Who is responsible for robotics and AI failures in surgery?

In Brazil, more procedures are being done using a robotic platform. Accordingly, the robotic platform is reducing bleeding and in-hospital days. The question is? Does medical responsibility changes with the use of technology? Some say it does not.

In 2024, more than 2000 injuries, 17000 platform failures, and 294 deaths were associated with robotic surgeries. Who is responsible? The doctor? The company? The patient? All of them? No one?

As Daniela Barros writes in Medscape in 2025, not all complications are due to medical error or problems with the equipment. We know that all procedures can have complications for which no one is responsible. I would also add that some complications are due to the patient’s comorbidities (e.g., obesity increases the surgical infection rate), which puts the responsibility on the patient. In this setting, the risk of an adverse effect associated with the technology is also present, and the patient must be well-informed of its possibility. Why? Because the lack of informed consent will be what sets the need for patient compensation.

Informed consent is paramount for medical protection. All patients must be informed of all possible side effects (including death) of a procedure, because when a patient accepts being submitted to a surgical procedure, he is accepting its complications. Additionally, data on the robot maintenance should always be registered in medical records.

Interesting from Daniela Barros’ article is the idea that system failure, such as a software error or defect in a robot part, places the responsibility on the company, not on the surgeon. I ask: How can that failure be proved in court? The company will always say that the doctor should have identified the failure and acted accordingly, eventually changing from robotic-assisted surgery to laparoscopic or even open surgery. I think no company will accept guilt without saying the medical team was responsible. Why? As soon as a company acknowledges that a part of its robot was malfunctioning and contributed to a severe complication, the company’s reputation and income will suffer, as many doctors will eventually stop using that platform. Remember… for companies, money always speaks louder.

Only certified doctors can use the robotic platform. They must learn how the robot works, operate on simulators, and perform surgeries with a proctor. Like airplane pilots, surgeons must have “flight hours”. In the proctor setting, is the proctor responsible for an error? Only if he was actively interfering in the surgery. But this is a grey area on which lawyers have different understandings.

Artificial intelligence (AI) is another area where legislation must act fast. AI will eventually help doctors in the decision-making process, but who will be responsible if AI fails? This will not be easy to decide. I believe AI will be responsible for several legal issues in the future. Some say that legislation should work to avoid automated decisions without supervision. Again, responsibility will fall on the doctor. Imagine the following scenarios:

• Scenario 1: The doctor accepts the AI decision, but the AI was wrong. Result: The patient suffers a complication.

• Scenario 2: The doctor declines the AI decision, but the AI was correct. Result: The patient suffers a complication.

Should doctors accept this responsibility blindly? Companies always say that the final call is the doctors’. Why? Companies want to have no responsibility for their product failures. Although AI can be of good help, it can also be a source of confusion. This should not be a doctor's responsibility.

In my opinion, most of the time, no one should be held accountable. In medicine, many decisions are not black or white; many factors are involved in the decision-making process (including the patient's own factors), and mistakes/misunderstandings can happen. Society needs to stop trying to find a human responsible for everything bad that happens to it.

In conclusion, legal issues are yet to be addressed. Technology is moving faster than legislation. As always, we are not preventing the problems. We are waiting for them to happen, and then we will try to find a “bad” solution and put the guilt on the medical team. Robot-assisted surgery and AI are moving medicine towards another level, but “the future of medicine cannot do without the human". The human touch is not negotiable and must be protected, or medicine will fail.

Link to article (only in Portuguese):

https://portugues.medscape.com/verartigo/6513121#vp_3

Dr. Carlos Eduardo Costa Almeida

General Surgeon

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