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Nawrat. Mini-invasive Surg 2020;4:28 I http://dx.doi.org/10.20517/2574-1225.2020.08 Page 5 of 16

If, however, we assume that we would like to operate in a place where our intervention is necessary by
methods that reduce the risk of damage to healthy tissues as much as possible, it means the loss of the
ability to freely view and touch the tissue, the inability to directly insert our hands in the place of surgery.
This is the current MIS dilemma. Is this beneficial for the patient? Can a surgeon possibly do this?

This is a challenge for creating new tools and both artificial intelligence and robots are one of them.

In the mathematical context, artificial intelligence is not an ordinary algorithm, which is a mathematical
record of a cause and effect relationship, but a system based on say, neural networks that map the way
of building memory pathways in the human brain - i.e., a decision system based on knowledge and
experience, similar to the learning process. We do not quite know why such a decision is made but we are
sure that the process of system optimization achieved the appropriate level of excellence. This is interesting
from the point of view of applying AI successfully in medicine, as it proves the existence of an art factor
in the craft of the doctor. You cannot replace a doctor with an automatic machine, i.e., a simple machine.
Algorithms alone are likely not enough. There must be artificial intelligence in the decision making process
and the robot in execution.

In medicine, artificial intelligence can definitely play a positive role in developing strategies and solutions
for operations.

The word “strategy” comes from the Greek words stratós - army, army, and ágein - to command. Carl von
Clausewitz defined that strategy is the science of using battles for war purposes. Strategy is not theoretical
planning, but it is very close to action, modified by a steady flow of information.

The word “tactics” comes from the Greek words tássein, meaning táttein stack, organize, arrange. The
commander creates and effectively uses the elemental system to combat factors such as destruction,
movement and information. Isn’t it also the essence of surgical intervention?

Surgery is a special human activity related to complex actions for achieving specific purposes. The
complexity of an action is the need to assess the condition of the starting issue and making decisions about
the distributed action in time divided into roles of the members of a special team.

Operation is a part of the patient’s treatment. The doctor develops a treatment strategy and tactics to define
the next elements of the procedure. Operation planning includes defining the space and subject of the
operation, choosing methods, materials and devices, program of using the operating and accompanying
team, and finally, the choice of the sequence of treatments, activities, movements and the impact of tools in
the space of operations. The way of conducting surgery significantly depends on the equipment available.

Planning and advisory systems - extended surgeon information space
The surgeon who operates in a less invasive way has impaired access to information from the patient’s
body, the surgical field. In the classic version of video-surgery, a very good quality image is obtained
- enlarged with clear outlines of contours and colors. We can support this set of visual information by
adding information obtained in the diagnostic and analytical process. The ways to visualize this additional
information is a separate field of ergonomics, including virtual and augmented reality technology.

In my team, we have been developing the use of computer simulation of surgical operations and the use
of physical modeling to improve the patient-specific decision making process for many years [Figure 1].
The skillful use of physicists’ knowledge allows us to obtain information, e.g., what will be the flow in a
given branch of the coronary vessels after performing a sequential or single bypass, what will be the flow,
pressure, regurgitation after implantation of a given type of prosthesis, etc.