Anne van Dalen

A review on the current applications of artificial intelligence in the operating room I 217 8 INTRODUCTION The last few years have seen a tremendous growth in the use of sensors, video, and digital devices in the operating room (OR). 1–3 These applications generate large amounts of data in various formats, often referred to as “big data.” 4 Big data sets are complex and may be analyzed computationally to reveal patterns, trends, and associations, especially relating to human behavior and interactions. Big data has the potential to become progressively useful in both guiding surgical care and optimizing clinical patient outcomes, if handled well. 5-8 A limitation often overseen in analyzing big data is that traditional data processing techniques are not able to handle these vast amounts of complex data. 9 The solution may lie in a research area that became popularly known as “artificial intelligence (AI).” The term AI is often used to describe the study of algorithms that enables machines to reason and perform cognitive functions such as learning, problem-solving, and decision- making. 10,11 Recently, AI has made its introduction into medicine and, even more recently, into the OR. 2 This is of interest as these high-risk environments are considered to be one of the most error-prone areas in the hospital, where outcome is highly dependent on use of modern technology generating multisource data. 12,13 As such, if properly used, AI may have great impact on surgical workflow and outcome. It may provide context-aware perioperative decision support, predict patterns in patient parameters, monitor progress, and develop new in situ training tools. 14–17 These are just a few examples. To date, AI applications are painting and predicting a promising future surgical landscape. Yet, as is often the case with new innovations, AI may become lost in its promise when it is unclear what the actual baseline and best use case is. 18–20 The current medical literature fixates predominantly on the future possibilities of AI in surgery, or more specifically, inside the OR. However, it is important to know the current situation—where does AI in the OR stand?—in order to validly decide on areas worthy of further exploration. The aim of this study is to systematically provide an overview of the current AI applications in surgery, used to support various processes inside the OR.