A Delphi consensus statement for digital surgery

Research output: Contribution to journalResearch articleContributedpeer-review


  • Kyle Lam - , Imperial College London (Author)
  • Michael D. Abràmoff - , University of Iowa (Author)
  • José M. Balibrea - , Hospital Clinic of Barcelona, University of Barcelona (Author)
  • Steven M. Bishop - , CMR Surgical (Author)
  • Richard R. Brady - , Newcastle University, Newcastle upon Tyne Hospitals NHS Foundation Trust (Author)
  • Rachael A. Callcut - , University of California at Davis (Author)
  • Manish Chand - , University College London (Author)
  • Justin W. Collins - , CMR Surgical, University College London (Author)
  • Markus K. Diener - , University of Freiburg (Author)
  • Matthias Eisenmann - , German Cancer Research Center (DKFZ) (Author)
  • Kelly Fermont - (Author)
  • Manoel Galvao Neto - , Instituto EndoVitta, Fundação Universitaria do ABC, Faculdade de Medicina do ABC (Author)
  • Gregory D. Hager - , Johns Hopkins University (Author)
  • Robert J. Hinchliffe - , University of Bristol (Author)
  • Alan Horgan - , Newcastle upon Tyne Hospitals NHS Foundation Trust (Author)
  • Pierre Jannin - , Université de Rennes 1 (Author)
  • Alexander Langerman - , Vanderbilt University, University of Toronto (Author)
  • Kartik Logishetty - , Imperial College London (Author)
  • Amit Mahadik - , Stryker Corporation (Author)
  • Lena Maier-Hein - , German Cancer Research Center (DKFZ), Heidelberg University , University of Toronto (Author)
  • Esteban Martín Antona - , Hospital Clinico Universitario San Carlos (Author)
  • Pietro Mascagni - , Catholic University of the Sacred Heart, Institute of Image-Guided Surgery, University of Strasbourg (Author)
  • Ryan K. Mathew - , University of Leeds, Leeds Teaching Hospitals NHS Trust (Author)
  • Beat P. Müller-Stich - , Heidelberg University , German Cancer Research Center (DKFZ) (Author)
  • Thomas Neumuth - , Leipzig University (Author)
  • Felix Nickel - , Heidelberg University  (Author)
  • Adrian Park - , Johns Hopkins University (Author)
  • Gianluca Pellino - , University of Campania Luigi Vanvitelli, Autonomous University of Barcelona (Author)
  • Frank Rudzicz - , University of Toronto, Vector Institute, Unity Health Toronto, Surgical Safety Technologies Inc (Author)
  • Sam Shah - , Ulster University (Author)
  • Mark Slack - , CMR Surgical, Cambridge University Hospitals NHS Foundation Trust, University of Cambridge (Author)
  • Myles J. Smith - , Royal Marsden NHS Foundation Trust, Institute of Cancer Research (Author)
  • Naeem Soomro - , Newcastle upon Tyne Hospitals NHS Foundation Trust (Author)
  • Stefanie Speidel - , National Center for Tumor Diseases (Partners: UKD, MFD, HZDR, DKFZ), Clusters of Excellence CeTI: Centre for Tactile Internet (Author)
  • Danail Stoyanov - , University College London (Author)
  • Henry S. Tilney - , Imperial College London, Frimley Health NHS Foundation Trust (Author)
  • Martin Wagner - , University Hospital Heidelberg, National Center for Tumor Diseases (NCT) Heidelberg (Author)
  • Ara Darzi - , Imperial College London (Author)
  • James M. Kinross - , Imperial College London (Author)
  • Sanjay Purkayastha - , Imperial College London (Author)


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.


Original languageEnglish
Article number100
Number of pages9
Journal npj digital medicine
Issue number1
Publication statusPublished - 19 Jul 2022

External IDs

Scopus 85134423864
PubMed 35854145
Mendeley cce82473-8066-3873-bf4e-549eb004e5ab
unpaywall 10.1038/s41746-022-00641-6
ORCID /0000-0002-4590-1908/work/163293945


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