Persisting and emerging ethical issues in robot-assisted surgery

Robot-assisted surgery (RAS) has rapidly evolved from experimental technology in the 1970s to a widely adopted surgical practice, with systems like Intuitive Surgical’s Da Vinci now performing millions of procedures worldwide. Despite its prevalence, ethical reflection on RAS has received comparatively little attention in medical ethics. This fact sheet outlines six key domains of persisting and emerging ethical issues given the increasing automation of robot-assisted surgery: (1) balancing benefits and harms; (2) responsibility and control, especially regarding accountability across surgeons, manufacturers, and robotic systems; (3) surgical training and learning, where competency and patient safety hinge on specialized skills and adequate certification; (4) the dual role of surgeons as innovators and caregivers; (5) financial incentives and economic pressures influencing medical decision-making; and (6) relational aspects, including shifts in surgeon-patient relation, teamwork, and dependency on robotic technologies. Looking ahead, the trend toward increasing robotic autonomy intensifies questions of responsibility, human–machine interaction, professional competence, and ethical oversight. Future ethical research must move beyond viewing surgical robots as mere instruments and instead address the implications of more autonomous systems for clinical practice, professional integrity, and patient well-being.