Artificial Intelligence and Surgery: Ethical Dilemmas and Open Issues.

BACKGROUND: Artificial intelligence (AI) applications aiming to support surgical decision-making processes are generating novel threats to ethical surgical care. To understand and address these threats, we summarize the main ethical issues that may arise from applying AI to surgery, starting from the Ethics Guidelines for Trustworthy Artificial Intelligence framework recently promoted by the European Commission. STUDY DESIGN: A modified Delphi process has been employed to achieve expert consensus. RESULTS: The main ethical issues that arise from applying AI to surgery, described in detail here, relate to human agency, accountability for errors, technical robustness, privacy and data governance, transparency, diversity, non-discrimination, and fairness. It may be possible to address many of these ethical issues by expanding the breadth of surgical AI research to focus on implementation science. The potential for AI to disrupt surgical practice suggests that formal digital health education is becoming increasingly important for surgeons and surgical trainees. CONCLUSIONS: A multidisciplinary focus on implementation science and digital health education is desirable to balance opportunities offered by emerging AI technologies and respect for the ethical principles of a patient-centric philosophy.

Why non-technical skills matter in surgery. New paradigms for surgical leaders.

The surgical literature is paying more and more attention to the topic of soft or non-technical skills (NTS), defined as those cognitive and social skills that characterize high-performing individuals and teams. NTS are essential in supporting surgeons in dealing with unexpected situations. During the COVID-19 pandemic, NTS have been considered crucial in defining situation awareness, enhancing decision making, communicating among groups and teams, and fostering leadership. With a "looking back and planning forward" approach, the current perspective aims at deepening the contribution of NTS for surgeons to deal with the unexpected challenges posed by the COVID crisis, surgical emergencies, the introduction of new technologies in clinical practice, to understand how such skills may help shape the surgical leaders of the future.

Fluoroless intravascular ultrasound image-guided liver navigation in porcine models.

BACKGROUND: An intravascular ultrasound catheter (IVUSc) was developed for intracardiac ultrasound to assess interventions with compelling results. However, intrahepatic vascular exploration was rarely tested and was always associated with X-ray techniques. The aim of this study was to demonstrate the feasibility to navigate through the whole liver using an IVUSc, providing high-quality images and making it unnecessary to use ionizing radiation. METHODS: An ex vivo pig visceral block and an in vivo pig model were used in this study. The IVUS equipment was composed of an US system, and of an 8 French lateral firing IVUSc capable of producing 90-degree sector images in the longitudinal plane. After accessing the intravascular space with the IVUSc into the models, predetermined anatomical landmarks were visualized from the inferior vena cava and hepatic veins and corroborated. RESULTS: IVUS navigation was achieved in both models successfully. The entire navigation protocol took 87 and 48 min respectively, and 100% (21/21) and 96.15% (25/26) of the landmarks were correctly identified with the IVUSc alone in the ex vivo and in vivo models respectively. IVUS allowed to clearly visualize the vasculature beyond third-order branches of the hepatic and portal veins. CONCLUSIONS: A complete IVUS liver navigation is feasible using the IVUSc alone, making it unnecessary to use ionizing radiation. This approach provides high-definition and real-time images of the complex liver structure and offers a great potential for future clinical applications during diagnostic and therapeutic interventions.

Percutaneous transhepatic cholangioscopy using a single-operator cholangioscope (pSOC), a retrospective, observational, multicenter study.

BACKGROUND AND AIMS: Percutaneous cholangioscopy (PC) is more complex and invasive than a transpapillary approach, with the need for a large percutaneous tract of 16 French (Fr) on average in order to advance standard percutaneous cholangioscopes. The aim of this study was to investigate whether percutaneous single-operator cholangioscopy (pSOC) using the SpyGlass™ DS system is feasible, safe, and effective in PC for diagnostic and therapeutic indications. MATERIALS AND METHODS: The data of 28 patients who underwent pSOC in 4 tertiary referral centers were retrospectively analyzed. Technical and clinical success for therapeutic procedures was assessed as well as diagnostic accuracy of pSOC-guided biopsies and visualization. Adverse events and the required number and size of dilatations were reviewed. RESULTS: 25/28 (89%) patients had a post-surgical altered anatomy. The average number of percutaneous dilatations prior to pSOC was 1.25 with a mean dilatation size of 11 French. Histopathology showed a 100% accuracy. Visual impression showed an overall accuracy of 96.4%. Technical and clinical success was achieved in 27/28 (96%) of cases. Adverse events occurred in 3/28 (10.7%) cases. CONCLUSION: pSOC is a feasible, safe, and effective technique for diagnostic and therapeutic indications. It may be considered an alternative approach in clinical cases where gastrointestinal anatomy is altered. It has the potential to reduce peri-procedural adverse events and costs. Prospective randomized-controlled trials are necessary to confirm the previously collected data.

Prevalence of cholelithiasis in Buenos Aires, Argentina.

BACKGROUND: Cholelithiasis is an important cause of morbidity in the world and it varies significantly depending on the region of study. OBJECTIVE: To assess the prevalence of cholelithiasis in Buenos Aires. MATERIAL AND METHODS: This is a cross-sectional, descriptive, observational study performed in a public hospital with tertiary care in Gastrointestinal Surgery. From July 2010 to December 2011, 1,875 healthy volunteers who underwent liver, gallbladder and pancreas ultrasound imaging were included and a questionnaire containing the individual's medical history was administered. The presence of cholelithiasis and its eventual risk factors were studied. RESULTS: Of 1,875 individuals, 866 were males (46.2%) and 1,009 females (53.8%), older than 20 years old with an average age of 46.1 + 16.7 years. Cholelithiasis was found in 410 inidviduals (21.9%); 285 (15.2%) diagnosed at the time of the study and 125 (67%) who had already undergone a cholecystectomy due to gallstones. CONCLUSIONS: The prevalence of cholelithiasis in Buenos Aires, capital city of Argentina, is 21.9%. A significant association was found between cholelithiasis and female gender, age, body mass index, history of colic pain, family history of cholelithiasis, smoking, fatty liver and number of pregnancies.

Prevalence of cholelithiasis in Buenos Aires, Argentina / Prevalence of cholelithiasis in Buenos Aires, Argentina.

BACKGROUND: Cholelithiasis is an important cause of morbidity in the world and it varies significantly depending on the region of study. OBJECTIVE: To assess the prevalence of cholelithiasis in Buenos Aires. MATERIAL AND METHODS: This is a cross-sectional, descriptive, observational study performed in a public hospital with tertiary care in Gastrointestinal Surgery. From July 2010 to December 2011, 1,875 healthy volunteers who underwent liver, gallbladder and pancreas ultrasound imaging were included and a questionnaire containing the individual’s medical history was administered. The presence of cholelithiasis and its eventual risk factors were studied. RESULTS: Of 1,875 individuals, 866 were males (46.2

) and 1,009 females (53.8

), older than 20 years old with an average age of 46.1 + 16.7 years. Cholelithiasis was found in 410 inidviduals (21.9

) diagnosed at the time of the study and 125 (67

) who had already undergone a cholecystectomy due to gallstones. CONCLUSIONS: The prevalence of cholelithiasis in Buenos Aires, capital city of Argentina, is 21.9

. A significant association was found between cholelithiasis and female gender, age, body mass index, history of colic pain, family history of cholelithiasis, smoking, fatty liver and number of pregnancies.

Prevalence of cholelithiasis in Buenos Aires, Argentina. / Prevalence of cholelithiasis in Buenos Aires, Argentina.

BACKGROUND: Cholelithiasis is an important cause of morbidity in the world and it varies significantly depending on the region of study. OBJECTIVE: To assess the prevalence of cholelithiasis in Buenos Aires. MATERIAL AND METHODS: This is a cross-sectional, descriptive, observational study performed in a public hospital with tertiary care in Gastrointestinal Surgery. From July 2010 to December 2011, 1,875 healthy volunteers who underwent liver, gallbladder and pancreas ultrasound imaging were included and a questionnaire containing the individuals medical history was administered. The presence of cholelithiasis and its eventual risk factors were studied. RESULTS: Of 1,875 individuals, 866 were males (46.2

) and 1,009 females (53.8

), older than 20 years old with an average age of 46.1 + 16.7 years. Cholelithiasis was found in 410 inidviduals (21.9

); 285 (15.2

) diagnosed at the time of the study and 125 (67

) who had already undergone a cholecystectomy due to gallstones. CONCLUSIONS: The prevalence of cholelithiasis in Buenos Aires, capital city of Argentina, is 21.9

. A significant association was found between cholelithiasis and female gender, age, body mass index, history of colic pain, family history of cholelithiasis, smoking, fatty liver and number of pregnancies.