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Elhage et al. Art Int Surg. 2025;5:247-53 https://dx.doi.org/10.20517/ais.2024.87 Page 251

implications of generative AI on medicine and within AWR specifically, though the field remains ripe for
[30]
study . Though there has been very little published on the use of generative AI within AWR, momentum
appears to be building. A recent study published in 2024 by Lima et al. aimed to evaluate the
appropriateness of recommendations from a publicly available Chatbot to common questions about ventral
hernia repair. Based on an expert review of the Chatbot’s answers to 23 questions, 74% of answers were
deemed to be appropriate by a majority of the reviewers. However, the authors highlighted known
difficulties with generative AI in the medical field, one importantly being the lack of, or the generation of,
false citations. A specific area where the Chatbot struggled in this scenario was in discussing the use of mesh
and surgical approaches. While these findings are exciting and encouraging, the technology remains far
[31]
from being applied in clinical practice .

FUTURE DIRECTIONS
The future of AI in AWR is exciting and we are merely at the tip of the iceberg. Much of future research will
be focused not only on improving upon current algorithms and developing new ones, but also on how we
[32]
can best validate these algorithms to ensure their safety . One can imagine a future where AI assistance
occurs at every level of surgical patient care: as an adjunct in preoperative decision making, for assistance
and guidance in the operating room, and even in the postoperative setting for early detection of
complications. Beyond simply creating new algorithms to answer questions or make predictions, the
surgical community must focus efforts on studying the best ways to deploy this technology into our daily
workflows, ensuring that we are using AI not only to improve patient outcomes, but also to improve
surgeon efficiency.

Another key direction for future research in the realm of AI and AWR will certainly be robotics. While the
implementation of computer vision into robotic platforms and autonomous robotics is beyond the scope of
[33]
this review, research has already started in the realm of AWR . Studies have begun to assess AI’s ability for
phase recognition within robotic inguinal hernia repair; however, this is proving difficult, and will only be
more difficult for AWR outside of inguinal hernia repair due to significant heterogeneity in case steps, order
of operations, and unique surgical anatomy . Beyond computer vision and autonomous robotic platforms,
[34]
AI research can influence the future of robotics by assisting with defining indications and predicting
outcomes for robotic versus open AWR. Current research, including randomized controlled trials, has not
shown significant differences in outcomes between the two modalities, leaving room for AI analytical
technology to potentially answer this question .
[35]
The future of AI lies not just in database and imaging analysis, but also in generative AI, which is poised to
play a larger and larger role in our clinical practice. While the aforementioned AWR-specific study evaluates
a chatbot’s response to questions, other fields in plastic surgery are pushing the envelope with generative AI
technologies. Within plastic surgery, generative AI has been used to generate consent material and answer
surgeon questions for intraoperative assistance [36,37] . While this technology is far from being ready to be used
clinically, it is exciting to picture a world where it will be seamlessly integrated into the framework of our
daily practice. Future studies focused on generative AI in AWR can utilize this technology to improve the
consent process and create new and improved mechanisms to educate patients and disseminate medical
information.

CONCLUSION
AI will continue to grow its presence in medicine as technology improves and our research into the field
deepens. AWR as a specialty has embraced this technology and is using it to better study and predict hernia
occurrence and AWR outcomes. Our review highlights key studies in the field, encompassing database