The ethical landscape of robot-assisted surgery. A systematic review

Background: Robot-assisted surgery has been widely adopted in recent years. However, compared to other health technologies operating in close proximity to patients in a vulnerable state, ethical issues of robot-assisted surgery have received less attention. Against the background of increasing automation that are expected to raise new ethical issues, this systematic review aims to map the state of the ethical debate in this field. Methods: A protocol was registered in the international prospective register of systematic reviews (PROSPERO CRD42023397951). Medline via PubMed, EMBASE, CINHAL, Philosophers' Index, IEEE Xplorer, Web of Science (Core Collection), Scopus and Google Scholar were searched in January 2023. Screening, extraction, and analysis were conducted independently by two authors. A qualitative narrative synthesis was performed. Results: Out of 1,723 records, 66 records were included in the final dataset. Seven major strands of the ethical debate emerged during analysis. These include questions of harms and benefits, responsibility and control, professional-patient relationship, ethical issues in surgical training and learning, justice, translational questions, and economic considerations. Discussion: The identified themes testify to a broad range of different and differing ethical issues requiring careful deliberation and integration into the surgical ethos. Looking forward, we argue that a different perspective in addressing robotic surgical devices might be helpful to consider upcoming challenges of automation.