Surgeon Attitudes Toward AI-Enhanced Robotic Surgery: A Survey on Autonomy, Liability, and Skill Erosion

Abstract

The integration of artificial intelligence (AI) into robotic surgery presents transformative potential but raises critical concerns about autonomy, liability, and skill erosion. This qualitative study explored Iranian surgeons' attitudes toward AI-enhanced robotic surgery through semi-structured interviews with 25 board-certified surgeons across diverse specialties. Thematic analysis revealed four major themes: (1) Perceptions of AI Autonomy, where surgeons supported assistive and shared-control systems but expressed skepticism toward unsupervised autonomy, particularly in Iran’s resource-constrained healthcare context; (2) Legal Liability and Accountability, with participants highlighting uncertainty about liability for AI-driven errors and calling for Iran-specific regulatory frameworks; (3) Skill Erosion, as surgeons, especially younger ones, feared over-reliance on AI could diminish manual dexterity and clinical judgment; and (4) Strategies for Skill Maintenance, emphasizing hybrid training models and simulation-based learning. Cultural and systemic factors, such as patient trust in surgeons and infrastructural limitations, further shaped attitudes. Compared to international studies, Iranian surgeons demonstrated greater concern about affordability, accessibility, and the lack of legal clarity. The findings underscore the need for context-sensitive integration of AI in surgery, balancing technological advancement with ethical, legal, and practical considerations.