Autonomy in surgical robots and its meaningful human control
Open accessAbstract
This article focuses on ethical issues raised by increasing levels of autonomy for surgical robots. These ethical issues are explored mainly by reference to state-ofart case studies and imminent advances in Minimally Invasive Surgery (MIS) and Microsurgery. In both area, surgicalworkspace is limited and the required precision is high. For this reason, increasing levels of robotic autonomy can make a significant difference there, and ethically justified control sharing between humans and robots must be introduced. In particular, from a responsibility and accountability perspective suitable policies for theMeaningfulHuman Control (MHC) of increasingly autonomous surgical robots are proposed. It is highlighted how MHC should be modulated in accordance with various levels of autonomy for MIS and Microsurgery robots. Moreover, finer MHC distinctions are introduced to deal with contextual conditions concerning e.g. soft or rigid anatomical environments.
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Many AI applications in health care have demonstrated performance that matches or even surpasses that of human physicians in medical diagnosis, execution of treatment and surgery.
“Many AI applications in health care have demonstrated performance that matches or even surpasses that of human physicians in medical diagnosis, execution of treatment and surgery.1–3”
From Patient perspectives on informed consent for medical AI: A web-based experiment (2024) · cites this paper as [1]
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Cites
Medical robotics—Regulatory, ethical, and legal considerations for increasing levels of autonomy
Yang, G., Cambias, J., Cleary, K., Daimler, E. A., Drake, J. M., Dupont, P. E., Hata, N., Kazanzides, P., Martel, S. M., Patel, R. V., et al. (2017) · Science Robotics · doi:10.1126/scirobotics.aam8638 · Cited by 754 · see citing works
Supervised autonomous robotic soft tissue surgery
Shademan, A., Decker, R., Opfermann, J. D., Léonard, S., Krieger, A., & Kim, P. C. W. (2016) · Science Translational Medicine · doi:10.1126/scitranslmed.aad9398 · Cited by 626 · see citing works
Meaningful Human Control over Autonomous Systems: A Philosophical Account
Santoni de Sio, F., & van den Hoven, J. (2018) · Frontiers in Robotics and AI · doi:10.3389/frobt.2018.00015 · Cited by 566 · see citing works
Primary and Revision Total Hip Replacement Using the Robodoc?? System
Bargar, W. L., Bauer, A., & rner, M. B. (1998) · Clinical Orthopaedics and Related Research · doi:10.1097/00003086-199809000-00011 · Cited by 426 · see citing works
If and Then: A Critique of Speculative NanoEthics
Nordmann, A. (2007) · NanoEthics · doi:10.1007/s11569-007-0007-6 · Cited by 354 · see citing works
Evolution of autonomous and semi‐autonomous robotic surgical systems: a review of the literature
Moustris, G. P., Hiridis, S., Deliparaschos, K. M., & Konstantinidis, M. K. (2011) · International Journal of Medical Robotics and Computer Assisted Surgery · doi:10.1002/rcs.408 · Cited by 323 · see citing works
Active Constraints/Virtual Fixtures: A Survey
Bowyer, S. A., Davies, B., & y Baena, F. R. (2013) · IEEE Transactions on Robotics · doi:10.1109/tro.2013.2283410 · Cited by 318 · see citing works
New steady-hand Eye Robot with micro-force sensing for vitreoretinal surgery
Uneri, A., Balicki, M. A., Handa, J., Gehlbach, P., Taylor, R. H., & Iordachita, I. (2010) · 2010 3rd IEEE RAS & EMBS International Conference on Biomedical Robotics and Biomechatronics · doi:10.1109/biorob.2010.5625991 · Cited by 291 · see citing works
Kassahun, Y., Yu, B., Tibebu, A. T., Stoyanov, D., Giannarou, S., Metzen, J. H., & Vander Poorten, E. (2016) · International Journal of Computer Assisted Radiology and Surgery · doi:10.1007/s11548-015-1305-z · Cited by 238 · see citing works
van den Berg, J., Miller, S., Duckworth, D., Hu, H., Wan, A., Fu, X., Goldberg, K., & Abbeel, P. (2010) · Proceedings - IEEE International Conference on Robotics and Automation/Proceedings · doi:10.1109/robot.2010.5509621 · Cited by 233 · see citing works
Human-Oriented Control for Haptic Teleoperation
Hirche, S., & BUSS, M. J. (2012) · Proceedings of the IEEE · doi:10.1109/jproc.2011.2175150 · Cited by 229 · see citing works
Murali, A., Sen, S., Kehoe, B., Garg, A., McFarland, S., Patil, S., Boyd, W. D., Lim, S., Abbeel, P., & Goldberg, K. (2015) · Proceedings - IEEE International Conference on Robotics and Automation/Proceedings · doi:10.1109/icra.2015.7139344 · Cited by 178 · see citing works
Mandibular reconstruction with vascularised bone flaps: a systematic review over 25 years
Brown, J. S., Lowe, D., Kanatas, A. N., et al. (2017) · British Journal of Oral and Maxillofacial Surgery · doi:10.1016/j.bjoms.2016.12.010 · Cited by 172 · see citing works
A teleoperated microsurgical robot and associated virtual environment for eye surgery
Hunter, I. W., Doukoglou, T. D., Lafontaine, S. R., Charette, P. G., Jones, L. A., Sagar, M. A., Mallinson, G. D., & Hunter, P. J. (1993) · Presence: Teleoperators and Virtual Environments · doi:10.1162/pres.1993.2.4.265 · Cited by 164 · see citing works
Sen, S., Garg, A., Gealy, D. V., McKinley, S., Jen, Y., & Goldberg, K. Y. (2016) · Proceedings - IEEE International Conference on Robotics and Automation/Proceedings · doi:10.1109/icra.2016.7487611 · Cited by 159 · see citing works
Use of the NeuroMate stereotactic robot in a frameless mode for functional neurosurgery
Varma, T. R. K., & Eldridge, P. R. (2006) · International Journal of Medical Robotics and Computer Assisted Surgery · doi:10.1002/rcs.88 · Cited by 155 · see citing works
Current Capabilities and Development Potential in Surgical Robotics
Hoeckelmann, M., Rudas, I. J., Fiorini, P., et al. (2015) · International Journal of Advanced Robotic Systems · doi:10.5772/60133 · Cited by 135 · see citing works
Nishihara, S., Sugano, N., Nishii, T., et al. (2006) · The Journal of Arthroplasty · doi:10.1016/j.arth.2006.01.001 · Cited by 107 · see citing works
Motion generation of robotic surgical tasks: Learning from expert demonstrations
Reiley, C. E., Plaku, E., & Hager, G. D. (2010) · Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society · doi:10.1109/iembs.2010.5627594 · Cited by 98 · see citing works
Merging machines with microsurgery: clinical experience with neuroArm
Sutherland, G. R., Lama, S., Gan, L. S., et al. (2012) · Journal of neurosurgery · doi:10.3171/2012.11.jns12877 · Cited by 88 · see citing works
The CyberKnife in Clinical Use: Current Roles, Future Expectations
Dieterich, S., & Gibbs, I. C. (2011) · Frontiers of radiation therapy and oncology · doi:10.1159/000322423 · Cited by 84 · see citing works
Needle path planning for autonomous robotic surgical suturing
Jackson, R. C., & Çavuşoğlu, M. C. (2013) · Proceedings - IEEE International Conference on Robotics and Automation/Proceedings · doi:10.1109/icra.2013.6630794 · Cited by 80 · see citing works
Classification of orbital exenteration and reconstruction
Kesting, M. R., Koerdt, S., Rommel, N., et al. (2017) · Journal of Cranio-Maxillofacial Surgery · doi:10.1016/j.jcms.2017.01.003 · Cited by 75 · see citing works
A single arm, single camera system for automated suturing
Iyer, S., Looi, T., & Drake, J. M. (2013) · Proceedings - IEEE International Conference on Robotics and Automation/Proceedings · doi:10.1109/icra.2013.6630582 · Cited by 56 · see citing works
Local Full-Thickness Excision as First Line Treatment for Sessile Rectal Adenomas
Rodríguez, J. M. ́., Aguilella, V., Gracia, J. A., et al. (2009) · Annals of Surgery · doi:10.1097/sla.0b013e318190496f · Cited by 52 · see citing works
Long-term outcome following upper extremity replantation after major traumatic amputation
Mattiassich, G., Rittenschober, F., Dorninger, L., et al. (2017) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-017-1442-3 · Cited by 51 · see citing works
End-to-End versus End-to-Side Microvascular Anastomosis: A Meta-analysis of Free Flap Outcomes
Ahmadi, I., Herle, P., Hunter‐Smith, D. J., et al. (2017) · Journal of Reconstructive Microsurgery · doi:10.1055/s-0037-1599099 · Cited by 49 · see citing works
Poumellec, M.-A., Foissac, R., Cegarra-Escolano, M., Barranger, E., & Ihrai, T. (2017) · Breast Cancer Research and Treatment · doi:10.1007/s10549-017-4110-2 · Cited by 46 · see citing works
Virtual fixture assistance for needle passing and knot tying
Chen, Z., Malpani, A., Chalasani, P., et al. (2016) · IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS) · doi:10.1109/iros.2016.7759365 · Cited by 37 · see citing works
Gijbels, A., Poorten, E. V., Stalmans, P., et al. (2015) · Proceedings - IEEE International Conference on Robotics and Automation/Proceedings · doi:10.1109/icra.2015.7139500 · Cited by 36 · see citing works
The Ethical and Legal Case Against Autonomy in Weapons Systems
Amoroso, D., & Tamburrini, G. (2017) · Global Jurist · doi:10.1515/gj-2017-0012 · Cited by 35 · see citing works
Self-citationOn banning autonomous weapons systems: from deontological to wide consequentialist reasons
Tamburrini, G. (1920) · Cambridge University Press eBooks · doi:10.1017/cbo9781316597873.006 · Cited by 33 · see citing works
Self-citationCurrent and emerging robotic assisted intervention for Notes
Zuo, S., & Wang, S. (2016) · Expert Review of Medical Devices · doi:10.1080/17434440.2016.1254037 · Cited by 30 · see citing works
Plastic Surgery Challenges in War Wounded I: Flap-Based Extremity Reconstruction
Sabino, J. M., Slater, J. C., & Valerio, I. L. (2016) · Advances in Wound Care · doi:10.1089/wound.2015.0656 · Cited by 27 · see citing works
Nakamura, J., Hagiwara, S., Orita, S., et al. (2017) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-017-1427-2 · Cited by 27 · see citing works
HIRL: Hierarchical Inverse Reinforcement Learning for Long-Horizon Tasks with Delayed RewardsPreprint
Krishnan, S., Garg, A., Liaw, R., Miller, L., Pokorny, F. T., & Goldberg, K. Y. (2016) · arXiv (Cornell University) · doi:10.48550/arxiv.1604.06508 · Cited by 27 · see citing works
Transanal Endoscopic Microsurgery for Rectal Neoplasms. How I Do It
Allaix, M. E., Arezzo, A., Arolfo, S., et al. (2012) · Journal of Gastrointestinal Surgery · doi:10.1007/s11605-012-2060-x · Cited by 26 · see citing works
Self-citationDynamic Guidance with Pseudoadmittance Virtual Fixtures
Pezzementi, Z. A., Okamura, A. M., & Hager, G. D. (2007) · Proceedings - IEEE International Conference on Robotics and Automation/Proceedings · doi:10.1109/robot.2007.363577 · Cited by 26 · see citing works
Safavi‐Abbasi, S., Kalani, M. Y. S., Frock, B., et al. (2017) · Journal of neurosurgery · doi:10.3171/2016.9.jns161165 · Cited by 25 · see citing works
Lee, C., Lee, C., Lu, J. C., et al. (2016) · Clinical Transplantation · doi:10.1111/ctr.12879 · Cited by 24 · see citing works
Ueda, H., Suzuki, R., Nakazawa, A., et al. (2017) · Procedia CIRP · doi:10.1016/j.procir.2017.04.027 · Cited by 21 · see citing works
Transoral Microsurgery for Treatment of Laryngeal and Pharyngeal Cancers
Suarez, C. M., & Rodrigo, J. P. (2012) · Current Oncology Reports · doi:10.1007/s11912-012-0286-0 · Cited by 20 · see citing works
Robotic transanal surgery for local excision of rectal neoplasms
Atallah, S. B., Quinteros, F., Martín-Pérez, B., et al. (2014) · Journal of Robotic Surgery · doi:10.1007/s11701-014-0463-2 · Cited by 18 · see citing works
Macmanus, J. E., Dameron, J. T., & Paine, J. R. (1950) · PubMed · Cited by 14 · see citing works
Transoral Endoscopic Head and Neck Surgery
Lim, G. C., Holsinger, F. C., & Li, R. J. (2015) · Hematology/Oncology Clinics of North America · doi:10.1016/j.hoc.2015.08.001 · Cited by 12 · see citing works
Qassemyar, Q., Aguilar, P., Temam, S., et al. (2016) · Annales de Chirurgie Plastique Esthétique · doi:10.1016/j.anplas.2016.11.003 · Cited by 12 · see citing works
Ethical Issues in the Introduction of New Technologies: From Mis to POEM
Ferreres, A. R., & Patti, M. G. (2015) · World Journal of Surgery · doi:10.1007/s00268-015-3067-8 · Cited by 7 · see citing works
Leclère, F. M., & CASOLI, V. M. (2016) · Hand surgery & rehabilitation · doi:10.1016/j.hansur.2015.12.010 · Cited by 6 · see citing works
Microinvasive glaucoma surgery: a new era in therapy
Minckler, D. S. (2016) · Clinical and Experimental Ophthalmology · doi:10.1111/ceo.12815 · Cited by 4 · see citing works
Strategien bei Komplexverletzungen an der Hand
Vester, H., & Deiler, S. (2017) · Der Unfallchirurg · doi:10.1007/s00113-017-0327-0 · Cited by 3 · see citing works
Flagged first, then by citations
Research works printed but not linked: 15
- N. Bhuta, S. Beck, R. Geiß, H.-Y. Liu, C. Kreß, Autonomous Weapons Systems, Law, Ethics, Policy, Cambridge University Press, 2016
- M. Maurer, J. C. Gerdes, B. Lenz, H. Winner, Autonomes Fahren: Technische, rechtliche und gesellschaftliche Aspekte, Springer Verlag, Berlin Heidelberg, Germany, 2015
- M. Yip, N. Das, Robot autonomy for surgery, CoRR, 2017, http: //arxiv.org/abs/1707.03080
- E. Vander Poorten, L. Esteveny, A. Gijbels, B. Rosa, L. Schoe- vaerdts, K. Willekens, et al., Use case for european robotics in ophthalmologic micro-surgery, In: Proceedings of the 5th Joint Workshop on New Technologies for Computer/Robot Assisted Surgery, Brussels, Belgium, 10-12 September 2015, 78-80
- D. Aarno, S. Ekvall, D. Kragic, Adaptive virtual fixtures for machine-assisted teleoperation tasks, In: Proceedings of the 2005 IEEE International Conference on Robotics and Automa- tion, April 2005, 1139-1144
- M. Jakopec, S. J. Harris, F. Rodriguez y Baena, P. Gomes, B. L. Davies, Acrobot: a "hands-on" robot for total knee replacement surgery, In: Proceedings of the 7th International Workshop on Advanced Motion Control, 2002, 116-120
- B. Hagag, R. Abovitz, H. Kang, B. Schmitz, M. Conditt. Surgical Robotics, chapter RIO: Robotic-Arm Interactive Orthopedic Sys- tem MAKOplasty: User Interactive Haptic Orthopedic Robotics, Springer, Boston, MA, 2011
- N. A. Netravali, M. Börner, W. L. Bargar, Computer-Assisted Mus- culoskeletal Surgery, chapter The Use of ROBODOC in Total Hip and Knee Arthroplasty, Springer, Cham, 2016
- A. Ebrahimi, M. H. Kalantar Motamedi, A. Ebrahimi, M. Kazemi, A. Shams, H. Hashemzadeh, Lip reconstruction after tumor ab- lation, World Journal of Plastic Surgery, 2016, 5(1),15-25
- Q. Qassemyar, P. Aguilar, S. Temam, F. Kolb, P. Gorphe, The thin ALT perforator flap for oropharyngeal robotic-assisted re- construction, Annales de Chirurgie Plastique Esthétique, 2017, 62(1), 1-7
- H. Vester, S. Deiler, Strategies for complex injuries of the hand, Der Unfallchirurg, 2017, 120(3), 237-251
- A. Gudeloglu, J. V. Brahmbhatt, S. J. Parekattil, Robotic-assisted microsurgery for an elective microsurgical practice, Seminars in Plastic Surgery, 2014, 28(1), 11-19
- G. Tamburrini, E. Datteri. Ethical reflections on health care robotics, In: R. Capurro, M. Nagenborg (Eds.), Ethics and Robotics, IOS Press, 2009, 35-48
- N. Sharkey, Staying in the loop: human supervisory control of weapons, In: N. Bhuta, S. Beck, R. Geiß, H.-Y. Liu, C. Kreß (Eds.), Autonomous Weapons Systems: Law, Ethics, Policy, Cambridge University Press, 2016, 23-38
- A. Mavroforou, E. Michalodimitrakis, C. Hatzitheofilou, A. Gi- annoukas, Legal and ethical issues in robotic surgery, Interna- tional Angiology, 2010, 29(1), 75-79
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Patient perspectives on informed consent for medical AI: A web-based experiment
Park, H. J. (2024) · DIGITAL HEALTH · doi:10.1177/20552076241247938 · Cited by 95 · see citing works
Designing Human-Agent Collaborations: Commitment, responsiveness, and support
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- Authors
- Ficuciello, F., Tamburrini, G., Arezzo, A., Villani, L., & Siciliano, B.
- Affiliations
- University of Naples Federico II (IT)
- University of Turin (IT)
- Corresponding author
- Ficuciello, Fanny
- Venue
- Paladyn, Journal of Behavioral Robotics
- Publisher
- Walter de Gruyter GmbH
- Published
- 2019-01-01
- Volume
- 10
- Issue
- 1
- Pages
- 30-43
- ISSN
- 2080-9778 (ISSN-L)
- 2081-4836
- OpenAlex
- W2904492562
- Cited by
- 92
- References
- 51
- Citations by year
- 2026: 4 · 2025: 11 · 2024: 20 · 2023: 11 · 2022: 10 · 2021: 13 · 2020: 17 · 2019: 5
- FWCI
- 17.40
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Paladyn Journal of Behavioral Robotics (publishedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
- INFM-OAR (INFN Catania) (submittedVersion, cc-by)
- Zenodo (CERN European Organization for Nuclear Research) (cc-by)
- Funders
- FP7 Ideas: European Research Council (320992)
- Topics
- Social Sciences › Safety Research › Ethics and Social Impacts of AI
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Social Sciences › Psychology › Social Psychology › Social Robot Interaction and HRI
- Keywords
- surgical robots, robot autonomy, meaningful human control, minimally invasive surgery, microsurgery, accountability and responsibility
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