Autonomous Robotic Surgical Systems: Needing Common Sense to Achieve Higher Levels of Autonomy Opinion

While executing a surgical procedure, surgeons not only rely on their specific medical knowledge but also on a set of skills that are “obvious” to them and allow for intuitively evaluating and reacting to the intervention evolution. Such skills belong to what is usually called common sense , which is essential to carry out an intervention. Although general common sense refers to all the basic concepts about the world and belongs to all human beings (e.g., the fact that a needle must be inserted from tip to eye), we believe that field-specific common sense is developed depending on individual experiences within a field of expertise. In surgery, field-specific common sense is the “glue” knowledge that is not explicitly described in surgical manuals, but it is acquired during lengthy surgical training. For example, a textbook does not explicitly describe how the needle should be held nor how it should be inserted in the human body, but this information is known by the domain experts. Understanding how to describe, represent, and learn this knowledge is paramount to developing robust and reliable autonomous robotic surgical systems (ARSSs). Developing ARSSs is a research trend of great interest for which taxonomies and paradigms have already been proposed. For more details, the reader is referred to 1 and 2. The importance and challenges of common sense have been discussed in other fields 3, 4, but to the best of our knowledge, this aspect has not yet been addressed in robotic surgery.