Image Changing in the Surgical Suite

Nirav Patel, Northwell Health

As more and more surgical procedures are performed using a digital imaging view, such as robotic, laparoscopic, or thoracoscopic, and displayed on a big screen, what will the future of surgical planning look like? In my opinion, the future will look like a repository of thousands or millions of recorded procedures, with AI analyzing patterns. AI can analyze an image or anatomy and identify how it was managed surgically. This replay can shorten the learning curve by thousands of hours, which, in the past, were spent on training. When I completed residency, I worked 110 hours a week. Nowadays, these processes are changing.

Surgery training can be expected to consist of more simulation, virtual reality, and augmented reality. Using screens in day-to-day life has been normalized, and medicine now revolves around the digital acquisition of images, digital synthesis of images, and AI analysis of images. So there is no longer as much guesswork. We used to presume how the blood flows, and that if a particular lesion in the heart is fixed, how the blood is going to flow could be concluded. Now, we have 4D flow imaging with MRI, giving us the timing of the cardiac cycle, with precision down to a fraction of milliliters, along with the amount of blood and its flow direction.

Don’t get me wrong — surgery is still an art. There is a point in the operating room at which the science stops and the art begins. But digital surgery is changing the reality of operations because we can accurately measure everything before we go into the operating room. The biggest barrier is: Do we have a repository of all these images and how do we collect it? Where do we collect it? Do we have the consent of every patient? How do we have de-identified information in there? It’s not straightforward. At Northwell Health, where I work, we have 54 robotic systems. Do we have the money to use a digital platform like this?

And there are other aspects to consider. We are already using 3D printing. If there is a lesion in the heart, for example, and the operation is to be performed by the trainee, a high-fidelity CAT scan, an MRI, or an echo image could be taken and a 3D printing of it could be created. The trainee could complete the stitching and cutting on the 3D-printed silicone model, which would mitigate patient risk because the rehearsal of the surgery allows the trainee to know what to expect. This is where I think imaging has made the biggest difference in surgery, limiting the surprises.

In the future, I think a virtual reality-based platform will be used to practice the majority of common operations, before getting to the patient. The trainees could be evaluated, for example, on how much port they are using, or not using, and this could be replicated for countless operations. Obviously, human anatomy and slides differ, but AI can analyze patterns. The final word will be the human component, but the use of AI will make surgery more precise.

Meet the author

Nirav Patel, M.D., is the director of robotic cardiac surgery for Northwell Health and the vice chairman of cardiovascular and thoracic surgery at Lenox Hill Hospital. He received his medical degree from Baroda Medical College in India. He recently collaborated with Fredrik Berselius, holder of two Michelin stars and founder and owner of Aska restaurant in New York, on a surgically inspired cookbook called The Heart Surgeon’s Cookbook; email: nipatel@northwell.edu.

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