A Delphi consensus statement for digital surgery

Kyle Lam (1) , Michael Abràmoff (2) , José Balibrea , Steven Bishop , Richard Brady , Rachael Callcut , Manish Chand , Justin Collins (3) , Markus Diener , Matthias Eisenmann (4) , Kelly Fermont , Manoel Galvao Neto , Gregory Hager (5) , Robert Hinchliffe , Alan Horgan , Pierre Jannin (6, 7) , Alexander Langerman , Kartik Logishetty , Amit Mahadik , Lena Maier-Hein (4) , Esteban Martín Antona , Pietro Mascagni (8, 9) , Ryan Mathew , Beat Müller-Stich (10) , Thomas Neumuth (11) , Felix Nickel , Adrian Park (12) , Gianluca Pellino , Frank Rudzicz , Sam Shah , Mark Slack , Myles Smith , Naeem Soomro , Stefanie Speidel , Danail Stoyanov , Henry Tilney , Martin Wagner , Ara Darzi , James Kinross (1) , Sanjay Purkayastha (1)

1 Imperial College London
2 University of Iowa [Iowa City]
3 UCL - University College of London [London]
4 DKFZ - German Cancer Research Center - Deutsches Krebsforschungszentrum [Heidelberg]
5 JHU - Johns Hopkins University
6 LTSI - Laboratoire Traitement du Signal et de l'Image
7 CHU Pontchaillou [Rennes]
8 ICube - Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie
9 IHU Strasbourg - L'Institut hospitalo-universitaire de Strasbourg
10 Heidelberg University Hospital [Heidelberg]
11 Universität Leipzig [Leipzig]
12 Johns Hopkins University School of Medicine [Baltimore]

The use of digital technology is increasing rapidly across surgical specialities, yet there is no consensus for the term ‘digital surgery’. This is critical as digital health technologies present technical, governance, and legal challenges which are unique to the surgeon and surgical patient. We aim to define the term digital surgery and the ethical issues surrounding its clinical application, and to identify barriers and research goals for future practice. 38 international experts, across the fields of surgery, AI, industry, law, ethics and policy, participated in a four-round Delphi exercise. Issues were generated by an expert panel and public panel through a scoping questionnaire around key themes identified from the literature and voted upon in two subsequent questionnaire rounds. Consensus was defined if >70% of the panel deemed the statement important and <30% unimportant. A final online meeting was held to discuss consensus statements. The definition of digital surgery as the use of technology for the enhancement of preoperative planning, surgical performance, therapeutic support, or training, to improve outcomes and reduce harm achieved 100% consensus agreement. We highlight key ethical issues concerning data, privacy, confidentiality and public trust, consent, law, litigation and liability, and commercial partnerships within digital surgery and identify barriers and research goals for future practice. Developers and users of digital surgery must not only have an awareness of the ethical issues surrounding digital applications in healthcare, but also the ethical considerations unique to digital surgery. Future research into these issues must involve all digital surgery stakeholders including patients.

Domains: Life Sciences [q-bio]

Kyle Lam, Michael Abràmoff, José Balibrea, Steven Bishop, Richard Brady, et al.. A Delphi consensus statement for digital surgery. npj Digital Medicine, 2022, 5 (1), pp.100. ⟨10.1038/s41746-022-00641-6⟩. ⟨hal-03776203⟩