The Role of Humans in Surgery Automation

Abstract Innovation in healthcare promises unparalleled potential in optimizing the production, distribution, and use of the health workforce and infrastructure, allocating system resources more efficiently, and streamline care pathways and supply chains. A recent innovation contributing to this is robot-assisted surgeries (RAS). RAS causes less damage to the patient's body, less pain and discomfort, shorter hospital stays, quicker recovery times, smaller scars, and less risk of complications. However, introducing a robot in traditional surgeries is not straightforward and brings about new risks that conventional medical instruments did not pose before. For instance, since robots are sophisticated machines capable of acting autonomously, the surgical procedure's outcome is no longer limited to the surgeon but may also extend to the robot manufacturer and the hospital. This article explores the influence of automation on stakeholder responsibility in surgery robotization. To this end, we map how the role of different stakeholders in highly autonomous robotic surgeries is transforming, explore some of the challenges that robot manufacturers and hospital management will increasingly face as surgical procedures become more and more automated, and bring forward potential solutions to ascertain clarity in the role of stakeholders before, during, and after robot-enabled surgeries (i.e. a Robot Impact Assessment (ROBIA), a Robo-Terms framework inspired by the international trade system 'Incoterms', and a standardized adverse event reporting mechanism). In particular, we argue that with progressive robot autonomy, performance, oversight, and support will increasingly be shared between the human surgeon, the support staff, and the robot (and, by extent, the robot manufacturer), blurring the lines of who is responsible if something goes wrong. Understanding the exact role of humans in highly autonomous robotic surgeries is essential to map liability and bring certainty concerning the ascription of responsibility. We conclude that the full benefits the use of robotic innovations and solutions in surgery could bring to healthcare providers and receivers cannot be realized until there is more clarity on the division of responsibilities channeling robot autonomy and human performance, support, and oversight; a transformation on the education and training of medical staff, and betterment on the complex interplay between manufacturers, healthcare providers, and patients.