AI Revolution: Robot-Assisted Surgery and Empowering Patient-Centered Healthcare

0:00 Speaker 1: Welcome to the Healthy, Wealthy and Wise podcast with Dr William Chokta, MDJD. Our mission is to empower you with the knowledge and the tools you need to thrive in all aspects of your lives. Join us now as we discuss everything from nutrition and exercise to money management and personal growth. Dr Chokta will provide insightful advice on how to improve your physical and financial health, as well as your emotional and mental well-being. Whether you're looking to boost your energy levels, unlock financial freedom or cultivate a more positive mindset, we've got you covered.

0:41 Get ready to become the best version of yourself? So let's get started. Here's Dr William Chokta, MDJD. Speaker 2: Good morning, welcome to our Healthy, wealthy and Wise podcast. This is part of our Leadership Masterclass series and it is designed to help you live long and thrive. We're delighted to have you with us today, and I am Dr William T Chokta. I will be your facilitator this morning. So welcome, and let's get started. Today, we're going to talk about artificial intelligent robots in surgery. That's true, artificial intelligent robots in surgery. I believe life is about being of service to others . I believe knowledge is power.

1:35 I believe leaders can change the world. One of the things I've learned in my 50 years of surgical practice is that it is important to have beliefs, because our beliefs affect our thoughts, our thoughts affect our feelings and our feelings affect our actions. So if you are not feeling well or you are not acting the way you think you should act, go back to your beliefs and make sure your belief systems are where they should be at the present time. With the Masterclass and with our podcast, i always like to have you think as doctors, think as physicians. Put yourself in the shoes of that physician as we go through this particular topic, and then it will make much more. It will be much more relevant and be much closer to what we're talking about. I always like to put up an outline , and the purpose of the outline is to tell you what we're going to talk about and to let you know when we're just about done.

2:40 I realize that you're very, very busy people and you have a lot on your plate and you have a lot to do, and I appreciate you sharing parts of your valuable time with us, and so we will certainly keep that in mind. We're going to talk about the definition of artificial intelligence. We'll then go to the benefits of AI in medicine in general. We'll talk about the benefits of AI robot assisted surgery applications. We'll talk about what those benefits are for physicians and we'll end up talking about what those benefits are for hospitals. When I start talking about the benefits of artificial intelligent robots for hospitals , then you know that I'm just about done. Well, what is artificial intelligence? One of the basic definitions is the simulation of approximation of human intelligence in machines. The simulation or approximation of human intelligence in machines. I like to simplify that and just say teaching machines to think. Artificial intelligence is basically teaching machines to think. Some of the goals of that is to have a computer enhanced learning, reasoning and perception. There are two basic categories of artificial intelligence. Technically, one category has to do with basic pattern recognition, where the machine

4:12 is taught how to recognize a certain pattern of data or pictures or images, etc. The other basic type is complex human emotion. Indeed, when you get into emotion and computers, that gets you into some of the controversial areas. For the most part, we will not get into that today, but that is an issue with computers, particularly with AI and with chatbots. We will talk about that a bit later , at another time. Basically, computers follow algorithms and these are patterns of data or rules of data that data has to follow. This is part and parcel to the process of how artificial intelligence is able to occur, if you just keep in mind that when we say artificial intelligence, we are talking about teaching machines to think . One of the ways that artificial intelligence has been very helpful in hospitals and in medicine in general is it helps all of us in healthcare to improve in our accuracy of diagnosis. It helps us to improve in our ability to evaluate medical images, particularly with x-rays, mris, ultrasounds and CAT scans. It improves our medical decision making, and this is mainly with a process called clinical

5:45 decision support. Whereas a physician, if I have a plan of action or therapy for a certain patient, and as I have to put that data into the computer, because all hospitals now are computer rise based on the Affordable Care Act, obamacare from 2010. And now what I put into that computer has to be correct or in alignment, if you will, with what that computer perceives as quality care. Otherwise it will not allow me to do that, and that's an extra protective layer, in my judgment , for quality patient care. And the other part of artificial intelligence and medicine is predictive analysis, and this gets a lot into executive management and staffing, nursing , staffing, position staffing, et cetera, et cetera. But all of this goes to quality patient care And this, indeed, is what we're most concerned about. So what are some of the benefits for patients in surgery? And let me say that when I say artificial intelligence, robot in surgery, i'm talking about robots in robot assisted surgery for patients. In other words, this is surgery that's robot assisted, so it's not just that's the robot running around in surgery. There are no humans there. No, no, no, no, no. That's not what I'm talking about. I'm talking about surgery that is robot assisted or AI

7:20 robot assisted, and there's some particular benefits to the patient, and one of the very obvious benefits to the patient is that patients have a shorter hospital stay And part of the reason for that is that the incision in general for these types of surgeries tend to be smaller And because of the small incision that decreases the risk of surgical site infection. It also decreases postoperative pain And many times allows these patients to recover much faster, and that's just ideal for a patient And if you've ever been a patient who's had surgery or had a family or friend or loved, one who had surgery, then you understand exactly what I'm talking about And you can appreciate how important it is to have the procedure done properly but have the patient not stay in the hospital any longer than they absolutely have to. One of the things that's important about robotic surgery is that it completely revolutionized the way operations are done in general in the operating room. As I mentioned before, i graduated from Yale Medical School 50 years ago. Matter of fact, we're celebrating our 50 year anniversary this year, 1973 . And what the traditional surgery is? the surgeon would stand at the bedside, do the operation and then leave. Well,

8:51 with robotic surgery, basically, you do not stand at the bedside , you sit at a console, computer console, and you do the surgery indirectly, moving the arms of the computer itself, which is in direct contact with the patient . I know that might seem a little confusing, but basically the physician is sitting and not standing. Now that may not seem like a very big deal, but I can assure you, during those early days of surgery, certainly in my career, we used to stand hours in the operating room, and so that physicality became a significant issue. So now to have surgery, particularly large operations or long operations, theoretically, where the physician can sit and merely work. A console makes it much easier physically for the surgeon and, in my judgment, provides better quality care for the patient. What are some other ways that the surgeon is benefited by this robotic cystic apparatus in the operating room ? Well, as I mentioned before, it allows a surgeon to do what we call a minimally invasive surgery instead of making the long incisions. And all of this takes time The long incision, more blood loss, more OR time because you have to close that long incision and clearly makes it much easier for the patient

10:26 not to have that long incision. Number one Secondly, as I mentioned, the surgeon is sitting as compared to standing long hours in the operating room A huge change in the traditional way that surgery is being done. Now, every single operation one does not use the robot, but I think it's fair to say that the robot-assisted surgery is probably used in most operations and the usage of the robots in surgery is continuing to grow. And thirdly, one of the benefits is the robot itself has a certain type of mechanical dexterity that allows the surgeon to manipulate the robot in ways that it would be very difficult for the surgeon to physically use their hand. I know that sounds a little complicated, but the bottom line is the robot is more flexible in many more different ways, which ends up making the surgery more efficient and safer. So another huge benefit for the robots in robot-assisted surgery in our operating rooms. What are some of the types of surgery that robots are used on? Well, pretty much most major types of surgery prostate surgery, general surgery, gynecological surgery, heart surgery and again , the usage is continuing to increase over time. What are some of the main advantages to the hospital for the robot? Remember what I said when I get

11:56 to advantages for the hospital. We're just about done. One of the huge advantages for the hospital is financial. Because of robots in the hospital or artificial intelligent robots in the hospital, hospitals have been able to increase their revenue stream over $100 billion , and at the very top of that list is robot-assisted surgery. Basically, most hospitals increase revenue based on procedures as compared to medication or number of days patients stay in the hospital. So anything that increases the efficiency and volume of procedures tends to increase revenue for the hospitals, and this is exactly what robot-assisted surgery does, and so it ends up being win-win theoretically. In summary, artificial intelligence is not the future, it is now, and this is certainly true in healthcare. Artificial intelligence is defined as computer learning or non-human learning, if you will.

13:03 Doctors like robots in surgery because surgery, physically and technically, is easier. Patients like robots in surgery or in robot-assisted surgery because it decreases pain, it decreases recovery time and it decreases hospital stay. Hospitals like robots assisting in surgery because it increases revenue. And remember, robots have been in surgery for 15 years, not just this year or last year, but their usage is growing and the number of types of surgery that they're being used on and the volume is significantly increasing. My basic principles God is in charge. I am a physician of faith and it is, indeed has been, my faith in God that has sustained me over the years. I have no bad days. I'm one of those people who believes that they've had enough bad days, so I decided a number of years ago that I would not have any more bad days, and so I do not. I have good days and I have great days. I have learned that don't sweat the small stuff, and most stuff is small.

14:18 Consequently, i don't worry about little things at least I try not to And I found that that keeps me stress free, or at least minimally stressed, and allows me to have a more fruitful and a more happy and happier day. Forgiveness is therapy. If there are things that individuals and circumstances have done to you, forgive them And you would be amazed how therapeutic it is, regardless of who's right or wrong or regardless of what the issues are just forgive, and that, indeed, is therapeutic. And finally, my final basic principle is that everything is relationship. Relationships are based on three things Mutual respect, mutual trust, good communication. If you have all three of those things, you have a very good relationship, whether it is a work relationship, a family relationship, a good friend relationship. And if you have a good relationship, then chances are you are happier in your life . In spite of issues always associated with surgery, and regardless of the operation and regardless of how new the technique is or the associated equipment, be it a robot or something else, surgery is still a very, very dangerous area And I think it's important to understand that, as patients, you have rights, and we've gone

15:50 over this before, but let me go over them again that, regardless of what type of technique is used, so who the position is or is not, all patients who are to have any type of operation need to have been given what we call informed consent. Those two words informed means that you should be given sufficient information in a way that you understand it, so that the second word consent you can consent or agree to the procedure, and this is particularly true with invasive procedures or the larger the procedure is. And the informed consent is very specific, regardless of what state you're in. It's very specific and it has to cover three particular elements, and those elements are risk benefits and alternative treatment. Risk benefits and alternative treatment What are the risks of the procedure? And the physician and or the proceduralist be it the surgeon or the anesthesiologist or nurse anesthetist should give you specifics about what those risks are, because, again, you want to be informed enough so that you can then make a decision about whether this is an appropriate operation for you. I would encourage you to have

17:22 family and or close friends with you. If you don't feel comfortable making these decisions completely by yourself , there's absolutely nothing wrong with that. But you want to be sure before you agree, because at the end of this process they're going to have you sign a form that says that you agree, that you've got sufficient information so that you can agree If English is not your first language, and even though the doctor or the nurse or whoever was the physician or whoever's going to do the procedure is talking to you and you think you don't understand everything. It's OK to say that. It's OK to say well, you know, my English is the best And I think I understand, but I don't understand. Blah, blah, blah, blah, blah, blah. A lot of times , because informed consensus are done on every single day, many times a day. The individuals given them tend to go very fast And it's important, because this is new for you as a patient, to slow them down and to say no, you need to go over that again. Explain it to me. If, again, english is not your first language, but you speak English and you speak it very well, it is within your right to say I want someone who speaks Tagalog to come and explain this to me, or this form that you've asked me to sign is in English And I don't understand all these words . And I want someone who speaks

18:54 Mandarin or Cantonese or Spanish to come and explain this to me, because I don't really understand. Most hospitals and organizations will not allow patients to use extensively their family members to interpret medical information, and if that indeed is the case, you have a right to say I want to have someone who can talk to me in my language. If I am Russian or Ukrainian, i want someone who can talk to me in my language so that I can make sure that I fully understand what it is that you're going to do to me. Another thing that's important to understand about informed consent that when you have surgery, there are basically two different areas of medicine or health care that are taking care of you. I'm talking about physician. Now There's a surgeon, obviously, who's going to do the operation.

19:53 Speaker 1: Whoever, he or she is . Speaker 2: But there's also another department called anesthesiologist. So there's an anesthesiologist, whoever he or she is, both of them are required to give you written information verbal and written information about what you're going to have to go through to have this operation. The surgeon is required to explain the human details, risk benefits, an alternative treatment about the surgery. The anesthesiologist is required to explain the human detail, risk benefits and alternative treatment before you have anesthesia. Now, if you're having a local anesthesia, then those risks may very well be small, but regardless, both are required to get consent from you or informed consent from you. And again, the informed part means that they need to give you information sufficient from your perspective not their perspective from your perspective that you can indeed consent and say okay, i understand and I agree to go ahead and let you put me to sleep for an hour or two hours or five hours or whatever the time may be. And the reason for that is, i like to say, that there's always a possibility of complications, there are always a possibility of issues, and it's not 100%, 100% of the time.

21:25 And so you need to be aware so that you can make decisions and have family or friends advise us , help you make decisions about whether you really want to have this procedure done at this time . Most of the times, patients will have those procedures done because the whole thing that brought you to the physician is something significant enough that you want to be healed or have this whole issue resolved. But don't feel rushed, and I know that's hard to fathom but you have rights and feel good and feel free to exercise your rights, because those rights are designed to protect you and to make sure that you get the very best care possible. So remember that there are two elements of an operation. There's a surgical element physician there's the anesthesia element physician and or nurse practitioner Okay, and so make sure, feel comfortable asking questions, i guess is what I'm trying to say Now. I understand that's a challenge.

22:35 I've been again, i've been in a position over 50 years and I know that most of you will basically do whatever we physicians ask you to do because you trust us and you respect us , et cetera, et cetera. Nothing wrong with that, that's completely appropriate. But you can also ask questions. Or it's also okay to say I do not understand, and there's nothing wrong with that. Just say I do not understand, i need more information, i need more time. Whatever those words are, i do not feel, rushed, unless it's a life-threatening operation and the decision has been made immediately. But if it's an elective operation, meaning that it is not life-threatening and it does not have to be done immediately, then feel free to.

23:19 And even if it is an enema risk operation, you still ask the questions. But certainly if it's an elective operation, feel free to ask those questions. What are the risks of this operation, what are the benefits of this operation And what are the alternatives of me not having this operation? And those three elements have to be discussed with you. They have to be in writing and you have to sign it to say that you have an agreement. So before you sign anything, make sure that you're comfortable as best as you can be and you have received that information. Well, what are some of the risks for, say, robotic assisted surgery? Basically, most of the literature suggests that robotic assisted surgery does not add a great deal to the basic risks of any type of operation, and surgery is risky and usually depends on the operation you're having, what your condition is prior to the surgery. But there are some things that may be relatively unique with using the robot, patients in very unique positions, sometimes during the time of the robotic surgery they may be turned certain ways, and so that can be issues that have to do with peripheral nerve damage, and so you want to make sure that appropriate patients all know this, as you're an anesthesiologist. But again, there's nothing wrong with you knowing that information, also

24:51 that there has to be appropriate padding to make sure that there's no nerve discomfort or damage after the operation. Sometimes you may be in a certain position doing surgery for a long period of time, and so you want to make sure that's the case. Anesthesiologists particularly make sure that the eyes are closed, unless it's an eye surgery, obviously And frequently they will change the eyes, because a lot of times when we close our eyes, even when we're asleep, we may not close the lid completely, And so if you can see any part of the eye that's open between the lids , that area could be damaged in terms of having it scratched or injured somehow. So usually good anesthesiologists and anesthesiologists know this They will cover the eyes and tape them. But again, just like the surgeon, the anesthesiologist has to give you informed consent . Informed consent, they have to say hi, i'm Dr So-and-so, i'm going to be providing anesthesia for you. Dr Blah-blah-blah is going to do the surgery, i'm going to do the anesthesia. Do you have any questions after they go through the litany of information to talk to you about ? And it's important again for you to be aware of that and for you to ask the appropriate questions that you may need to ask to make sure that everything

26:22 goes well with your operation. Now, again, the procedure itself is going to have brisk And the surgeon should go over those risks with you. But anesthesia will also have brisk And so the anesthesiologist is required by law and by ethics to go over those risks with you. And if you are in any way uncomfortable, it is OK to get second opinions, say, well, you know, i need to talk to So-and-so, that's OK, unless it's a life-threatening situation. And again, you still have the right to consent if you are alert, awake and can give consent to that being done. So please keep that in mind. So most of the complications associated with robotic-assisted surgery tend to be those things that are associated with positioning of the patient during the time of the operation And they tend to fall into the area of the anesthesiologist And again, depending on the surgery , because the surgeons themselves position patients, certainly in orthopedics and other types of procedures, and so both have a dual responsibility there to make sure that everything occurs. Ok, again, there's no question that there are benefits to robotic-assisted surgery, but,

27:53 like with any type of surgery, there are always risks, certainly if you're going to be asleep, and it's important that those risks be explained to you in the form of verbally and in writing, and in a language and in a way using words that you can understand. They cannot be using big words that make no sense to you, because you're not a physician and may not be medically inclined. That is not your responsibility. That is the physicians and the healthcare team's responsibility. So feel free to search your rights And, if you're uncomfortable, bring a friend or somebody with you who will do that for you. That's OK , because one of the things that has occurred in the area of Obamacare 2010 Affordable Care Act is that healthcare is now patient-centered. It is patient-centered And that means that you're the patient, the most important person in the room, and so you're well within your rights to a searcher of rights And if there's any pushback, small or large, rethink whether you want to have these individuals take care of you, if indeed you have that option at the time. And my final thought be the change you want to see in the world. Be the change you want to see in the world. Thank you so much for spending your valuable time with us. Have a great day.