Surgical teams in the AI–robotics age

The integration of artificial intelligence (AI) and robotics will have pivotal and disruptive implications for surgery, and surgical team roles and responsibilities—warranting multistakeholder discussion.

AI-based surgical co-pilots will leverage advances in vision-language models (VLMs), vision-language-action (VLA) models, and causal AI to comprehensively understand surgical workflows and environments, and will allow for causal inference, decision-making support, and autonomous surgical assistance via robotic systems.

Integrated robotic systems will undertake roles throughout all perioperative phases, including intraoperative surgical actions, emergency responses, and assistive and logistical functions—some with embodied AI-based autonomy implemented with human-in-the-loop oversight and control.

Team roles will be redefined: surgeons will continue as procedural leaders, responsible for supervision, coordination, and high-level decision-making; scrub nurses will supervise assistive robotic systems and oversee workflow integration; and circulating nurses will coordinate autonomous logistics robots.

Solutions are needed to ensure clarity of liability, minimization of bias in AI systems, seamless integration of autonomous robotic systems amid surgical teams’ roles, global equity, and robust product regulation in the context of rapid technological progress and the particular challenges posed by adaptive AI.