Operational framework and training standard requirements for AI-empowered robotic surgery.

BACKGROUND: For autonomous robot-delivered surgeries to ever become a feasible option, we recommend the combination of human-centered artificial intelligence (AI) and transparent machine learning (ML), with integrated Gross anatomy models. This can be supplemented with medical imaging data of cadavers for performance evaluation. METHODS: We reviewed technological advances and state-of-the-art documented developments. We undertook a literature search on surgical robotics and skills, tracing agent studies, relevant frameworks, and standards for AI. This embraced transparency aspects of AI. CONCLUSION: We recommend "a procedure/skill template" for teaching AI that can be used by a surgeon. Similar existing methodologies show that when such a metric-based approach is used for training surgeons, cardiologists, and anesthetists, it results in a >40% error reduction in objectively assessed intraoperative procedures. The integration of Explainable AI and ML, and novel tissue characterization sensorics to tele-operated robotic-assisted procedures with medical imaged cadavers, provides robotic guidance and refines tissue classifications at a molecular level.

Legal, regulatory, and ethical frameworks for development of standards in artificial intelligence (AI) and autonomous robotic surgery.

BACKGROUND: This paper aims to move the debate forward regarding the potential for artificial intelligence (AI) and autonomous robotic surgery with a particular focus on ethics, regulation and legal aspects (such as civil law, international law, tort law, liability, medical malpractice, privacy and product/device legislation, among other aspects). METHODS: We conducted an intensive literature search on current or emerging AI and autonomous technologies (eg, vehicles), military and medical technologies (eg, surgical robots), relevant frameworks and standards, cyber security/safety- and legal-systems worldwide. We provide a discussion on unique challenges for robotic surgery faced by proposals made for AI more generally (eg, Explainable AI) and machine learning more specifically (eg, black box), as well as recommendations for developing and improving relevant frameworks or standards. CONCLUSION: We classify responsibility into the following: (1) Accountability; (2) Liability; and (3) Culpability. All three aspects were addressed when discussing responsibility for AI and autonomous surgical robots, be these civil or military patients (however, these aspects may require revision in cases where robots become citizens). The component which produces the least clarity is Culpability, since it is unthinkable in the current state of technology. We envision that in the near future a surgical robot can learn and perform routine operative tasks that can then be supervised by a human surgeon. This represents a surgical parallel to autonomously driven vehicles. Here a human remains in the 'driving seat' as a 'doctor-in-the-loop' thereby safeguarding patients undergoing operations that are supported by surgical machines with autonomous capabilities.

Hormonal Correlates of Exploratory and Play-Soliciting Behavior in Domestic Dogs.

Exploration and play are considered to be crucial behaviors during mammalian development. Even though the relationship between glucocorticoids and exploratory behavior, stress, and anxiety is well described in the literature, very little is known about their role in play behavior in non-rodents. Likewise, the functional role of the "social hormone" oxytocin in exploration, play, stress, and anxiety is still unknown. The present work addresses this literature gap by studying plasma hormone profiles for cortisol (CORT) and oxytocin (OT) of domestic dogs exposed to a novel arena containing two unfamiliar trainers who did not interact with the dogs. We provide evidence suggesting a functional relationship between hormonal measures of cortisol and oxytocin and adaptive behavior (play-soliciting and exploration) in freely behaving domestic dogs. We have taken into account several possible factors in our analyses and interpretations, from the nature and quality of the measurements to demographic factors to statistical robustness. Our results indicate that reduced CORT levels are associated with increments of both play-soliciting behavior frequency and exploratory behavior duration. Furthermore, taken together, our data and our simulations suggest a relationship between OT and the enactment of play-soliciting behaviors by freely behaving domestic dogs that must be further investigated. Future studies should consider naturalistic structured and semi-structured experimental approaches linking behavior with (neuro) physiological measures, taking into account demographic factors such as age and relevant interphase factors such as the sex of the dog; and socio-historic factors such as the playfulness of the dog, history of interaction with young humans, among others, to take full account of interaction between humans and animals in comparative studies (Parada and Rossi, 2018).