Department of Surge ry, University of Florida Health, Gainesville, Florida.
Departments of Biomedical Engineering, Computer and Information Science and Engineering, and Electrical and Computer Engineering, University of Florida, Gainesville, Florida.
J Surg Res. 2020 Sep;253:92-99. doi: 10.1016/j.jss.2020.03.046. Epub 2020 Apr 24.
Surgeons perform two primary tasks: operating and engaging patients and caregivers in shared decision-making. Human dexterity and decision-making are biologically limited. Intelligent, autonomous machines have the potential to augment or replace surgeons. Rather than regarding this possibility with denial, ire, or indifference, surgeons should understand and steer these technologies. Closer examination of surgical innovations and lessons learned from the automotive industry can inform this process. Innovations in minimally invasive surgery and surgical decision-making follow classic S-shaped curves with three phases: (1) introduction of a new technology, (2) achievement of a performance advantage relative to existing standards, and (3) arrival at a performance plateau, followed by replacement with an innovation featuring greater machine autonomy and less human influence. There is currently no level I evidence demonstrating improved patient outcomes using intelligent, autonomous machines for performing operations or surgical decision-making tasks. History suggests that if such evidence emerges and if the machines are cost effective, then they will augment or replace humans, initially for simple, common, rote tasks under close human supervision and later for complex tasks with minimal human supervision. This process poses ethical challenges in assigning liability for errors, matching decisions to patient values, and displacing human workers, but may allow surgeons to spend less time gathering and analyzing data and more time interacting with patients and tending to urgent, critical-and potentially more valuable-aspects of patient care. Surgeons should steer these technologies toward optimal patient care and net social benefit using the uniquely human traits of creativity, altruism, and moral deliberation.
手术操作和与患者及照护者共同做出决策。人类的灵巧性和决策能力存在生物学局限性。智能自主机器具有增强或替代外科医生的潜力。外科医生不应否认、愤怒或漠视为这一可能性，而应理解并引导这些技术的发展。更深入地研究手术创新和从汽车行业吸取的经验教训，可以为这一过程提供信息。微创手术和手术决策的创新遵循经典的 S 形曲线，分为三个阶段：（1）新技术的引入，（2）相对于现有标准实现性能优势，以及（3）达到性能平台期，随后被具有更高机器自主性和更少人为影响的创新所取代。目前没有一级证据表明，使用智能自主机器执行手术操作或手术决策任务可以改善患者结局。历史表明，如果出现此类证据，且这些机器具有成本效益，那么它们将增强或替代人类，最初是在密切的人工监督下执行简单、常见、常规的任务，然后是执行复杂任务，只需要最低限度的人工监督。这一过程在分配错误责任、使决策与患者价值观相匹配以及取代人力方面带来了伦理挑战，但可能使外科医生花费更少的时间收集和分析数据，而将更多的时间用于与患者互动，并处理紧急、关键且潜在更有价值的患者护理方面。外科医生应该利用创造力、利他主义和道德思考等人类特有的特质，引导这些技术实现最佳的患者护理和净社会效益。
