Ethical considerations in the era of AI, automation, and surgical robots: there are plenty of lessons from the past

Technology has been a driving force of current advances in healthcare and surgery over recent years. Examples of such technological advances are easily identified in minimally invasive surgery where modern surgical techniques are driven by the advanced designs and miniaturization of surgical instruments to reduce trauma. Minimally invasive surgery is an umbrella term which encompasses laparoscopic, endoscopic and robotic-assisted surgeries. Using trocar ports surgeons access surgical sites and illuminate the operating field with LED or fiber optics, so that the patient’s internal anatomy can be viewed from internal cameras in the endoscope or laparoscope 1 . Specialized surgical instruments are inserted through the trocar ports to manipulate anatomy, dissect, ablate and suture tissue. Robotic-assisted surgery is an extension of minimally invasive surgery, where surgeons operate remotely using a tele-operated platform, generally from within the same operating room 2 . Specialized instruments are inserted through the trocar ports and controlled by the surgeon remotely using flexible manipulators as an extension of the surgeon’s movements. Central to this technology is data processing and control algorithms translating the surgeons hand movements into precise movements of these miniaturized instruments with automated tremor cancellation. These systems are used generally for abdominal and thoracic surgery, and these by far are the most common type of surgical robot. There are orthopedic systems which take predefined precise and preprogrammed instructions from the surgeon, using data generated from 3D scans, and then carries out some of the procedure autonomously under direct supervision. Other systems build models from MRI data and use force feedback to maintain the surgeons working movements within a safe working area, examples of which can be found in neuro surgery. Surgery more than ever is turning into an information industry where there is both huge potential for patient benefit, however the complexity of problems increases, and careful navigation is required to ensure patient safety 3 .