Kigali, Rwanda — In the health sector, the fast adoption of artificial intelligence (AI) will lead to a major shift
“Surgeons are innovators by the very virtue of what we do – we cut, we dissect, and we need gadgets. We think of innovations and inventions to help us care for patients who need surgical care,” Dr. Kathryn Chu, the director of the Center for Global Surgery at Stellenbosch University in South Africa said at the Pan African Surgical Conference in Kigali, Rwanda.
There are critical challenges facing the global healthcare system, including the lack of access to essential services for 4.5 billion people and the predicted shortage of 10 million healthcare workers by 2030, primarily in low- and middle-income nations, according to the World Economic Forum (WEF). It’s estimated that 1.3 billion people are being pushed deeper into poverty, or extreme poverty, due to the financial hardship caused by health services payments, according to the World Health Organization (WHO).
However, some of the gaps can be addressed using artificial intelligence.
“AI is not the future – it’s the present. It’s here to expand our time, take away repetitive tasks, and make our lives better,” said Dr. Allyn Ausländer, Associate Vice President of Research at Operation Smile, the non-profit that has provided free cleft lip and palate surgeries to more than 300,000 patients worldwide.
Experts predict that AI will aid clinicians in making more accurate and timely decisions by automating routine administrative tasks and reducing time spent on electronic health record systems. But even though AI has so much potential, it’s not being used widely yet, and there’s a risk we might miss out on its full benefits.
However, the healthcare sector lags behind other industries in adopting artificial intelligence despite rapid technological advances.
Dr. Chu traced key milestones in surgical innovation, which include stents, bypass procedures, and implants. The surgical stapler, which was originally invented by the Russians in the early 1900s and has since evolved significantly, was one of the breakthroughs she referred to. She said the surgical stapler drastically changed how procedures are performed, particularly in colorectal surgery.
“The field of artificial intelligence is the broad field where the development of smart systems and machines carry out tasks that were normally done by humans,” she said.
“Artificial intelligence is the broad field of developing systems that perform tasks typically done by humans. Within AI, machine learning uses algorithms and big data to make decisions based on patterns, while deep learning involves artificial neural networks to reach conclusions without – though I disagree – always needing human intervention,” said Dr. Chu.
“The idea of global surgery is to improve access to surgical care worldwide. I think that’s why we’re all here,” she said. “These advances must, however, be guided by ethical considerations. We must ask: Is the innovation equitable, sustainable, and respectful of the local context? “These are critical questions when introducing new technologies or methods.”
Dr. Chu emphasized the critical role of ethical principles, including doing good (beneficence), avoiding harm (non-maleficence), ensuring fairness (justice), and respecting patients’ rights to make their own decisions (autonomy).
“As surgeons, we take the Hippocratic Oath, which includes doing no harm and prioritizing patient well-being. But justice – ensuring fairness and equity – is more complex. We must consider not just the patient in front of us, but also those we aren’t treating, whether in our hospital, health district, or entire country.”
Challenges of data privacy
As healthcare systems embrace digital transformation, cybersecurity has become a top priority as data breaches, cyberattacks, and system failures endanger patient safety.
“When it comes to data privacy, the key is to balance risk,” Dr. Ausländer said. Operation Smile emphasizes, for example, that refusing to participate in research will not affect their treatment, even if data are collected with the best intentions. We must ensure patients are fully informed and have the option to opt out without affecting their care.”
She raised concerns about the widespread absence of strong data protection measures globally. The challenge lies, however, in applying AI responsibly, a concern that will become more and more important as discussions about AI integration in healthcare continue.
Ausländer said that while ethical considerations are crucial, an overly cautious approach to healthcare could exclude African data from AI training. This could limit the advancement of medical technologies for patients. “As a global community, we haven’t figured out data protection. While health is one of the most ethically conscious fields, I worry we might overthink it to the point where African data isn’t included in AI training, which would be a missed opportunity for progress.”
Dr. Ausländer said that AI will not replace humans, but rather boost their performance and productivity. Healthcare providers would be able to reduce their administrative workload, especially in areas like Africa, where medical professionals are overburdened with administrative tasks.
Watch this Operation Smile video to see the potential of AI and how it can transform a surgeon’s daily work
However, she said that the main challenge in bringing AI tools, such as note-taking software for doctors, to Africa is not the complexity of the technology but the need for locally relevant data. “For example, if an AI tool trained in the U.S. or Europe is used here, it might not work because the way doctors dictate notes or prioritize information could be completely different. The time-consuming part is gathering enough local data to train the model so it’s relevant and unbiased for the context.”
“Telemedicine is one of the simplest ways AI can change healthcare access,” she said. “By enabling virtual consultations, follow-ups, and scheduling, patients won’t need to travel for certain types of care, which can be transformative, especially in underserved areas.”
As far as surgery goes, said Dr. Ausländer, AI will not directly solve the shortage of surgeons, but it may improve patient detection, like cleft lip and palate at birth, and optimize supply chain management and cost savings. AI may enhance efficiency in healthcare, however, she warned against over-reliance on it and said that human expertise and compassion remain irreplaceable.
Innovation – Real Impact?
Dr. Chu is concerned about whether innovations within local healthcare systems are sustainable, and whether patients have meaningful choices or are simply forced to accept what is presented to them.
She worked on a project developed by UK engineers and piloted in South Africa to develop a rugged prosthesis for lower-limb amputees in rural Africa. The prosthetics were tested on young male trauma patients, not the entire amputee population, and data was sent back to a UK university for refinement, mirroring how many AI-driven innovations operate.
While the intent was beneficence – to help patients – we must ask: What if it doesn’t work or causes harm? Was it equitable? Were local patients involved in its development? Who owns the data collected, and will it benefit the local population or just the developers?”
“Simulation is now here to stay as part of our medical education.”
The purpose of using simulation in surgical training is to allow surgeons to develop skills and competence without practicing on patients, said Dr. Chu. Simulators enable trainees to rehearse rare but critical scenarios, such as accidental injuries to major blood vessels, which is important for operating room readiness.
“For example, as an abdominal surgeon, cutting into the inferior vena cava is a dreaded complication. Simulators let us practice such scenarios so we’re prepared if they occur.” She drew parallels to aviation: “Pilots use simulators to practice emergencies, like the Hudson River landing. In surgery, simulators help us simulate high-stakes situations, such as trauma cases with limited resources, before they occur.”
Dr. Chu said the role of AI and simulation in surgical training has the potential to be a “great equalizer”, but we must ask: Will simulators widen the gap between low-resource and high-resource settings, or will they close it?”
The beauty of low-tech simulators is that they can be connected to laptops, making them accessible even in resource-limited settings. However, in high-resource countries, virtual reality simulators are already in use, creating a disparity in training opportunities.”
She said medical students are already using advanced technologies such as virtual reality (VR) simulators in some parts of the world.
“When we learned colonoscopy, we did not have virtual reality 3D colonoscopy simulators to practice on. For most of us in the African continent, this is still not available,” she said. This disparity raises a critical question about whether surgical education is “leapfrogging ahead in certain countries” while others lack access to these essential training tools.
“AI can help us make decisions before the operation, in the operating room, and afterward.”
AI can assist in several ways, Dr Chu said. “… this is a 42-year-old woman with rectal bleeding, and we found colon cancer during colonoscopy. The AI can help you decide what the best prehabilitation and pre-op steps needed, which pre-op antibiotics to give, what type of operation would be best for this patient given the risk factors, and help predict the surgical site infection risk and anastomotic leak rate afterward.”
To demonstrate the limitations of artificial intelligence when trained on inadequate or biased data, Dr. Chu used a mHealth app designed to detect surgical site infections. Despite its success in the UK, the app failed in Africa because it was developed with data from emergency abdominal surgeries and light-skinned patients. AI’s effectiveness depends solely on the quality and relevance of the data it is trained on.
She said that while this technology can make accurate decisions without human intervention, it also poses risks. How transparent is the process of how AI came up with the answers that it did?
Can AI make better decisions than the human surgeon?
AI can assist surgeons by identifying the critical view of safety during gallbladder surgery, showing the cystic artery and cystic duct in real-time, Dr Chu said. But what happens if the AI is wrong and misidentifies the common bile duct? Who takes responsibility for that error, she asked, “certainly not ChatGPT”.
While AI can be a valuable tool in the operating room, she said, it does not replace the surgeon’s training and decision-making abilities. “AI is a tool for us as surgeons. But we went to medical school, and we did all the surgical training to be able to also input our decisions.”
Dr. Ausländer agrees that healthcare providers should use AI tools thoughtfully and with a clear understanding of their capabilities.
“As medical providers, if you’re going to use AI, it’s your responsibility to understand what you’re using and how it works. You should be able to answer questions about it and not blindly trust the tool,” Dr. Ausländer said. “ChatGPT is a good starting point, but it’s not the ending point. You have to fact-check everything it generates and verify it with reliable sources. You can’t just copy-paste and assume it’s correct.”
Dr. Chu reiterated that while surgical innovation and AI are integral to modern practice, the challenge lies in their appropriate application.”Simulators can bridge the gap between resource-limited and high-resource settings, but they can also widen it. The question is, how can we creatively use simulators to provide the best education for all trainees?”
She said integrating ethical considerations into AI and innovation training is key, ensuring surgeons understand both the benefits and limitations of these tools.
“AI can improve surgical decision-making, but we must balance its power with our own expertise. The ethics of innovation and AI should be a mandatory part of surgical training, as understanding its benefits and pitfalls can make us better surgeons,” said Dr. Chu.
“Artificial intelligence is not a substitute for human intelligence; it is a tool to amplify human creativity and ingenuity.”
Edited by Juanita Williams
