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Transforming surgery with data, AI, and cloud

Information from multiple physicians and thousands operations are being fed into a massive database on Microsoft Azure to help make surgery better and safer

Everyone’s body is different. Ask any surgeon. Even so-called “routine” operations vary from patient to patient and from procedure to procedure.

That means it is all but impossible for doctors to master operating skills just through training. They need time and experience in hospital theaters. But a new way to assemble and impart knowledge is coming.

A research team at Japan’s National Cancer Center (NCC) is collecting and tagging data that is based on the combined expertise of multiple physicians who have conducted thousands of operations. The aim is to build a massive surgical database in the cloud. There, mountains of information would be analyzed and harnessed with artificial intelligence (AI) and eventually shared with medical schools and applied in operating theaters.

The team believes that by bringing together human intelligence and machine intelligence, the database could revolutionize surgery, shine a light on new discoveries, lead to life-saving innovations, and deliver much-needed cost efficiencies.

man at tablet
Dr. Nobuyoshi Takeshita of Japan’s National Cancer Center.

Researchers at the NEXT Medical Device Innovation Center at the NCC’s Hospital East in Chiba, just northeast of Tokyo, are taking a first step in the project by focusing on endoscopic surgery.

Right now, a surgeon inserts an endoscope – a thin, flexible tube with a video camera – through a small incision or a natural orifice, like a patient’s mouth or nostril. The tube also contains tiny surgical instruments, which are controlled by a surgeon as he or she looks at a video screen.

There have been significant strides in this type of keyhole surgery in recent years.

But now the NCC wants to take it to a new level by using that database in the development next-generation cancer treatments as well as new medical devices and training. To achieve this, researchers have chosen Microsoft as one of its main technology partners.

Aging demographics 

A prime driver of this effort is Japan’s aging demographics. “Owing to the extreme longevity of the populace, the number of cancer patients is skyrocketing,” explains Dr. Nobuyoshi Takeshita of the NCC Hospital East’s Department of Colorectal Surgery and the NEXT Medical Device Innovation Center’s Surgical Device Information Office.

“With technological advances, surgical procedures involving endoscopes and other devices are on the increase. However, the more advanced the technology, the more urgent is the need to deal with the risks of extreme longevity while training doctors, ensuring safety, and otherwise maintaining the quality of medical care.”

Until now, the techniques and judgment of endoscopic surgeons, and the efficiency and safety they demonstrate when they perform surgery, have been available only as “tacit knowledge.” In other words, it is so complex and hands-on that it is challenging to teach to others.

                                                                                                              “Owing to the extreme longevity of the populace, the number of cancer patients is skyrocketing.”

– Dr. Nobuyoshi Takeshita

During the past two years, researchers have been taking on this challenge by digitizing and uploading thousands of hours of endoscopic surgery video into the database so as to offer real-life views of multiple surgeons as they carry out actual procedures.

From this, the researchers aim to apply AI to the database’s massive volume of digital information so that medical students and doctors will be able to access it for training and advice. The database could also be used by surgeons to improve operating procedures and also in the development of new surgical devices and surgical evaluation and support systems. 

More than 40 healthcare facilities across Japan have endorsed the project. And so far, the NCC’s team has gathered up more than 1,000 video cases, which is the world’s most extensive compilation of its kind.

Video of processes, tasks, and movements by surgeons, and the phenomena they encountered during surgery, have been tagged, classified, and stored for instant search and use.

A doctor doing surgery with a team in an operating theater
The team building the database expects it will make a significant contribution to medical innovation around the world.

To handle such a massive amount of information, the researchers chose Microsoft Azure as their cloud computing platform because of its strong track record in the healthcare sector.

“We deal with sensitive information in the cloud in the form of surgical videos. Therefore, what we wanted was a service from a reliable company,” Dr. Takeshita says. “The Intelligent Cloud, Intelligent Edge concept that Microsoft promotes was another element in our decision, as it aligned with our own vision as well.

“Going forward, we also hope to implement a ‘physician’s database of tacit knowledge’ in medical devices, which represent the intelligent edge. With Microsoft Azure already equipped with the necessary functionality, including Azure Stack for extending the cloud environment to the edge, the potential for the continuing expansion of valuable services was yet another reason for our decision.”

In the future, there are plans to deploy Azure SQL Database, Azure Storage, and Azure App Services to realize a serverless environment. And later, AI technologies such as Microsoft Cognitive Services and Azure Machine Learning will be applied.

Dr. Takeshita’s specialty is gastrointestinal surgery. With the database in place, he sees an opportunity to “turn outstanding Japanese surgical skills and technologies into products.”  

“Japan conducts a lot of gastrointestinal surgery, and I believe our technical skills in that area are very advanced when compared internationally. So, for our next step, we will start collecting and databasing surgical data for the large intestine, along with the stomach and surrounding organs.” 

Dr. Takeshita believes it won’t be long before the database starts making a significant contribution to medical innovation around the world.

For further details on this project, see here.