Robotic Surgery on the Verge of Medical Ethics and Liability: Cross-Sectional Study in Ain Shams University Hospitals

Abstract

Background: Robotic surgery is one of the newest techniques applied in surgery hoping tominimize pain and time spent in recovery. It can perform complicated surgical techniquesthrough small incisions, leaving very few scars. Multiple robotic surgical systems are currentlyin use, but the most popular is the da Vinci® Surgical System. The growing implementation ofrobotic surgeries is mandating the understanding of their application's ethical and legal aspects. There are multiple ethical considerations including respect for autonomy, beneficence, non- maleficence, and justice. The robotic manufacturer, the surgical team, and the hospitals areconsidered the stakeholders who are at risk of medico-legal compliance in performing roboticsurgeries. If robotic surgery is progressively applied, surgeons must ensure that patients get fairand reasonable treatment respecting their human rights and dignity. Aim of the Work: Thisstudy is aimed at evaluating the ethical and medico-legal commitment of the medical staff inrobotic surgery in Ain Shams University (ASU) Hospitals. Participants and Methods: A Self- administered structured questionnaire was created and filled by the general surgeons, urologysurgeons, obstetricians, and gynecologists working in Ain Shams University (ASU) Hospitals, during the period from June 2022 to December 2022. Results: 78% of participants had satisfyingknowledge with a total score ranging from 3 to 5 with a Median (IQR) of 4 (4-5): 80% ofparticipants had excellent practice and attitude while 20% had good practice and attituderegarding the ethics of robotic surgery. 16% of participants had excellent awareness of medicolegality while 78% of the participants had a good awareness of it. There was no significantrelation between the knowledge, practice, and attitude of the surgeons operating robotic systemswith their demographic data except for their working experience. However, a positive correlationwas found between the practice and attitude total score and the awareness of medico-legalitytotal score. There was a highly significant relation between the awareness of medico-legalitytotal score and the surgeon’s involvement in the robotic operation. The medical error total scoreranged from 0 to 4 with a Median (IQR) of 1 (1 – 2). Conclusion: Most surgeons working atASU hospitals have satisfying knowledge, accepted practice, and attitude, good awareness ofmedico-legal issues, and medical errors regarding the ethics of robotic surgery, and would preferrobotic surgery over conventional surgery in the future.