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Objective: To understand better the public perception and comprehension of medical technology such as artificial intelligence (AI) and robotic surgery. In addition to this, to identify sensitivity to their use to ensure acceptability and quality of counseling. Subjects and Methods: A survey was conducted on a convenience sample of visitors to the MN Minnesota State Fair (n = 264). Participants were randomized to receive one of two similar surveys. In the first, a diagnosis was made by a physician and in the second by an AI application to compare confidence in human and computerbased diagnosis. Results: The median age of participants was 45 (interquartile range 28-59), 58% were female (n = 154) vs 42% male (n = 110), 69% had completed at least a bachelor's degree, 88% were Caucasian (n = 233) vs 12% ethnic minorities (n = 31) and were from 12 states, mostly from the Upper Midwest. Participants had nearly equal trust in AI vs physician diagnoses. However, they were significantly more likely to trust an AI diagnosis of cancer over a doctor's diagnosis when responding to the version of the survey that suggested that an AI could make medical diagnoses (p = 9.32e-06). Though 55% of respondents (n = 145) reported that they were uncomfortable with automated robotic surgery, the majority of the individuals surveyed (88%) mistakenly believed that partially autonomous surgery was already happening. Almost all (94%, n = 249) stated that they would be willing to pay for a review of medical imaging by an AI if available. Conclusion: Most participants express confidence in AI providing medical diagnoses, sometimes even over human physicians. Participants generally express concern with surgical AI, but they mistakenly believe that it is already being performed. As AI applications increase in medical practice, health care providers should be cognizant of the potential amount of misinformation and sensitivity that patients have to how such technology is represented.

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Objectives To assess the effects of Retzius‐sparing (RS) robotic‐assisted laparoscopic prostatectomy (RALP) compared to standard RALP for the treatment of clinically localized prostate cancer. Methods We performed a systematic search of multiple databases and the grey literature with no restrictions on the language of publication or publication status, up until June 2020. We included randomized controlled trials (RCTs) comparing RS‐RALP with standard RALP. We performed a meta‐analysis using a random‐effect model. The quality of evidence was assessed on an outcome basis according to the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Results Our search identified six records of five unique RCTs, of which two were published studies, one was in press, and two were abstract proceedings. There were 571 randomized participants, of whom 502 completed the trials. The mean age of participants was 64.6 years and the mean prostate‐specific antigen level was 6.9 ng/mL. Approximately 54.2% of participants had cT1c disease, 38.6% had cT2a‐b disease, and 7.1% had cT2c disease. RS‐RALP probably improves continence within 1 week after catheter removal (risk ratio [RR] 1.74, 95% confidence interval [CI] 1.41–2.14; I2 = 0%; studies = 4; participants = 410; moderate‐certainty evidence). Assuming 335 per 1000 men undergoing standard RALP are continent at this time point, this corresponds to 248 more men per 1000 (137 more to 382 more) reporting continence recovery. RS‐RALP may increase continence at 3 months after surgery compared to standard RALP (RR 1.33, 95% CI 1.06–1.68; I2 = 86%; studies = 5; participants = 526; low‐certainty evidence). Assuming 750 per 1000 men undergoing standard RALP are continent at this time point, this corresponds to 224 more men per 1000 (41 more to 462 more) reporting continence recovery. We are very uncertain about the effects of RS‐RALP on serious adverse events compared to standard RALP (RR 1.40, 95% CI 0.47–4.17; studies = 2; participants = 230; very low‐certainty evidence). Conclusions The findings of this review indicate that RS‐RALP may result in better continence outcomes than standard RALP up to 6 months after surgery. Continence outcomes at 12 months may be similar. The disadvantages of RS‐RALP may be higher positive surgical margin rates. We are very uncertain about the effect on biochemical recurrence‐free survival and potency outcomes. Longer‐term oncological and functional outcomes are lacking, and no preplanned subgroup analyses could be performed to explore the observed heterogeneity. Surgeons should discuss these trade‐offs and the limitations of the evidence with their patients when considering this approach.

626 Background: The 2019 Kidney and Kidney Tumor Segmentation challenge (KiTS19) was an international competition held in conjunction with the 2019 International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI) and sought to stimulate progress on this automatic segmentation frontier. Growing rates of kidney tumor incidence led to research into the use of artificial inteligence (AI) to radiographically differentiate and objectively characterize these tumors. Automated segmentation using AI objectively quantifies complexity and aggression of renal tumors to better differentiate and describe the tumors for improved treatment decision making. Methods: A training set of over 31,000 CT images from 210 patients with kidney tumors was publicly released with corresponding semantic segmentation masks. 106 teams from five continents used this data to develop automated deep learning systems to predict the true segmentation masks on a test set of an additional 13,500 CT images in 90 patients for which the corresponding ground truth segmentations were kept private. These predictions were scored and ranked according to their average Sørensen-Dice coefficient between kidney and tumor across the 90 test cases. Results: The winning team achieved a Dice of 0.974 for kidney and 0.851 for tumor, approaching the human inter-annotator performance on kidney (0.983) but falling short on tumor (0.923). This challenge has now entered an “open leaderboard” phase where it serves as a challenging benchmark in 3D semantic segmentation. Conclusions: Results of the KiTS19 challenge show deep learning methods are fully capable of reliable segmentation of kidneys and kidney tumors. The KiTS19 challenge attracted a high number of submissions and serves as an important and challenging benchmark in 3D segmentation. The publicly available data will further propel the use of automated 3D segmentation analysis. Fully segmented kidneys and tumors allow for automated calculation of all types of nephrometry, tumor textural variation and discovery of new predictive features important for personalized medicine and accurate prediction of patient relevant outcomes.

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There is a large body of literature linking anatomic and geometric characteristics of kidney tumors to perioperative and oncologic outcomes. Semantic segmentation of these tumors and their host kidneys is a promising tool for quantitatively characterizing these lesions, but its adoption is limited due to the manual effort required to produce high-quality 3D segmentations of these structures. Recently, methods based on deep learning have shown excellent results in automatic 3D segmentation, but they require large datasets for training, and there remains little consensus on which methods perform best. The 2019 Kidney and Kidney Tumor Segmentation challenge (KiTS19) was a competition held in conjunction with the 2019 International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI) which sought to address these issues and stimulate progress on this automatic segmentation problem.A training set of 210 cross sectional CT images with kidney tumors was publicly released with corresponding semantic segmentation masks. 106 teams from five continents used this data to develop automated systems to predict the true segmentation masks on a test set of 90 CT images for which the corresponding ground truth segmentations were kept private. These predictions were scored and ranked according to their average Sørensen-Dice coefficient between the kidney and tumor across all 90 cases. The winning team achieved a Dice of 0.974 for kidney and 0.851 for tumor, approaching the inter-annotator performance on kidney (0.983) but falling short on tumor (0.923). This challenge has now entered an "open leaderboard" phase where it serves as a challenging benchmark in 3D semantic segmentation.