Humans use tools: From handcrafted tools to artificial intelligence.

Human evolution is instrument based. Humans created tools >2 million years ago to aid them in hunting, gathering, and defense, allowing them to build shelters and farms and transport goods and people over great distances. Written records preserved our knowledge and experiences for future generations. Instruments have greatly influenced surgery. Knives and needles were used by ancient surgeons, whereas lasers, endoscopes, and robotics are used today. Artificial intelligence (AI) is the future of surgical instruments, increasing precision through self-evaluation, but development remains in the early stages. Vascular surgery research and practice has used AI-powered systems that can track patient progress and identify vascular disease risk using deep learning and pattern recognition, as well as improved radiological interpretation of vascular imaging and medicine. Using insights and data-driven recommendations, AI-powered decision support systems could help surgeons in enhancing patient outcomes by providing guidance to navigate complex anatomy and identify anomalies. Robots can assist surgeons in performing risky, complex operations with optimal outcomes. Human expertise and AI will revolutionize surgery, enhancing its safety, precision, and efficacy. Surgical applications of AI raise numerous questions and debates. Data must be representative of all populations, data management must protect the privacy of patients and physicians, and the AI decision-making process must be clarified to produce validated models that can be used ethically. Vascular surgeons' judgment and experience should not be automated. Instead, AI should contribute to the efficiency and effectiveness of vascular surgeons. Human clinicians must interpret AI-generated data, use clinical judgment, and build empathy, compassion, and shared decision-making to sustain doctor-patient relationships. From simple tools to complex modern technologies, the history of tools reveals human creativity. Our environment has been altered by technology, ensuring our survival and growth. AI is still a half-told tale that will inspire and amaze us for years to come.

Prevalence of abdominal aortic aneurysms in four different metropolitan areas in Mexico.

OBJECTIVE: Epidemiological data on aneurysmal disease affecting the abdominal aorta in Latin American countries are limited. In our institution, the National Institute of Medical Sciences and Nutrition Salvador Zubiran (INCMNSZ), we have reported an Abdominal Aortic Aneurysm (AAA) prevalence of 3.26% in patients at risk from our Ultrasound (US) screening program. We aim to determine and compare the prevalence of undetected AAA in four different Metropolitan areas in Mexico to justify further US screening efforts. METHODS: A cross-sectional multicenter study was conducted in 9 different academic institutions. Abdominal Computed Tomographies (CT) from patients with age equal or greater than 55 years in our center (INCMNSZ), and in 65 year old patients and older in the remainder institutions were systematically reviewed. Abdominal aortic diameters were measured at the level of the superior (SMA) and inferior mesenteric arteries (IMA) in nonaneurysmal aortas and maximum diameters in the found AAA. Categorical data were analyzed by nonparametric statistic test at significance level (P < 0.05), the Pearson test was used to determine the correlation of age and aortic diameters. RESULTS: The cohort included a total of 12, 936 patients paired with respect gender (53% females, with a mean age of 69 years), the AAA prevalence found in the studied Mexican population was 3.08% (399 AAA patients). In centers where more than 200 CTs scans were reviewed, the prevalence was 4.03%, compared to the 4.63% found in centers with less than 200 studies (P = 0.41). In patients between the ages of 55 to 64 from INCMNSZ (3889 total), the prevalence was 0.77%, supporting the need of focused US-screening programs in individuals at the age of 65 and older in our country. CONCLUSIONS: The introduction of a national US Screening Program for the detection of AAA in Mexico represents a challenge in our current health system. This Multicenter initiative demonstrates that our AAA prevalence is not different to other international reports; imaging screening might represent cost-effective strategy for reduction of aneurysm-related mortality.