Robotic surgery and artificial intelligence in spine and brain surgery: Ethical challenges

Abstract

Two of the most sizeable technological advances in contemporary Brain and Spine Surgery, namely real-time 3D neuronavigation and surgical robotics, are well matched for artificial intelligence (AI). AI can be defined as the capability of a computer algorithm to perform more efficiently tasks or reasoning processes, mimicking human intelligence, especially in those areas, which require the manipulation of big data and knowledge. The popularity of robotics surgery is triggering over the last 15 years with initial successful experiences in Urology, in cavity-dependent surgical specialties and, recently, in Spine surgery and Neurosurgery. The ethical nuance associated with robotic-assisted (RA) surgery is the distance between the patient and the surgeon, with no real interaction, which can generate a degree of skepticism, misunderstanding and, even, litigation. The widespread use of robots can lead among surgeons to a shortage of critical experience, which is usually forged through direct hands-on contact with patients and may prove critical in case of failure or unavailability of robotic systems. The costs of RA surgery and its availability in most hospitals, especially in low-and middle-income countries, limit the access of most patients to the new technologies. Proper use of AI should observe a set of ethical principles and comply with set of universal values that guide humans. Ethical and legal positions should be consonant to frame the standards of practice, validate specialists' accreditations, design insurance coverage, issue specific informed consents and bring accountability to the developers, owners, and users of robots. According to Amara's law, "We tend to overestimate the effect of a new technology in the short run and underestimate the effect in the long run. " Here we review pertinent bioethics concepts related to use of RA surgery and the putative harmful side effects of AI applicability. Clinicians and patients must be familiar with ethical concerns involved in the increasing use of robotic surgery.