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

Background: Robotic surgery is one of the newest techniques applied in surgery hoping to minimize pain and time spent in recovery. It can perform complicated surgical techniques through small incisions, leaving very few scars. Multiple robotic surgical systems are currently in use, but the most popular is the da Vinci® Surgical System. The growing implementation of robotic 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  obotic manufacturer, the surgical team, and the hospitals are considered the stakeholders who are at risk of medico-legal compliance in performing robotic surgeries. If robotic surgery is progressively applied, surgeons must ensure that patients get fair and reasonable treatment respecting their human rights and dignity. Aim of the Work: This study is aimed at evaluating the ethical and medico-legal commitment of the medical staff in robotic surgery in Ain Shams University (ASU) Hospitals. Participants and Methods: A Self- administered structured questionnaire was created and filled by the general surgeons, urology surgeons, obstetricians, and gynecologists working in Ain Shams University (ASU) Hospitals, during the period from June 2022 to December 2022. Results: 78% of participants had satisfying knowledge with a total score ranging from 3 to 5 with a Median (IQR) of 4 (4-5): 80% of participants had excellent practice and attitude while 20% had good practice and attitude regarding 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 significant relation between the knowledge, practice, and attitude of the surgeons operating robotic systems
with their demographic data except for their working experience. However, a positive correlation was found between the practice and attitude total score and the awareness of medico-legality total score. There was a highly significant relation between the awareness of medico-legality total score and the surgeon’s involvement in the robotic operation. The medical error total score ranged from 0 to 4 with a Median (IQR) of 1 (1 – 2). Conclusion: Most surgeons working at
ASU hospitals have satisfying knowledge, accepted practice, and attitude, good awareness of medico-legal issues, and medical errors regarding the ethics of robotic surgery, and would prefer robotic surgery over conventional surgery in the future.