Kehagias Dimitrios, Lampropoulos Charalampos, Bellou Aggeliki, Kehagias Ioannis
Department of Upper GI Surgery, Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, Cottingham, Hull, HU16 5 JQ, UK.
Department of Surgery, University of Patras, Patras, Greece.
Updates Surg. 2025 May 12. doi: 10.1007/s13304-025-02227-9.
Identifying the critical view of safety (CVS) and other safe anatomic landmarks during laparoscopic cholecystectomy (LC) is the cornerstone for avoiding bile duct injuries (BDI). Artificial intelligence (AI), which has infiltrated in the operating room, appears as a promising tool, enabling surgeons to safely dissect during LC. The aim of this study is to investigate the AI models and their performance for identifying these critical structures. A systematic literature review of the PubMed and Google Scholar databases was conducted using medical subject headings (MeSH). Studies presenting the application of AI models for identifying CVS and anatomic landmarks were included and analyzed in terms of performance and reliability. Clinical feasibility trials with preliminary data were separately analyzed. Seventeen studies were found eligible and analyzed for various parameters. Generating AI models for identifying CVS and anatomic landmarks during LC is feasible, while their performance in terms of accuracy, precision and recall has remarkably improved. Regarding their reliability, intersection over union (IoU) and F1/Dice scores have been improved, as well. AI models can be successfully deployed in the operating room, and could assist surgeons in decision-making. Implementation of AI during LC for identifying CVS and important anatomic landmarks appears as a feasible and promising option. Preliminary data are encouraging in terms of performance but still major obstacles and barriers need to be overcome. Whether this will lead to reduced BDIs and enhanced patient safety, requires more well-designed studies. PROSPERO database registration: (UIN: CRD42024557432).
在腹腔镜胆囊切除术(LC)中识别关键安全视野(CVS)和其他安全解剖标志是避免胆管损伤(BDI)的基石。已渗透到手术室的人工智能(AI)似乎是一种很有前景的工具,可使外科医生在LC手术中安全地进行解剖。本研究的目的是调查用于识别这些关键结构的人工智能模型及其性能。使用医学主题词(MeSH)对PubMed和谷歌学术数据库进行了系统的文献综述。纳入了展示人工智能模型用于识别CVS和解剖标志的应用的研究,并从性能和可靠性方面进行了分析。对具有初步数据的临床可行性试验进行了单独分析。共筛选出17项符合条件的研究,并对各种参数进行了分析。生成用于识别LC术中CVS和解剖标志的人工智能模型是可行的,而且其在准确性、精确性和召回率方面的性能有了显著提高。在可靠性方面,交并比(IoU)和F1/Dice分数也有所提高。人工智能模型可以成功部署在手术室中,并可协助外科医生进行决策。在LC术中应用人工智能识别CVS和重要解剖标志似乎是一种可行且有前景的选择。初步数据在性能方面令人鼓舞,但仍需克服一些主要的障碍。这是否会导致BDI减少并提高患者安全性,还需要更多设计良好的研究来证实。PROSPERO数据库注册号:(UIN:CRD42024557432)