Artificial intelligence is already transforming medicine, especially in fields where images and text are an essential part of the clinical workflow. For Radiology, Pathology, and even fields like Dermatology and Gastroenterology, AI tools are rapidly being utilized. Yet, surgery remains an “AI desert.” A recent study evaluated 1,430 AI/ML-enabled devices authorized by the FDA, and less than 5% were employed in the operating room.
Using a problem-focused approach, I explore near-term opportunities and real-world problems (and barriers) to using artificial intelligence in the operating room. Capturing and annotating surgical video is the cornerstone.
Dr. Chris Holsinger,
Stanford University
But how can surgeons capture this and work with computer scientists? Frameworks, such as the surgical action triplet (instrument, action, target) and emerging surgical foundation models allow automated decoding of operative activity. But challenges remain. A broader ontology of surgery must be developed in collaboration with computer scientists to address these problems.
I present two use cases to explore these concepts. Thyroidectomy is one of the most common operations still performed almost entirely as an open surgical procedure. On the other hand, transoral robotic surgery is a niche procedure addressing a rapidly growing “epidemic” of HPV-mediated throat cancer. Current solutions for surgeons are described. Ultimately, building scalable, curated video datasets will advance algorithm development and allow for AI to enter the OR, solving real-world problems. But this process also will transform surgical education, from the medical student to the early-career surgeon, helping surgical training evolve beyond the Halstedian apprenticeship toward competency-based assessment and lifelong learning. A robust partnership with CS will be critical as this nascent field launches.
Dr. Chris Holsinger currently serves as Professor of Head and Neck Surgery and Director of the Head and Neck Oncology Program at Stanford University. Dr Holsinger’s research focuses on robotics, surgical innovation, AI, and clinical trials. In 2005, he described the surgical anatomy of the lateral oropharynx in English which helped to advance the burgeoning field of transoral robotic surgery. He helped refine several TORS techniques and served as the principal investigator of the FDA investigational device exemption trial in 2016-2017 for the single-port robotic surgical system.
He currently serves as Chair of the Surgical Subcommittee, for the NRG Oncology’s Head and Neck Working Group. He served as surgical PI for RTOG920, the largest post-op clinical trial in H&N oncology and also served as head of surgeon credentialing for ECOG3311. His current research focuses on AI in surgery and endoscopy, cognitive world models, autonomy, as well as multimodal profiling of HPV-mediated oropharynx cancer.
He graduated in 1990 cum laude from Vanderbilt College of Arts and Sciences with a major in molecular biology and in 1995 with his medical degree from Vanderbilt School of Medicine. He completed his internship and residency at Baylor College of Medicine and his Fellowship in head and neck surgical oncology at The University of Texas M. D. Anderson Cancer Center. In 2003, he was awarded a Fulbright Scholarship to study surgery at the University of Paris with Professor Ollivier Laccourreye and with Professor Wolfgang Steiner at the Georg- August University in Göttingen. From 2003-2013, Dr. Holsinger worked at the Department of Head and Neck Surgery at the University of Texas M.D. Anderson Cancer Center. In 2013, Dr. Holsinger moved to Stanford University to serve as Chief of Head and Neck Surgery, where he also led H&N Multidisciplinary Cancer Care Clinical Program.