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Intraoperative Applications of Artificial Intelligence in Robotic Surgery: A Scoping Review of Current Development Stages and Levels of Autonomy

Vasey, Baptiste, Lippert, Karoline A.N., Khan, Danyal Z., Ibrahim, Mudathir, Koh, Chan Hee, Layard Horsfall, Hugo, Lee, Keng Siang, Williams, Simon, Marcus, Hani J., McCulloch, Peter·2023·Annals of Surgery
DOI 10.1097/sla.0000000000005700PMC PMC10631501
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Abstract

Objective: A scoping review of the literature was conducted to identify intraoperative artificial intelligence (AI) applications for robotic surgery under development and categorize them by (1) purpose of the applications, (2) level of autonomy, (3) stage of development, and (4) type of measured outcome. Background: In robotic surgery, AI-based applications have the potential to disrupt a field so far based on a master-slave paradigm. However, there is no available overview about this technology’s current stage of development and level of autonomy. Methods: MEDLINE and EMBASE were searched between January 1, 2010 and May 21, 2022. Abstract screening, full-text review, and data extraction were performed independently by 2 reviewers. The level of autonomy was defined according to the Yang and colleagues’ classification and stage of development according to the Idea, Development, Evaluation, Assessment, and Long-term follow-up framework. Results: One hundred twenty-nine studies were included in the review. Ninety-seven studies (75%) described applications providing Robot Assistance (autonomy level 1), 30 studies (23%) application enabling Task Autonomy (autonomy level 2), and 2 studies (2%) application achieving Conditional autonomy (autonomy level 3). All studies were at Idea, Development, Evaluation, Assessment, and Long-term follow-up stage 0 and no clinical investigations on humans were found. One hundred sixteen (90%) conducted in silico or ex vivo experiments on inorganic material, 9 (7%) ex vivo experiments on organic material, and 4 (3%) performed in vivo experiments in porcine models. Conclusions: Clinical evaluation of intraoperative AI applications for robotic surgery is still in its infancy and most applications have a low level of autonomy. With increasing levels of autonomy, the evaluation focus seems to shift from AI-specific metrics to process outcomes, although common standards are needed to allow comparison between systems.

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  • While current clinical use of robotic platforms remains at the level of robot assistance (autonomy level 1), research is progressing toward higher autonomy, with conditional autonomy demonstrated in preclinical models.

    “While current clinical use remains at the level of robot assistance (autonomy level 1), research is progressing toward higher autonomy, with conditional autonomy demonstrated in preclinical models [50]”

    From Artificial Intelligence in Oncologic Thoracic Surgery: Clinical Decision Support and Emerging Applications (2026) · cites this paper as [50]

    The Results (Level of System Autonomy; page unavailable) report level 1 robot assistance in most reviewed AI applications and level 3 conditional autonomy in two studies assessed in silico or ex vivo. But the Abstract Results say none of the reviewed applications was clinically investigated in humans. The paper therefore supports the preclinical progress toward higher autonomy, not the assertion that current clinical use is at level 1. (LLM, conf=0.88)

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Research works printed but not linked: 26

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Authors
Vasey, B., Lippert, K. A. N., Khan, D. Z., Ibrahim, M., Koh, C. H., Layard Horsfall, H., Lee, K. S., Williams, S., Marcus, H. J., & McCulloch, P.
Affiliations
  • Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
  • Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
  • Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
  • Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, UK
ORCID
Vasey, Baptiste
Venue
Annals of Surgery
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2022-09-30
Volume
278
Issue
6
Pages
896-903
ISSN
0003-4932
DOI
10.1097/sla.0000000000005700
PMC
PMC10631501
Cited by
75
References
5
Language
en
Licence
creativecommons.org/licenses/by/4.0/%20http://creativecommons.org/licenses/by/4.0/ (unspecified)

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