions.2 If integrated with digital surgery platforms of the future, these models may enable us to fine-tune surgical techniques and enhance perioperative care. Consequently, we anticipate not just a reduction in the incidence of complications, but also a reduction in hospital length of stays and overall improvement of the patient experience.
Better Follow-Up to Promote Obesity Treatment
Follow-up and constant management are crucial in the longitudinal treatment of obesity. AI can play a significant role in ensuring that patients receive continuous, personalized support. By processing patient data, AI can help in crafting individualized follow-up plans unique to specific patients’ medical and personal needs, facilitate remote monitoring, and signal when intervention is necessary, thereby fostering sustained weight loss and management of comorbid conditions.
Digital Surgery Platforms
The advent of digital surgery platforms brings new opportunities to surgical training and quality improvement. These platforms can capture and analyze intraoperative images, providing immediate feedback and aiding in the continual refinement of surgical techniques. They also offer the ability to segment data for research and educational purposes, contributing to a collective upskilling of the surgical community. Additionally, through the consistent recording of surgical procedures, these platforms can assist in creating a benchmark for quality and process improvement, driving the entire field toward better levels of performance. These implications are significant for all of us—surgeons, clinical leadership, credentialing bodies, and payors. We need to be on the forefront of this movement.
The Future Is Collaborative
While AI and digital technologies present us with tools of increasing power, their full potential can only be realized through collaboration between surgeons, data scientists, patients, and policymakers. There is a critical need for a shared framework of ethical guidelines, commitment to patient privacy, and ongoing dialogue on the balance between technological innovation and human insight.
The integration of AI and digital surgery within the field of metabolic and bariatric surgery is not simply a technical upgrade—it is a paradigm shift. We are not enhancing surgical procedures alone; we are reimagining the entire patient journey. From the moment a patient is identified as a candidate, through the surgery and continued follow-up, AI and digital surgery can deliver care that is more accessible, personalized, safe, and effective. We must move forward with cautious optimism and active participation, ensuring that as we understand and deploy these tools, we remain ever mindful of placing our patients first.
References
- Silcox R, Blaustein M, Khandelwal S, et al. Telemedicine use decreases the carbon footprint of the bariatric surgery preoperative evaluation. Obes Surg. 2023;33(8):2527–2532.
- Romero-Velez G, Dang J, Barajas-Gamboa JS, et al. Machine learning prediction of major adverse cardiac events after elective bariatric surgery. Surg Endosc. 2023.
ChatGPT Perspective
Editor’s note: The following is a response provided by ChatGPT, an artificial intelligence tool developed by OpenAI (San Francisco, CA, USA), when asked the following query: “Provide a synopsis of the impact of artificial intelligence on metabolic and bariatric surgery.” The summary has been edited for style and clarity.
Artificial Intelligence (AI) is poised to usher in a new era in the field of metabolic and bariatric surgery, offering a multitude of applications that have the potential to transform patient care, surgical outcomes, and surgical techniques, particularly through the use of robotic platforms.
In the realm of patient selection, AI presents a groundbreaking opportunity to refine the selection process. By sifting through extensive datasets, AI algorithms can pinpoint ideal candidates for metabolic and bariatric surgery, considering a myriad of factors such as comorbidities, genetic predispositions, and lifestyle. This precision ensures that procedures are targeted toward those individuals most likely to benefit, optimizing healthcare resources and increasing patient satisfaction.
AI’s impact on surgical outcomes is equally significant. Real-time data analysis enables the early detection of complications, reducing postoperative risks. Moreover, predictive analytics powered by AI can help craft personalized postoperative care plans, improving patient adherence and overall success rates.
In the realm of surgical techniques, AI can seamlessly integrate with robotic platforms, refining and enhancing procedures. AI-guided robotic surgery brings greater precision and dexterity to the operating room, resulting in less invasive surgeries and a reduced risk of complications. Additionally, surgeons can harness AI-driven augmented reality systems to enhance visualization during complex surgeries, making procedures safer and more efficient.
The benefits of AI in this field are profound. Personalized care plans based on individual patient data lead to improved outcomes, while AI-driven robotic surgery reduces operating time, lowering the risk of human error and enhancing patient safety. Moreover, AI’s ability to rapidly process and analyze vast amounts of data improves decision-making, benefiting both patients and medical professionals.
However, this transformation is not without its challenges. The use of AI in healthcare necessitates the collection and analysis of patient data, raising legitimate concerns about data privacy and security. Additionally, there is a risk of misuse or overreliance on AI without the appropriate training and oversight, which can lead to errors in decision-making.
Looking to the future, the potential evolution of AI in metabolic and bariatric surgery is promising. We can anticipate even more sophisticated predictive models that enable early intervention in complications. Furthermore, the integration of AI with virtual reality and telemedicine could facilitate remote consultations and surgeries, expanding access to specialized care. In addition, AI-powered decision support systems could extend to nutritional counseling and ongoing lifestyle guidance for patients.
In conclusion, AI’s integration into metabolic and bariatric surgery holds the promise of enhancing patient selection, improving surgical outcomes, and refining surgical techniques. While there are potential risks and challenges to navigate, as technology advances, the field stands to undergo a profound transformation, ultimately leading to improved patient care and long-term success.
Category: Current Issue, Perspectives
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