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      A Delphi consensus statement for digital surgery

      research-article
      1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 7 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 9 , 21 , 22 , 23 , 1 , 24 , 14 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 34 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 7 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 1 , 53 , 34 , 35 , 1 , 2 , 1 , , 1
      NPJ Digital Medicine
      Nature Publishing Group UK
      Medical ethics, Health policy, Surgery

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          Abstract

          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.

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          Most cited references28

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          Research guidelines for the Delphi survey technique.

          Consensus methods such as the Delphi survey technique are being employed to help enhance effective decision-making in health and social care. The Delphi survey is a group facilitation technique, which is an iterative multistage process, designed to transform opinion into group consensus. It is a flexible approach, that is used commonly within the health and social sciences, yet little guidance exists to help researchers undertake this method of data collection. This paper aims to provide an understanding of the preparation, action steps and difficulties that are inherent within the Delphi. Used systematically and rigorously, the Delphi can contribute significantly to broadening knowledge within the nursing profession. However, careful thought must be given before using the method; there are key issues surrounding problem identification, researcher skills and data presentation that must be addressed. The paper does not claim to be definitive; it purports to act as a guide for those researchers who wish to exploit the Delphi methodology.
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            The global landscape of AI ethics guidelines

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              Artificial Intelligence in Surgery

              The aim of this review was to summarize major topics in artificial intelligence (AI), including their applications and limitations in surgery. This paper reviews the key capabilities of AI to help surgeons understand and critically evaluate new AI applications and to contribute to new developments.
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                Author and article information

                Contributors
                j.kinross@imperial.ac.uk
                Journal
                NPJ Digit Med
                NPJ Digit Med
                NPJ Digital Medicine
                Nature Publishing Group UK (London )
                2398-6352
                19 July 2022
                19 July 2022
                2022
                : 5
                : 100
                Affiliations
                [1 ]GRID grid.7445.2, ISNI 0000 0001 2113 8111, Department of Surgery and Cancer, , Imperial College, ; London, UK
                [2 ]GRID grid.7445.2, ISNI 0000 0001 2113 8111, Institute of Global Health Innovation, , Imperial College London, ; London, UK
                [3 ]GRID grid.214572.7, ISNI 0000 0004 1936 8294, Department of Ophthalmology and Visual Sciences, , University of Iowa, ; Iowa City, IA USA
                [4 ]GRID grid.214572.7, ISNI 0000 0004 1936 8294, Department of Electrical and Computer Engineering, , University of Iowa, ; Iowa City, IA USA
                [5 ]GRID grid.410458.c, ISNI 0000 0000 9635 9413, Department of Gastrointestinal Surgery, , Hospital Clínic de Barcelona, ; Barcelona, Spain
                [6 ]GRID grid.5841.8, ISNI 0000 0004 1937 0247, Universitat de Barcelona, ; Barcelona, Spain
                [7 ]GRID grid.509025.b, ISNI 0000 0004 6359 0626, CMR Surgical Limited, ; Cambridge, UK
                [8 ]GRID grid.1006.7, ISNI 0000 0001 0462 7212, Newcastle Centre for Bowel Disease Research Hub, , Newcastle University, ; Newcastle, UK
                [9 ]Department of Colorectal Surgery, Newcastle Hospitals, Newcastle, UK
                [10 ]GRID grid.27860.3b, ISNI 0000 0004 1936 9684, Department of Surgery, , University of California, ; Davis, CA USA
                [11 ]GRID grid.83440.3b, ISNI 0000000121901201, Department of Surgery and Interventional Sciences, , University College London, ; London, UK
                [12 ]GRID grid.5963.9, Department of General and Visceral Surgery, , University of Freiburg, ; Freiburg im Breisgau, Germany
                [13 ]GRID grid.5963.9, Faculty of Medicine, , University of Freiburg, ; Freiburg im Breisgau, Germany
                [14 ]GRID grid.7497.d, ISNI 0000 0004 0492 0584, Division of Computer Assisted Medical Interventions (CAMI), , German Cancer Research Center (DKFZ), ; Heidelberg, Germany
                [15 ]Solicitor of the Senior Courts of England and Wales, Independent Researcher, Bristol, UK
                [16 ]Endovitta Institute, Sao Paulo, Brazil
                [17 ]FMABC Medical School, Santo Andre, Brazil
                [18 ]GRID grid.21107.35, ISNI 0000 0001 2171 9311, The Malone Center for Engineering in Healthcare, , The Johns Hopkins University, ; Baltimore, MD USA
                [19 ]GRID grid.21107.35, ISNI 0000 0001 2171 9311, Department of Computer Science, , The Johns Hopkins University, ; Baltimore, MD USA
                [20 ]GRID grid.5337.2, ISNI 0000 0004 1936 7603, Department of Vascular Surgery, , University of Bristol, ; Bristol, UK
                [21 ]GRID grid.410368.8, ISNI 0000 0001 2191 9284, LTSI, Inserm UMR 1099, , University of Rennes 1, ; Rennes, France
                [22 ]GRID grid.412807.8, ISNI 0000 0004 1936 9916, Otolaryngology, Head & Neck Surgery and Radiology & Radiological Sciences, , Vanderbilt University Medical Center, ; Nashville, TN USA
                [23 ]GRID grid.415502.7, International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, , St. Michael’s Hospital, University of Toronto, ; Toronto, ON Canada
                [24 ]GRID grid.433922.d, ISNI 0000 0004 0412 8255, Stryker Corporation, ; Kalamazoo, MI USA
                [25 ]GRID grid.7700.0, ISNI 0000 0001 2190 4373, Faculty of Mathematics and Computer Science, , Heidelberg University, ; Heidelberg, Germany
                [26 ]GRID grid.7700.0, ISNI 0000 0001 2190 4373, Medical Faculty, , Heidelberg University, ; Heidelberg, Germany
                [27 ]GRID grid.415502.7, LKSK Institute of St. Michael’s Hospital, ; Toronto, ON Canada
                [28 ]GRID grid.411068.a, ISNI 0000 0001 0671 5785, Department of Surgery, , Hospital Clínico San Carlos, ; Madrid, Spain
                [29 ]GRID grid.414603.4, Fondazione Policlinico Universitario A. Gemelli IRCCS, ; Rome, Italy
                [30 ]GRID grid.480511.9, IHU-Strasbourg, Institute of Image-Guided Surgery, ; Strasbourg, France
                [31 ]GRID grid.11843.3f, ISNI 0000 0001 2157 9291, ICube, , University of Strasbourg, ; Strasbourg, France
                [32 ]GRID grid.9909.9, ISNI 0000 0004 1936 8403, School of Medicine, , University of Leeds, ; Leeds, UK
                [33 ]GRID grid.415967.8, ISNI 0000 0000 9965 1030, Department of Neurosurgery, , Leeds Teaching Hospitals NHS Trust, ; Leeds, UK
                [34 ]GRID grid.5253.1, ISNI 0000 0001 0328 4908, Department of General, Visceral and Transplantation Surgery, , Heidelberg University Hospital, ; Heidelberg, Germany
                [35 ]GRID grid.5253.1, ISNI 0000 0001 0328 4908, National Center for Tumor Diseases, ; Heidelberg, Germany
                [36 ]GRID grid.9647.c, ISNI 0000 0004 7669 9786, Innovation Center Computer Assisted Surgery (ICCAS), , Universität Leipzig, ; Leipzig, Germany
                [37 ]GRID grid.21107.35, ISNI 0000 0001 2171 9311, Department of Surgery, Anne Arundel Medical Center, School of Medicine, , Johns Hopkins University, ; Annapolis, MD USA
                [38 ]GRID grid.9841.4, ISNI 0000 0001 2200 8888, Department of Advanced Medical and Surgical Sciences, , Università degli Studi della Campania “Luigi Vanvitelli”, ; Naples, Italy
                [39 ]GRID grid.411083.f, ISNI 0000 0001 0675 8654, Colorectal Surgery, , Vall d’Hebron University Hospital, ; Barcelona, Spain
                [40 ]GRID grid.17063.33, ISNI 0000 0001 2157 2938, Department of Computer Science, , University of Toronto, ; Toronto, ON Canada
                [41 ]GRID grid.494618.6, Vector Institute for Artificial Intelligence, ; Toronto, ON Canada
                [42 ]Unity Health Toronto, Toronto, ON Canada
                [43 ]Surgical Safety Technologies Inc, Toronto, ON Canada
                [44 ]GRID grid.12641.30, ISNI 0000000105519715, Faculty of Future Health, College of Medicine and Dentistry, , Ulster University, ; Birmingham, UK
                [45 ]GRID grid.120073.7, ISNI 0000 0004 0622 5016, Department of Urogynaecology, , Addenbrooke’s Hospital, ; Cambridge, UK
                [46 ]GRID grid.5335.0, ISNI 0000000121885934, University of Cambridge, ; Cambridge, UK
                [47 ]GRID grid.424926.f, ISNI 0000 0004 0417 0461, The Royal Marsden Hospital, ; London, UK
                [48 ]GRID grid.18886.3f, Institute of Cancer Research, ; London, UK
                [49 ]GRID grid.420004.2, ISNI 0000 0004 0444 2244, Department of Urology, , Newcastle Upon Tyne Hospitals NHS Foundation Trust, ; Newcastle upon Tyne, UK
                [50 ]GRID grid.461742.2, ISNI 0000 0000 8855 0365, Division of Translational Surgical Oncology, , National Center for Tumor Diseases (NCT/UCC), ; Dresden, Germany
                [51 ]GRID grid.4488.0, ISNI 0000 0001 2111 7257, Centre for Tactile Internet with Human-in-the-Loop (CeTI), TU Dresden, ; Dresden, Germany
                [52 ]GRID grid.83440.3b, ISNI 0000000121901201, Wellcome/ESPRC Centre for Interventional and Surgical Sciences, , University College London, ; London, UK
                [53 ]GRID grid.412923.f, ISNI 0000 0000 8542 5921, Department of Colorectal Surgery, , Frimley Health NHS Foundation Trust, ; Frimley, UK
                Author information
                http://orcid.org/0000-0001-6407-4912
                http://orcid.org/0000-0002-3490-0037
                http://orcid.org/0000-0002-0733-8958
                http://orcid.org/0000-0003-4549-3606
                http://orcid.org/0000-0002-6662-9763
                http://orcid.org/0000-0003-0866-463X
                http://orcid.org/0000-0002-0469-9539
                http://orcid.org/0000-0001-7288-3023
                http://orcid.org/0000-0002-2609-9876
                http://orcid.org/0000-0001-6999-5024
                http://orcid.org/0000-0002-8322-6421
                http://orcid.org/0000-0002-7743-8479
                http://orcid.org/0000-0002-9831-9110
                http://orcid.org/0000-0001-7815-7989
                http://orcid.org/0000-0002-0427-7643
                http://orcid.org/0000-0003-0187-8328
                Article
                641
                10.1038/s41746-022-00641-6
                9296639
                35854145
                5d9b76ef-b26f-4d4a-a601-35a4293d1250
                © The Author(s) 2022

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 18 October 2021
                : 24 June 2022
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                © The Author(s) 2022

                medical ethics,health policy,surgery
                medical ethics, health policy, surgery

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