LungSurg: A Generative AI System for Segmentation and Phase Classification in Thoracoscopic Lobectomy

The integration of artificial intelligence (AI) into surgical practices is advancing towards greater intelligence and precision. This study assesses the potential of AI in video-assisted thoracoscopic surgery (VATS) lobectomy for lung cancer by developing an AI system named LungSurg. LungSurg comprises two interconnected networks: a segmentation network for identifying intrathoracic anatomy and surgical instruments, and a classification network for recognizing surgical phases. We prospectively collected 222 VATS lobectomy videos from eight centers, generating over 32,000 annotations and more than one million frames with phase information. In external validation, the segmentation network achieved mean Average precision scores of 0.745 for the left lung and 0.726 for the right lung across various instruments and anatomical structures. The classification network demonstrated Top-1 and Top-3 accuracies of 71.5% and 88.0%, respectively, in identifying 14 surgical phases. Comparative experiments revealed that LungSurg performed comparably to senior surgeons in anatomical identification and surpassed them in sensitivity. In addition, an educational study showed that surgical residents trained with LungSurg significantly improved their anatomical identification and phase classification skills compared to those using conventional methods. These results indicate that LungSurg accurately analyzes VATS lobectomy procedures, highlighting the feasibility and potential of AI-driven tools in enhancing thoracic surgical practices.