Page 76 - Read Online

Page 379 Novotny et al. Art Int Surg 2024;4:376-86 https://dx.doi.org/10.20517/ais.2024.52

VR and AR are of great benefit in the field of breast surgery, especially in breast reconstruction with deep
inferior epigastric perforator (DIEP) flaps. These technologies allow preoperative planning by visualizing
the complex anatomical structures of the perforators. One example is the visualization of blood vessels
based on CT angiograms, which helps surgeons determine the optimal position for the perforators during
surgery . Intraoperative AR-based visualization of perforator vessels has been shown to be more reliable
[20]
[18]
than traditional methods such as Doppler ultrasound . Nonetheless, up to now, finding the perforator by
Doppler US is a proven conventional method.

In South Korea, liposuction has been supported by AI for several years. The 365mc Motion Capture and
Artificial Intelligence assisted Liposuction (M.A.I.L.) system employs advanced analytics to examine billions
of movements, enabling the use of AI to identify the optimal movements for a successful procedure.
Conversely, the M.A.I.L. system transmits visual and haptic (touch-based) notifications to the surgeon’s
hand in the event of a potentially hazardous movement, thereby enabling real-time micro-adjustments. The
movements of the cannula are recorded on nine different axes to further improve ML for future
interventions. With each operation performed, the system expands its database, increasing its precision and
[21]
accuracy . A recently developed virtual robotic system has performed significantly better than experienced
surgeons in basic surgical tests on pig tissue. More broadly, this proves that AI can be trained to perform
[22]
highly complex technical skills . Despite these technological advances, surgical robots are not yet widely
used in plastic surgery, although they could offer advantages such as eliminating tremors and scaling
movements. However, reports of the use of robots in lymphatic reconstruction and free flap dissection
[23]
indicate increasing acceptance .
One of the main applications of VR and AR technologies in upper extremity (UE) plastic and reconstructive
surgery is postoperative rehabilitation, particularly for patients with phantom pain following amputation.
VR is used as an alternative to mirror therapy by simulating the amputated limb to help the patient process
the visual and proprioceptive sensations of the lost limb . Postoperative care is equally complex, requiring
[24]
close monitoring to prevent complications such as infections, tissue necrosis, or suboptimal healing . Early
[25]
detection of complications is crucial but often difficult to achieve with traditional methods. AI technologies
have the potential to revolutionize postoperative care by offering predictive analytics based on real-time
data. For example, AI-powered systems can monitor wound healing, predict the likelihood of
complications, and provide timely alerts for early intervention. This not only improves patient safety but
also reduces the need for revisions or secondary surgeries . This can help in postoperative surveillance of
[26]
microvascular flap surgery. The postoperative compliance rates for each patient can be assessed individually
and an effective discharge plan can be developed in combination with discharge management. This can
improve the length of stay and postoperative outcome and reduce the bureaucratic workload . Discharge
[27]
planning is a critical issue at a time when hospitals are chronically overcrowded and understaffed. Staff
shortages, a large wave of retirements, and an ever-growing and aging population demand efficient and
universal solutions. The solution can only be found through precise and accurate planning, and this is what
AI offers .
[28]

LEARNING CURVE OF SURGEONS
Surgery is a profession that requires endless practice and training. AI offers a whole new world of training
methods, from virtual tutoring to VR simulators and training robots. VR can also be used in medical
education, where it is widely used as a training tool. Many commercial products are already on the market
and are being used successfully in medical education . Another application of VR in UE surgery is
[12]
microsurgery training. VR has proven to be particularly useful for super-microsurgical procedures, such as
the treatment of lymphoedema, which involves extremely small vessels and lymphatic channels.