Patients’ perceptions of ethical issues in semi-autonomous robot-assisted surgery

Jie Ying Wu, Sydney Varnado, Ashley Leon, Camella J. Carlson, Alexander Langerman, Laurie L. Novak, Michelle L Houston, Irene D. Feurer, Elisa J. Gordon

Abstract Background Artificial intelligence enables surgical robots to perform certain actions without surgeon control or semi-autonomously. Patient willingness to undergo surgery via an automated machine is a key barrier to adoption of emerging robotic technology. Further, semi-autonomous surgical robots raise numerous ethical concerns, yet little is known about patients’ perceptions of these issues. We assessed patients’ perceptions of ethical issues in semi-autonomous robot-assisted surgery (RAS) and how their perceptions would affect decision-making about undergoing semi-autonomous RAS. Methods Adult patients who underwent surgery within the prior three years, with a non-autonomous robot or without any robot, were recruited via email. We conducted semi-structured teleconference interviews that included open- and closed-ended questions, to assess factors affecting patient decision-making and ethical concerns about semi-autonomous RAS, and demographics. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using thematic analysis. Results Fifty patients participated. Most participants were female (62%), White (52%), and the mean age was 53. Most patients (56%) would undergo semi-autonomous RAS. However, willingness varied by which surgical process the robot would have control over. Many patients (46%) were highly willing to undergo semi-autonomous RAS when the robot has control over instruments. Four themes emerged about ethical concerns driving patients’ willingness to undergo semi-autonomous RAS: (1) desire for informed consent to express self-determination, (2) semi-autonomous RAS introduces new risks to procedures, (3) doctor-patient relationship and trust can facilitate patients’ willingness to undergo semi-autonomous RAS, and (4) semi-autonomous RAS comprises an important surgical innovation, conferring benefits. Conclusion Our findings suggest that most patients would be willing to undergo semi-autonomous RAS. Willingness was related to ethical considerations of informed consent, perceived risks, level of surgeon versus robot control over surgical processes, doctor-patient relationship, and perceived benefits. Addressing patients’ perceptions of semi-autonomous RAS may facilitate greater integration of surgical robots into clinical practice.