A Delphi consensus statement for digital surgery

Research output: Contribution to journalResearch articleContributed


  • Kyle Lam - (Author)
  • Michael D. Abràmoff - (Author)
  • José M. Balibrea - (Author)
  • Steven M. Bishop - (Author)
  • Richard R. Brady - (Author)
  • Rachael A. Callcut - (Author)
  • Manish Chand - (Author)
  • Justin W. Collins - (Author)
  • Markus K. Diener - (Author)
  • Matthias Eisenmann - (Author)
  • Kelly Fermont - (Author)
  • Manoel P. Galvao Neto - (Author)
  • Gregory D. Hager - (Author)
  • Robert J. Hinchliffe - (Author)
  • Alan Horgan - (Author)
  • Pierre Jannin - (Author)
  • Alexander J. Langerman - (Author)
  • Kartik Logishetty - (Author)
  • Amit Mahadik - (Author)
  • Lena Maier-Hein - (Author)
  • Esteban Martín Antona - (Author)
  • Pietro Mascagni - (Author)
  • Ryan K. Mathew - (Author)
  • Beat P. Müller-Stich - (Author)
  • Thomas Neumuth - (Author)
  • Felix Nickel - (Author)
  • Adrian Park - (Author)
  • Gianluca Pellino - (Author)
  • Frank Rudzicz - (Author)
  • Sam Shah - (Author)
  • Mark Slack - (Author)
  • Myles J. Smith - (Author)
  • Naeem Soomro - (Author)
  • Stefanie Speidel - , Department of Radiation Oncology, Clusters of Excellence CeTI: Centre for Tactile Internet (Author)
  • Danail Stoyanov - (Author)
  • Henry S. Tilney - (Author)
  • Martin Wagner - (Author)
  • Ara W. Darzi - (Author)
  • James M. Kinross - (Author)
  • Sanjay Purkayastha - (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


Library keywords