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Surgery is a critical function of the healthcare system, key to addressing a substantial portion of the global disease burden. The integration of advanced artificial intelligence (AI) and robotics ecosystems into the operating room (OR) promises to radically transform surgery, with profound implications. This article analyzes the current state of surgical AI and robotic systems; presents a vision for their future, highlighting technological and research challenges and their associated impact on surgical teams; and discusses the ethical and regulatory implications. AI systems will use complex, multimodal data streams collected from patients, surgical teams, robots, and the OR environment to become increasingly capable of situational awareness, workflow recognition, performance benchmarking, causal inference, outcome prediction, and intraoperative decision-making to optimize surgical actions. Robotics will move from passive instrument-handling tools to autonomous systems with human-in-the-loop control, with embodied AI and enhanced sensor-based perception providing comprehensive spatial–temporal understanding, anticipatory behaviors, and adaptive learning. The surgeon’s role will shift toward supervision, coordination, and high-level decision-making, while nurses, assistants, and anesthesiologists will have additional competencies complemented by clinical data scientists and AI and robotic integration engineers. Ethical challenges will include liability and the implications of diluted authority chains, the potential for AI bias to exacerbate health inequalities, and the concentration of research and industry in resource-rich nations. New regulatory and compliance frameworks, trial methods, reporting standards, and training approaches will be needed to ensure the safety and effectiveness of these systems. Ultimately, AI and robotics should sustain, rather than disrupt, surgical practices by refining the skills of care providers to achieve true personalized surgery and propel procedural and technological advancements.
Granados et al. (Thu,) studied this question.