More on artificial intelligence in medicine and surgery

Part 1

A survey published in the journal arXiv predicted with a 50% probability that high-level machine intelligence would equal human performance as a surgeon in approximately 35 years. See graph below. 

Click on the figure to enlarge it

We have already seen a machine beat the world’s best Go player. Although Go is a complicated game, it lends itself to mathematical analysis unlike what one might experience when doing a pancreatic resection.

A potential flaw in this study is that the surveyed individuals were all artificial intelligence researchers who predicted that machines would not be their equal for over 85 more years with the 75% likelihood of this occurring being over 200 years from now.

I suspect if surgeons were asked the same questions, we would say it would take over 85 years for machines to be able to operate as well as we can and 35 years until artificial intelligence researchers would be replaced by their creations.

[Thanks to @EricTopol for tweeting a link to the arXiv paper.]

Part 2

Similar to the question “who is responsible if a driverless car causes an accident?” is “when artificial intelligence botches your medical diagnosis, who’s to blame?” An article on Quartz discussed the topic.

[Digression: The article matter-of-factly states “Medical error is currently the third leading cause of death in the US… ” This is untrue. See this post of mine and this one from the rapid response pages of the BMJ.]

If artificial intelligence was simply being used as a tool by human physician, the doctor would be on the hook. However indications are that artificial intelligence may be more accurate than humans in diagnosing diseases and soon may be able to function independently.

If a machine makes a diagnostic error, are the designers of the software responsible? Is it the company that made the device? What about the entity owns the system? No one knows.

The Quartz piece did not address this. Who is responsible if a nonhuman surgeon makes a mistake during an operation?

I’m sorry I won’t be around 35 years to hear how this is settled.

Will robots eliminate the need for surgeons?

A medical student from Germany emailed me saying he had always wanted to be a surgeon, but someone told him that by 2030 surgeons would no longer be needed because robots would be doing all the operations. He worried that after years of studying and hard work, he might lose his job to “R2-D2.”

He mentioned IBM’s Watson and a recent paper that appeared in the journal Science Translational Medicine about a robot that can handle and suture bowel.

He asks, “What do you think about the future of surgery?”

Thank you for your email and the link to the paper.

I read the paper and was amused by its title "Supervised autonomous robotic soft-tissue surgery" which is an oxymoron. The definition of autonomous is "acting independently or having the freedom to do so." This “supervised” robot is not really autonomous.

The robot is capable of performing a nearly technically perfect intestinal anastomosis but still needs a human surgeon to open the abdomen, prepare the bowel for the procedure, tidy up, and close. I'm not sure that this is any different than when surgical staplers were introduced. This robot is simply making the operation easier and possibly more precise.

Surgeons will still be needed in case the robot makes a mistake like causing bleeding while placing a suture near the mesentery. If bleeding in that area is not promptly controlled, a large hematoma can develop and possibly compromise the blood supply to the anastomosis. And will the robot be able to decide who needs an operation and when to do it?

One worrisome byproduct of surgical stapling is that many graduates of residency programs within the last 15 or 20 years have little experience in performing a hand sewn bowel anastomosis. What will they do if the hospital runs out of staplers? Soon, I guess they could consult the (somewhat) autonomous robot.

I have written about automation and the erosion of surgical skills. This problem also affects pilots. I have also addressed the concept of  robots operating alone. I don't see it happening any time soon.

I think there will always be a need for surgeons. Even the smartest robot is going to have some trouble dealing with a trauma patient who is hypotensive.

The future will take care of itself. In the 1980s, people were concerned about the demise of general surgery. Opinion pieces with titles like “Will the general surgeon become extinct?” and “Is general surgery a dying specialty?” appeared in major journals like JAMA and the World Journal of Surgery.

Then in 1990, laparoscopic cholecystectomy opened the door to a whole new area of general surgery that no one had ever dreamed of.

Good luck with your studies and your surgical career.