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微创手术:技术变革的历史与法律视角

Minimally invasive surgery: a historical and legal perspective on technological transformation.

作者信息

Jeganathan J Ravichandran, Jegasothy Ravindran, Sia Woon Teen

机构信息

Monash Medical University, Petaling Jaya, Malaysia.

Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia.

出版信息

J Robot Surg. 2025 Jul 21;19(1):408. doi: 10.1007/s11701-025-02589-7.

Abstract

Minimally Invasive Surgery (MIS) has experienced a significant evolution over the last 5,000 years, progressing from basic manual methods to sophisticated, robot-assisted approaches. The evolution of minimally invasive surgery (MIS) has been influenced by significant advancements in endoscopic visualization, electrosurgery, and laparoscopic tools, while recent innovations in artificial intelligence (AI) and robotic systems have further augmented surgical accuracy, minimized operative trauma, and enhanced patient outcomes. Notwithstanding its therapeutic advantages, minimally invasive surgery presents considerable medicolegal complications. The escalating intricacy of surgical technologies and procedures has resulted in an increased possibility of malpractice claims, presenting significant financial and professional hazards to healthcare providers. This requires the establishment of effective risk mitigation techniques, encompassing thorough surgical training, credentialing procedures, and compliance with established clinical standards. This review is divided into three sections: (1) the historical development and technological milestones of MIS; (2) the present landscape and future trajectories, emphasizing AI and robotic integration; and (3) the ethical and legal implications associated with MIS advancements, encompassing informed consent, surgeon liability, and patient safety concerns. The document underscores the pressing necessity for the advancement of legal and ethical frameworks to align with technological progress. Balancing innovation with ethical and legal safeguards is essential to ensure both progress and protection in modern surgical practice.

摘要

在过去的5000年里,微创手术(MIS)经历了重大变革,从基本的手工方法发展到复杂的机器人辅助方法。微创手术(MIS)的发展受到内窥镜可视化、电外科和腹腔镜工具等重大进步的影响,而人工智能(AI)和机器人系统的最新创新进一步提高了手术准确性,将手术创伤降至最低,并改善了患者预后。尽管微创手术具有治疗优势,但它也带来了相当多的法医学并发症。手术技术和程序的日益复杂导致医疗事故索赔的可能性增加,给医疗服务提供者带来了重大的财务和职业风险。这就需要建立有效的风险缓解技术,包括全面的手术培训、认证程序以及遵守既定的临床标准。本综述分为三个部分:(1)微创手术的历史发展和技术里程碑;(2)当前形势和未来发展轨迹,重点是人工智能和机器人集成;(3)与微创手术进步相关的伦理和法律问题,包括知情同意、外科医生责任和患者安全问题。该文件强调了推进法律和伦理框架以跟上技术进步的迫切必要性。在创新与伦理和法律保障之间取得平衡对于确保现代外科实践中的进步和保护至关重要。

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