Surgical Community Research Articles

Surgeons’ Perspectives on Liability for the Use of Artificial Intelligence Technologies in the United States and European Union: Results From a Focus Group Study

Objective: To examine surgeons’ perspectives on liability for using artificial intelligence (AI)-driven technologies in surgery in the United States and the European Union. Background: The introduction of AI-driven technologies in surgery can improve surgical performance and patient outcomes. However, liability risks might inhibit their implementation in the operating room. We report here the results of a focus group study that explored surgeons’ perspectives on liability for using AI-driven technologies in surgery in the United States and the European Union. Methods: Participants were identified through a call for participation disseminated through personal and professional networks. Inclusion criteria were: (1) adults (at least 18 years of age); (2) surgeons based in either the United States or in one of the European Union’s Member States, with a preference for those specializing in gastrointestinal surgery to facilitate better discussions about the vignettes that involved a colorectal surgical procedure; (3) ability to comfortably read and communicate in English; (4) willingness to consent to participation, and (5) willingness to consent to keeping the focus group meeting content, participants, and discussions confidential. Results: We conducted 6 focus groups via Zoom with a total of 18 participants (11 EU surgeons and 7 US surgeons). The following main themes emerged: (1) acknowledgment of the potential benefits of using AI-driven technology in surgery, (2) acceptance of surgeon responsibility, (3) recognition that AI may impact the standard of care, (4) skepticism about potential liability for AI manufacturers, and (5) the importance of patient information and consent. Conclusions: Despite the potential future benefits of integrating AI into surgical practice, surgeons will benefit from (1) an increased understanding of how AI-driven technologies will deliver these benefits and (2) increased clarity surrounding how AI-driven technologies will be governed by both regulators and the surgical community. While our study focused on surgeons’ perspectives, it could also provide valuable insights for other healthcare providers using AI to treat patients.

High-fidelity surgical simulator for the performance of craniofacial osteotomies.

The oral and maxillofacial (OMF) surgical community is making an active effort to develop new approaches for surgical training in order to compensate for work-hour restrictions, mitigate differences between training standards, and improve the efficiency of learning while minimizing the risks for the patients. Simulation-based learning, a technology adopted in other training paradigms, has the potential to enhance surgeons' knowledge and psychomotor skills. We developed a fully immersive, high-fidelity virtual simulation trainer system based on Kitware's open-source visualization and interactive simulation libraries: the Interactive Medical Simulation Toolkit (iMSTK) and the Visualization Toolkit (VTK). This system allows surgeons to train for the crucial osteotomy step in bilateral sagittal split osteotomy (BSSO) using a pen-grasp oscillating saw that is controlled in the virtual environment using a 3D Systems Geomagic Touch haptic device. The simulator incorporates a proficiency-based progression evaluation system to assess the correctness of the cut and provide user feedback. Three expert clinicians and two senior residents tested our pilot simulator to evaluate how the developed system compares to the performance of real-life surgery. The outcomes of the face and content validation study showed promising results with respect to the quality of the simulated images and the force feedback response they obtained from the device matched what they expected to feel. The developed trainer has the potential to contribute to a reduction in the prevalence of adverse surgical outcomes after OMF surgeries involving osteotomies. Observing the clinicians and talking through some of the difficulties helped us identify key areas for improvement. Future work will focus on further clinical evaluation for the BSSO surgical scenario and extension of the trainer to include other craniofacial osteotomy procedures.

Robotic versus laparoscopic cholecystectomy: Can they be compared? A narrative review and personal considerations disproving low-level evidence.

Laparoscopic cholecystectomy (LC) is the gold standard for the treatment of symptomatic gallstones, acute cholecystitis, and acute gallstone pancreatitis. In recent years, the development and diffusion of robotic surgery have provided surgeons with the opportunity to apply this innovative approach to cholecystectomy, yielding interesting results. However, as with any new surgical technique, robotic cholecystectomy (RC) has met with skepticism within the surgical community. Beyond the understandable concerns regarding increased costs, some authors have claimed that RC is associated with a higher complication rate compared to LC. We reviewed the existing literature on this subject, discussing the limitations and strengths of the most significant publications and critically analyzing them. The analysis of the literature indicates that RC is safe and effective, with no definitive evidence of its inferiority compared to LC. Some of the published papers are of low quality and biased, even with significant sample sizes. Furthermore, we believe that comparing an established technique like LC with a new and not yet standardized one such as RC is somewhat illogical. RC represents a significant advance in minimally invasive surgery and should be viewed as an opportunity to familiarize oneself with the robotic device and to enhance the surgeon's skills in preparation for more complex robotic operations. The robotic approach can be beneficial in selected cases of cholecystectomy where fine dissection is required. With further reductions in costs, RC could become the future gold standard for benign gallbladder disorders.

Patients and Spine Surgeons' Perspectives regarding Decision-Making and Outcomes in Lumbar Surgery: An Exploratory, Qualitative Study.

Decision-making in lumbar surgery for degenerative conditions is influenced by various factors, including patient expectations and empowerment. The role of patient-reported outcomes (PROs) in guiding these decisions is underexplored. This study aims to understand the perspectives of patients and spine surgeons in decision-making for lumbar surgery and explore their perspectives on the relevance and influence of pre- and post-surgery PROs. An exploratory qualitative study was conducted between February 2022 and November 2023. A total of 15 patients with degenerative lumbar conditions and 9 spine surgeons from 5 tertiary public hospitals in Singapore were recruited. Data were analyzed using a framework analysis approach, ensuring validity through member checking, reflexive journals, and data source triangulation. Three overarching categories emerged: "expectations and outcomes," "decision empowerment," and "surgical experiences." There is a shift toward shared decision-making, highlighting the importance of patient-centric approaches. Surgical decisions are primarily influenced by PROs, particularly health-related quality of life (HRQoL) and pain relief. Patients prioritize pain relief and improvements in daily functioning, while surgeons also emphasize avoiding postoperative complications. Decision support tools, including PRO data, are essential but need better accessibility and integration within clinical settings. Positive surgical experiences are driven by clear communication, trust with surgeons, swift recovery, and no regrets post-surgery. Our study emphasizes the importance of patient-centered approaches in lumbar surgery decision-making, particularly regarding pre- and post-surgery PROs. Implementing these approaches may enhance patient satisfaction and surgical outcomes, urging the surgical community to prioritize informed, empathetic decision-making to improve healthcare quality.

Opinion, uptake and current practice of robot-assisted upper gastrointestinal and oesophagogastric surgery in the UK: AUGIS national survey results.

The uptake of upper gastrointestinal (GI) robotic surgery in the United Kingdom (UK), and Europe more widely, is expanding rapidly. This study aims to present a current snapshot of the practice and opinions of the upper GI community with reference to robotic surgery, with an emphasis on tertiary cancer (oesophagogastric) resection centres. An electronic survey was circulated to the UK upper GI surgical community via national mailing lists, social media and at an open-invitation conference on robotic upper GI surgery in January 2023. The survey included questions on surgeons' current practice or planned adoption (if any) of robotics at individual and unit level, and their opinions on robotic upper GI surgery in general. Priority ranking and Likert-scale response options were used. In total, 81 respondents from 43 hospitals were included. Thirty-four resectional centres responded, including 30 of 31 (97%) recognised upper GI cancer centres in England. Respondents reported performing robotic surgery in 21 of 34 (61.8%) resectional centres, with a median of 65 procedures per centre performed at the time of the survey (range 0-500, interquartile range 93.75). Every centre without a robotic programme expressed a desire or had active plans to implement one. Respondents ranked surgeon ergonomics as the most important reason for pursuing robotics, followed by improvements in patient outcomes and oncological efficacy. Robotic upper GI practice is nascent but rapidly growing in the UK with plans for uptake in almost all tertiary centres. There is growing opinion that this is likely to become the predominant surgical approach in future with benefits to both patients and surgeons. This snapshot offers a point of reference to all stakeholders in upper GI surgery.

Protective Effects of Authenticity Against Depression, Suicide, and Burnout among Surgeons.

Physician burnout and poor mental health are highly prevalent issues within the surgical community. Authenticity, defined as the degree to which individuals align their actions with their true selves, has been identified as a potential factor facilitating positive mental health. This study explores the impact of authenticity on burnout, depression, and suicide among surgeons. Members of the department of surgery at a large academic medical center were sent an anonymous survey between April and May 2023. The survey evaluated authenticity using Authenticity Scale, depression using Patient Health Questionnaire, burnout using Copenhagen Burnout Inventory, and suicidality using Ask-Suicide Screening Questions (ASQ) tool. Of the 170 surgeons, 94 (55.3%) completed the survey. Higher Authentic Living Scores correlated with reduced burnout (r = -0.21, p = 0.047) and depression (r = -0.37, p = 0.0002). Conversely, higher Accepting External Influence (AEI) scores were associated with increased depression (r = 0.23, p = 0.023), and higher Authenticity Self-Alienation (ASA) scores were associated with increased burnout (r = 0.43, p < 0.0001) and depression (r = 0.48, p < 0.0001). Although authenticity domain scores were not significantly associated with ASQ, specific AEI and ASA questions indicated an elevated odds ratio (p = 0.029 and p = 0.010, respectively) of a positive ASQ. Authentic Living Score increased with advancement in professional rank (p = 0.007), whereas AEI (p = 0.0001), ASA (p = 0.003), depression (p = 0.014), and ASQ (p = 0.02) decreased. In this study, higher authenticity was associated with a lower likelihood of burnout and depression among surgeons. This study contributes valuable insights into the development of targeted intervention and support mechanisms aimed at promoting authenticity and mental health within the surgical profession.

Binary and Nonbinary Transgender Patient Experiences Accessing Gender-affirming Top Surgery.

Transgender and gender diverse (TGD) individuals face barriers when seeking top surgery, or bilateral mastectomies, as part of surgical transition, leading to delayed care and adverse health outcomes. Understanding differential experiences between nonbinary and binary patients is crucial for improving TGD patient care, but this distinction is seldom made in the current literature. This single-center cross-sectional mixed-methods survey study conducted between 2022 and 2023 enrolled all consecutive TGD patients undergoing top surgery. Significant differences between datasets were determined by two-sample unpaired t tests. Summative content analysis and descriptive analysis were performed for free-text responses. Thirty-seven binary and 71 nonbinary patients completed the survey. Lack of funding, long wait times within the healthcare system, and long wait times to access surgery were the three most impactful barriers for both cohorts. Nonbinary patients were more impacted by a lack of TGD-friendly surgeons and community physicians, prejudice from surgical center staff and community doctors, and employment concerns. More binary patients desired a "masculine chest" and to stop using a binder. The nonbinary group more frequently desired a "smaller chest" and had greater variability of surgical goals. Binary and nonbinary TGD patients both experience barriers to top surgery; however nonbinary patients may experience distinct barriers and have differential surgical goals. It is important to discuss specific surgery goals and offer top surgery options beyond bilateral mastectomy with nipple grafting, especially with nonbinary patients.

Conservative and surgical treatment of deep vein thrombosis: choice of the professional surgical community

Conservative and surgical treatment of deep vein thrombosis: choice of the professional surgical community

Embracing Our Differences: Advancing Diversity, Equity, and Inclusion Through Perioperative Nursing Education.

A focus on diversity, equity, and inclusion (DEI) in a health care system is critical to ensure patient safety and improve the health outcomes of all surgical patients and communities. Some patient populations continue to experience disparities that negatively affect their burden of illness, ability to access quality care, and health-related outcomes. Unconscious (or implicit) bias among clinicians can lead to unintentional discrimination against marginalized groups. Organization and perioperative leaders should recognize the importance of developing a workplace culture committed to DEI and implement strategies to educate and empower clinicians to embrace these initiatives. When developing educational offerings on DEI for personnel, educators should use a framework and a variety of educational strategies, such as listening tours, computer-based learning, simulations, and journal and book clubs, to engage teams focused on optimizing the health and well-being of the diverse surgical populations in their communities.

A needs assessment for simulation-based training in emergency urological skills in Ethiopia.

Urologic emergencies are common and complications from their management are high. Simulation-based education (SBE) is a highly effective training method, allowing trainees to learn both technical and nontechnical skills in a safe environment. Training in the management of urological emergencies is limited in many healthcare settings, so we performed a needs assessment for a urological emergencies SBE course in Ethiopia. This study presents data from a descriptive cross-sectional, survey-based survey of consultants and residents in the Ethiopian surgical community. The survey was disseminated using online Google Forms, through social media (WhatsApp), and to colleagues in the College of Surgeons of East, Central and Southern Africa (COSECSA) via email and social media. One hundred-seven results were received; two were discarded due to incomplete data. Fifty three of the respondents were general surgeons and 38 of the respondents were urologists. Sixty nine respondents strongly agreed that simulation-based training was important for first-year surgical residents, whereas twenty-five respondents agreed and nine respondents strongly disagreed; one respondent disagreed and one was neutral. Eighty seven respondents suggested a 3-day training course, whereas 17 respondents suggested a two-day course. More than 80 of the respondents rated training in the management of acute urinary retention, acute scrotum, urethral, and suprapubic catheterization as extreme or very important and 79 respondents wanted education about urologic trauma and Fournier's gangrene. Surgical and urology residents in Ethiopia have expressed a need for, and a strong interest in, simulation-based urological emergency training.

Chest tube size selection for pleural effusion: from the perspective of thoracic surgeons and pulmonologists

ABSTRACT Background The current discourse within the thoracic surgical and pulmonological communities pertains to a contentious debate over the optimal selection criteria for thoracostomy tube diameters utilized in the management of pleural effusions. A comprehensive examination of the variables that inform the clinical decision-making paradigm for the determination of appropriate chest tube calibers is imperative to enhance patient management and elevate the prognostic results. Objectives The objective of this inquiry is to elucidate the determinants that influence thoracic surgeons and pulmonologists in their selection of chest tube size for the management of pleural effusions. Methods This cross-sectional study was based on an electronic questionnaire that was sent to the targeted populations through e-mail or a professional WhatsApp. The survey assessed the considerations of chest tube size selection as well as the respective advantages, disadvantages, and potential complications related to each size. Results The conducted study encompassed participants, with a nearly even distribution between thoracic surgeons (49.1%) and pulmonologists (50.9%). Most of these practitioners are within tertiary-level medical institutions (82.1%). A preference for small-bore chest tubes (SBCT), defined as < 14 French (Fr), was indicated by 54.8% of participants. The drawbacks associated with SBCT, such as kinking (60%) and blockage (70%), influenced the decision-making process negatively, while pain was a significant factor in the selection against LBCT (64%). Ultrasound guidance was a positive influence for the selection of SBCT (55%). Complications associated with LBCT included visceral and vascular injuries (55.7%), wound infection (45.3%), re-expansion pulmonary edema (43.3%), and subcutaneous emphysema (57.5%). In contrast, malposition was a complication more commonly associated with SBCT (49.1%). Conclusion The decision regarding chest tube size was influenced by several critical factors which included the nature of pleural effusion, the volume of pleural fluid, and potential complications specific to the size of the chest tube used.

Individually customized gender affirming genital procedures: techniques and considerations.

Gender-affirming surgery is being increasingly performed for transgender and gender-diverse individuals diagnosed with gender dysphoria. However, there is a group of patients who may seek outcomes that are either a combination of or altogether different from those of binary procedures such as penile inversion vaginoplasty or phalloplasty. We describe surgical techniques for less commonly performed gender-affirming genital procedures, in order to introduce these procedures to the medical and surgical community. Operative techniques for phallus-preserving vaginoplasty, vagina-preserving phalloplasty, and removal of genitalia with creation of perineal urethrostomy are described. Demographic characteristics and complications of these procedures in 16 patients are reported. Individually customized gender-affirming genital procedures, such as phallus-preserving vaginoplasty, vaginal-preserving phalloplasty, and removal of genitalia and creation of perineal urethrostomy, may better affirm the identities of some gender-diverse patients, and may also preserve desired sexual function of natal genitalia.

Analysis of Fluid-Structure Interaction Mechanisms for a Native Aortic Valve, Patient-Specific Ozaki Procedure, and a Bioprosthetic Valve.

The Ozaki procedure is a surgical technique which avoids to implant foreign aortic valve prostheses in human heart, using the patient's own pericardium. Although this approach has well-identified benefits, it is still a topic of debate in the cardiac surgical community, which prevents its larger use to treat valve pathologies. This is linked to the actual lack of knowledge regarding the dynamics of tissue deformations and surrounding blood flow for this autograft pericardial valve. So far, there is no numerical study examining the coupling between the blood flow characteristics and the Ozaki leaflets dynamics. To fill this gap, we propose here a comprehensive comparison of various performance criteria between a healthy native valve, its pericardium-based counterpart, and a bioprosthetic solution, this is done using a three-dimensional fluid-structure interaction solver. Our findings reveal similar physiological dynamics between the valves but with the emergence of fluttering for the Ozaki leaflets and higher velocity and wall shear stress for the bioprosthetic heart valve.

Elective splenectomy for hematological diseases: a vanishing indication

IntroductionSplenectomy has been used as a diagnostic and therapeutic tool in the management of hematological diseases for many years. However, the emergence of new medical therapies has modified guidelines for many hematological diseases for which splenectomy was previously considered. We aimed to evaluate the evidence of a decrease in the hematological indications for splenectomy and the reasons and justifications for this change.Material and methodsWe conducted a single-center, retrospective analysis of patients who underwent laparoscopic splenectomy for hematological disease between January 2010 and December 2023. Patients were classified into four groups: 1 autoimmune and hemolytic diseases (HAD), (2) lymphomas, (3) myeloproliferative diseases (MPN), and (4) other splenic diseases. We recorded the annual incidence of splenectomy and the ratio of new medical cases, demographic and clinical data and surgical outcomes.ResultsDuring the study period, 98 patients were referred for splenectomy. There was a significant progressive decrease in this surgical indication, particularly regarding HAD (p < 0.001). The indication for splenectomy for immune thrombocytopenic purpura (ITP) declined to zero despite an increase in the number of patients diagnosed with this disorder (p < 0.001). The pattern of decrease in AHAI and Evans syndrome was similar to that in ITP. The group of splenectomies due to lymphoma persisted consistently during the study period, as did the indication for splenectomy in the context of lymphoma treatment. Splenectomy due to massive splenomegaly secondary to MPN was indicated only in one patient. Splenectomies due to other causes were similarly distributed over the years.ConclusionsOur findings confirm a significant decrease in the indication for elective surgery for hematological diseases, mainly regarding autoimmune disease. The surgical community and surgical departments should be aware of this situation yet maintain the skills to adopt this technique both safely and efficiently.

Advanced Visualization in Minimally Invasive Spine Surgery: The Ergonomics, Economics, and Evolution of Camera-Based Tubes and Retractors.

Tubular spine surgery has emerged as a hallmark of minimally invasive spine (MIS) procedures. In recent years, thanks to technological advances, tubular dilators and retractors have been integrated with digital cameras to allow for ergonomic, high-definition visualization of the surgical field. To detail the evolution, ergonomics, economics, and outcomes of camera-based tubular spine surgery, spanning the origins of MIS tubular techniques to the current use of operative microscopes and tube-mounted digital cameras (TMDCs). This is a narrative review of studies examining the evolution of tubular spine surgery as well as its most recent advances, with a particular emphasis on advances in visualization of the surgical field. Despite early resistance to tubular techniques due to a steep learning curve, minimally invasive tubular approaches are being increasingly adopted by the mainstream spine surgical community, which has resulted in an expansion of both indications and procedural modalities. This can largely be attributed to the increased quality of visualization, as evidenced by improvements in microscopes as well as emerging technologies like exoscopes and TMDCs. Tubular MIS procedures have also achieved superior efficacy compared with open surgical approaches for the treatment of several spinal pathologies while allowing for improved ergonomics, which may have lasting consequences on surgeon longevity. Advances in visualization technologies have allowed tubular surgery to become an effective, ergonomic, and muscle-sparing alternative to open spine surgery. Further research is necessary to quantify the true costs and outcomes associated with nascent TMDC technology. This work elucidates developments in visualization for tubular spine surgery.

Robot-assisted mitral valve surgery may be supported by patient-specific planning aid in port placement

Robotic-assisted mitral valve surgery is gaining renewed popularity in the global surgical community. Appropriate patient-specific planning is pivotal for the safety and effectiveness of this procedure. One main step in this perspective is represented by the choice of placement of four ports in the right chest, for the introduction of robotic arms. Individual anatomical features (e.g., chest morphology and position of the mitral valve inside the chest) may determine inadequate surgical exposure, conversion to open procedure, or refusal for the technique. Currently, and contrary to robotic-assisted procedures in other surgical specialties, there is no dedicated approach or tool for patient-specific planning aimed at formally addressing these issues preoperatively. Herein, we present a dedicated, comprehensive method entailing: a homemade algorithm for rib segmentation (deep learning approach) and identification of intercostal spaces / candidate port entry sites; semiautomatic definition of a target working volume (mitral valve); definition of dedicated Performance Measure J* based on each potential triad of thoracic ports entry sites. We propose the dedicated J* parameter to better indicate the optimal patient-specific entry port solution than other parameters (h_e, ic, CCI and E). Prospective clinical studies should be based on the J* parameter. We hypothesize that this approach, dedicated to the requirements of robotic-assisted mitral valve surgery, may enhance the safety and the diffusion of this surgical strategy.

Surgical training; destination unknown?

Background A surgical fellowship allows both additional training as well as maintenance of surgical skills while searching for a steady job. As the presence of fellows usually does not results in a measurably higher productivity, fellowshipsmay be considered a form of disguised unemployment. The aim of this study is to evaluate the career flow of a surgical trainee to a staff position and to determine the number of surgeons working on temporary basis within the general surgery workforce in Flanders. Methods All surgeons graduated in Flanders between 2000 and 2022 were invited to fill out a web-based survey concerning their current and past employment. Reminders were sent out after 2 and 4 weeks. Statistical analysis was performed with SPSS version 27.0 (IBM Inc., Chicago, IL, USA.) Results Response rate was 64% (292/457) with 76% of respondents currently working as surgeons, 14% (38) as fellows and 10% working outside the surgical domain. Eighty-two percent of current fellows graduated in 2019 or later. Thirty-one percent of surgeons graduated in 2019 are still working as fellows. For surgeons graduated in 2020, 2021 and 2022 this is 45%, 80% and 90% respectively. Compared to staff surgeons the number of additional training years (2,8 ± 1,0 vs 2,2 ± 1,3; p = 0,009). and the number of applications (6,6 ± 5 vs 3,3 ± 3; p < 0,001) is significantly higher for current fellows Conclusion This study shows that disguised unemployment is present in the general surgical community in Flanders. The status of “fellow” should be incorporated in calculations concerning future needs of the surgical workforce in order to prevent open unemployment.

Identifying and addressing mentorship gaps in European trauma and emergency surgical training. Results from the Young European Society of Trauma and Emergency Surgery (yESTES) mentorship survey

PurposeEuropean training pathways for surgeons dedicated to treating severely injured and critically ill surgical patients lack a standardized approach and are significantly influenced by diverse organizational and cultural backgrounds. This variation extends into the realm of mentorship, a vital component for the holistic development of surgeons beyond mere technical proficiency. Currently, a comprehensive understanding of the mentorship landscape within the European trauma care (visceral or skeletal) and emergency general surgery (EGS) communities is lacking. This study aims to identify within the current mentorship environment prevalent practices, discern existing gaps, and propose structured interventions to enhance mentorship quality and accessibility led by the European Society for Trauma and Emergency Surgery (ESTES).MethodsUtilizing a structured survey conceived and promoted by the Young section of the European Society of Trauma and Emergency Surgery (yESTES), we collected and analyzed responses from 123 ESTES members (both surgeons in practice and in training) across 20 European countries. The survey focused on mentorship experiences, challenges faced by early-career and female surgeons, the integration of non-technical skills (NTS) in mentorship, and the perceived role of surgical societies in facilitating mentorship.ResultsFindings highlighted a substantial mentorship experience gap, with 74% of respondents engaging in mostly informal mentorship, predominantly centered on surgical training. Notably, mentorship among early-career surgeons and trainees was less reported, uncovering a significant early-career gap. Female surgeons, representing a minority within respondents, reported a disproportionately poorer access to mentorship. Moreover, while respondents recognized the importance of NTS, these were inadequately addressed in current mentorship practices. The current mentorship input of surgical societies, like ESTES, is viewed as insufficient, with a call for structured programs and initiatives such as traveling fellowships and remote mentoring.ConclusionsOur survey underscores critical gaps in the current mentorship landscape for trauma and EGS in Europe, particularly for early-career and female surgeons. A clear need exists for more formalized, inclusive mentorship programs that adequately cover both technical and non-technical skills. ESTES could play a pivotal role in addressing these gaps through structured interventions, fostering a more supportive, inclusive, and well-rounded surgical community.

Transforming Health Advocate Initiatives in Punjab and beyond through Surgical Community Engagement

Transforming Health Advocate Initiatives in Punjab and beyond through Surgical Community Engagement

Evaluating the Accuracy of ChatGPT in Common Patient Questions Regarding HPV+ Oropharyngeal Carcinoma.

Large language model (LLM)-based chatbots such as ChatGPT have been publicly available and increasingly utilized by the general public since late 2022. This study sought to investigate ChatGPT responses to common patient questions regarding Human Papilloma Virus (HPV) positive oropharyngeal cancer (OPC). This was a prospective, multi-institutional study, with data collected from high volume institutions that perform >50 transoral robotic surgery cases per year. The 100 most recent discussion threads including the term "HPV" on the American Cancer Society's Cancer Survivors Network's Head and Neck Cancer public discussion board were reviewed. The 11 most common questions were serially queried to ChatGPT 3.5; answers were recorded. A survey was distributed to fellowship trained head and neck oncologic surgeons at 3 institutions to evaluate the responses. A total of 8 surgeons participated in the study. For questions regarding HPV contraction and transmission, ChatGPT answers were scored as clinically accurate and aligned with consensus in the head and neck surgical oncology community 84.4% and 90.6% of the time, respectively. For questions involving treatment of HPV+ OPC, ChatGPT was clinically accurate and aligned with consensus 87.5% and 91.7% of the time, respectively. For questions regarding the HPV vaccine, ChatGPT was clinically accurate and aligned with consensus 62.5% and 75% of the time, respectively. When asked about circulating tumor DNA testing, only 12.5% of surgeons thought responses were accurate or consistent with consensus. ChatGPT 3.5 performed poorly with questions involving evolving therapies and diagnostics-thus, caution should be used when using a platform like ChatGPT 3.5 to assess use of advanced technology. Patients should be counseled on the importance of consulting their surgeons to receive accurate and up to date recommendations, and use LLM's to augment their understanding of these important health-related topics.