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Plenary Session takes on responsible AI and green urology

Will the surge of artificial intelligence (AI) and other technologies eventually cause the obsolescence of open surgery? Prof. Prokar Dasgupta (GB) addressed this during his state-of-the-art lecture “How do I see the urology theatre of 2030?” in the Plenary Session “The future of urology: From carbon footprint to artificial intelligence” chaired by Prof. Thomas Knoll (DE) and Prof. Arnulf Stenzl (DE).

Prof. Dasgupta foresees a continued rise of robotics in the urology operating room; improved clinical outcomes through image guidance; and reduced waste and better efficiency using responsible AI. He predicted, “At least the one thing we know for 2030 is this: robotic surgery for most cancers is cheaper than open surgery.”

As new tools come into the market, Prof. Dasgupta advised, “Use a standardised method of reporting, otherwise we won’t learn from our mistakes”. He then discussed the four stages of the IDEAL framework for surgical robotics: (1) Idea, (2a) Development and (2b) Exploration, (3) Assessment, and (4) Long-Term Monitoring.

Prof. Dasgupta predicted that the Internet of Skills (human skills can be delivered or acquired without physical boundaries) will humanise surgery. He mentioned the first telesurgery consensus conference held in February 2024 in Florida, U.S. which featured operating from a control room, which can be 3,000 km away, with no latency/jitter due to 5G technology. He added that operating remotely can also reduce carbon footprint.

“My views on AI are slightly different; it should be for everyone and not just for the privileged few. AI will have the greatest impact when everyone can access it and when it’s built with everyone’s benefit in mind,” stated Prof. Dasgupta.

He also underscored that open surgery is not dead. Prof. Dasgupta argued, “Some tasks can be automated such as suturing, but to do everything automatically, that’s just science fiction”. He cited the levels of autonomy from the Automation Classification used in Surgical Robotics then stated that there is no Level 4 (High Autonomy; robot makes medical decisions with direct human supervision) and Level 5 (Full autonomy; robot surgeon performs entire operation independently). “We have to do this responsibly. We need a Weizenbaum test. What is the effect of these machines on society, on you and me? Who is gaining and losing from this? These are the questions we need to ask.”

Prof. Dasgupta urged the next generation to learn surgical data science which he predicts to be relevant by 2030.

A greener future in urology

As emerging technologies and methodologies impact current and future clinical practice, carbon footprint reduction and sustainability become end goals. The Plenary Session also focused on the best way to reduce carbon footprint in urology.  Experts Dr. Stacy Loeb (US) and Dr. Annemarie Leliveld-Kors (NL) offered the US and EU perspectives, respectively.

Dr. Loeb stated that telemedicine and virtual meetings offer significant environmental advantages. She shared that there are 48 studies covering 68,465,481 telemedicine consultations, which saved 691,825 tons of CO2. Dr. Loeb urged to consider the climate impact of meetings and a physical meeting must take place, she offered suggestions such minimising travel distance for attendees, partnering with eco-friendly hotels, electronic registration and materials, and climate-friendly food, to name a few.

She added that streamlining clinical pathways also reduces emissions, and counselling patients on plant-based diets can jointly improve urological and planetary health.

Providing the European perspective, Dr. Leliveld-Kors emphasised on raising awareness on green solutions and alternatives, the “10 R Strategies on circularity” (listed from high to low levels of circularity: refuse, reduce, redesign, re-use, repair, refurbish, remanufacture, re-purpose, recycle, and recover), collaboration, innovation, and education.

Specific to urology, Dr. Leliveld-Kors shared insights on single versus reusable cystoscopes and ureterenoscopes; non-sterile versus sterile gloves; and waste, carbon, and energy production in urological surgery, to name a few.

She mentioned hurdles that need to be to addressed such as inadequate facilities and education; medical device regulation; European-wide collaboration and interaction with other specialties; and ethical discussions about sustainable healthcare.

The discussion was moderated by Prof. Kari Tikkinen (FI).

(Re)view these and more presentations on the EAU24 Resource Centre.