Lam Kyle, Abràmoff Michael D, Balibrea José M, Bishop Steven M, Brady Richard R, Callcut Rachael A, Chand Manish, Collins Justin W, Diener Markus K, Eisenmann Matthias, Fermont Kelly, Neto Manoel Galvao, Hager Gregory D, Hinchliffe Robert J, Horgan Alan, Jannin Pierre, Langerman Alexander, Logishetty Kartik, Mahadik Amit, Maier-Hein Lena, Antona Esteban Martín, Mascagni Pietro, Mathew Ryan K, Müller-Stich Beat P, Neumuth Thomas, Nickel Felix, Park Adrian, Pellino Gianluca, Rudzicz Frank, Shah Sam, Slack Mark, Smith Myles J, Soomro Naeem, Speidel Stefanie, Stoyanov Danail, Tilney Henry S, Wagner Martin, Darzi Ara, Kinross James M, Purkayastha Sanjay
Department of Surgery and Cancer, Imperial College, London, UK.
Institute of Global Health Innovation, Imperial College London, London, UK.
NPJ Digit Med. 2022 Jul 19;5(1):100. doi: 10.1038/s41746-022-00641-6.
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.
数字技术在各个外科专业中的应用正在迅速增加，但对于“数字外科”这一术语尚无共识。这一点至关重要，因为数字健康技术带来了外科医生和外科患者所特有的技术、管理和法律挑战。我们旨在定义数字外科这一术语及其临床应用所涉及的伦理问题，并确定未来实践的障碍和研究目标。来自外科、人工智能、行业、法律、伦理和政策等领域的38位国际专家参与了四轮德尔菲法调查。问题由一个专家小组和公众小组通过一份围绕从文献中确定的关键主题的范围界定问卷提出，并在随后的两轮问卷中进行投票。如果超过70%的专家小组认为该陈述重要且不到30%的专家认为不重要，则达成共识。最后举行了一次在线会议来讨论共识声明。将数字外科定义为利用技术来加强术前规划、手术操作、治疗支持或培训，以改善结果并减少伤害，这一定义获得了100%的共识。我们强调了数字外科中有关数据、隐私、保密和公众信任、同意、法律、诉讼和责任以及商业伙伴关系的关键伦理问题，并确定了未来实践的障碍和研究目标。数字外科的开发者和使用者不仅必须了解医疗保健中数字应用所涉及的伦理问题，还必须了解数字外科所特有的伦理考量。对这些问题的未来研究必须让包括患者在内的所有数字外科利益相关者参与进来。
