Digital Surgery Raises Ethical Questions in Medicine

Surgery has always evolved in step with technological advancements. After the introduction of anesthesia and antiseptic techniques in the 19th century, it underwent a revolution with medical imaging, minimally invasive surgery, and robotic assistance. Today, a new era is dawning with artificial intelligence, augmented reality, digital twins, and telemedicine. These innovations are transforming every stage of care: planning, the intervention itself, and postoperative follow-up. They promise greater precision, improved patient safety, and personalized treatments.

However, this evolution raises complex ethical questions. Who bears responsibility in the event of an error when algorithms contribute to surgical decisions? How can transparency be ensured when artificial intelligence systems often operate as black boxes, incomprehensible even to experts? Patients must now consent not only to an operation but also to the use of their data by digital tools whose workings they do not understand.

Surgical robots, capable of analyzing images in real time and guiding practitioners’ actions, reduce the risk of human error. Some systems can even perform precise steps of an intervention, such as drilling a bone to a predefined depth. But as these technologies gain autonomy, the question of responsibility becomes blurred. In the event of a complication, who is responsible: the surgeon, the hospital, the software developer, or the robot manufacturer? Current legal frameworks struggle to answer this question, leaving healthcare professionals in a state of uncertainty.

Another challenge concerns the training of future surgeons. Over-reliance on robotic assistance could lead to a gradual loss of manual skills. If young doctors primarily learn to operate consoles and digital interfaces, what will happen in the event of a technical failure? Could manual surgery become an obsolete skill, to the point where no one would know how to operate without robotic assistance?

Augmented reality and digital twins also open up new perspectives. Augmented reality allows the overlay of 3D anatomical reconstructions directly onto the surgical field, helping surgeons visualize tumors, vessels, or nerves in real time. Digital twins, on the other hand, are virtual models of patients created from medical data. They enable the simulation of interventions before performing them, the evaluation of the consequences of different strategies, or the prediction of postoperative outcomes. However, these technologies are not infallible: calibration errors or algorithmic biases can distort the results.

Telemedicine and remote surgery are also becoming a reality. Thanks to ultra-fast internet connections and remotely controlled robots, a surgeon can now operate on a patient located thousands of kilometers away. These advancements could democratize access to high-quality care in remote regions. But they also raise questions about data confidentiality and system security.

Finally, the ownership of health data is a major issue. Today, patients’ medical information can be analyzed by hospitals, insurance companies, start-ups, or algorithms. Who owns this data? How can its protection and ethical use be guaranteed? In a world where data is increasingly valuable, these questions are becoming crucial.

Digital surgery is not just a technical revolution but also a philosophical and ethical transformation of medicine. The fundamental principles of medical ethics—autonomy, beneficence, non-maleficence, and justice—remain unchanged, but their application must adapt to this new context. The challenge is not to reject these innovations but to integrate them responsibly, ensuring that patient well-being remains at the heart of every decision.

Documentation and Sources

Reference Document

DOI: https://doi.org/10.1007/s00264-026-06893-1

Title: Bioethics in the era of digital surgery: artificial intelligence, robotics, telesurgery and the surgical black box: who owns the mistakes? Who owns my health data?

Journal: International Orthopaedics

Publisher: Springer Science and Business Media LLC

Authors: Andreas F. Mavrogenis; Konstantinos V. Tsihrintzis; Philippe Hernigou; Marius M. Scarlat