Surgical robots enhanced with next-generation artificial intelligence could fundamentally reshape how operations are performed, provided that ethical and regulatory challenges are properly addressed.
This is according to a team of experts, including researchers from King’s College London.
Writing for Frontiers in Science, the team, including Emeritus Professor Prokar Dasgupta – who recently performed the UK’s first long distance robotic operation – and Dr Alejandro Granados, suggests that ‘embodied AI’ could safely augment surgical practice and usher in an era of truly personalised surgery.
AI-enabled robotic systems have the potential to significantly improve surgical teams’ performance, awareness and decision-making, while increasing operational effectiveness and efficiency.
However, the paper says progress will depend on clear regulatory frameworks and sustained human oversight.
The analysis highlights several unresolved questions, including:
• How regulators should manage systems that continue to learn and evolve after approval
• How bias in datasets can be prevented from reinforcing healthcare inequalities
• How global imbalances in research and industry concentration can be addressed.
Professor Dasgupta said the pace of change could be rapid: ‘Using advanced AI and robotics in the operating room is very exciting. The next few years will see intelligent robots impact all stages of surgery, including techniques, emergency responses, team roles, workflows, and assistive functions.’
However, the team cautions that AI systems must support, rather than disrupt, established surgical practice.
Professor Prokar Dasgupta said: ‘With AI’s promise comes profound implications for clinical practice and the continued safe function of surgical teams. These warrant multistakeholder discussion to ensure clarity of liability, minimisation of bias, integration of autonomous robotic systems within surgical teams, global equity, and robust product regulation.’
Future advances are expected to include AI embedded directly into surgical robots and connected to sensor rich operating theatres. These systems could develop spatial awareness, learn and adapt in real time, benchmark performance, provide autonomous assistance and deliver feedback to teams during procedures.
New large datasets from patients, surgical staff and robotic sensors could also enable AI systems to provide real-time decision support, helping surgeons optimise each action during surgery.
Predictive models could also enable surgeons to visualise the likely outcome of different choices before acting, improving patient outcomes through what researchers describe as cause-and-effect recognition.
First author Dr Alejandro Granados of King’s College London said surgery was approaching a turning point.
‘Surgery is on the brink of a profound transformation, where technology will not only help predict outcomes but also guide clinicians toward the most optimal, personalised treatment for each patient.’
The paper argues that current regulatory approaches, which approve medical devices based on a fixed design, are poorly-suited to adaptive AI systems that can change after deployment.
It suggests that reforms to licensing routes, device classification, post-market surveillance, and compliance standards will be necessary to manage higher-risk technologies.
Dr Granados said: ‘AI’s ability to learn presents an unprecedented puzzle. We are at a pivotal time in surgery where we need to begin answering those questions to ensure patients can benefit from the wealth of benefits AI powered operating rooms bring.’
Standardised clinical trial metrics for AI software, closer collaboration between regulators and professional bodies on training, and new partnerships to ensure lower income countries also benefit from innovation are also recommended.
Co-author of the paper, Professor Sebastien Ourselin added that human oversight must remain a priority ‘to ensure safety and patient confidence going forward’.
