Human-Robot collaboration in surgery: Advances and challenges towards autonomous surgical assistants

2025-07-15

AI Summary

This study addresses critical bottlenecks in reliability, safety, and efficacy of Autonomous Surgical Assistant Robots (ASARs) during complex intraoperative collaboration with surgeons, focusing on four core challenges: behavioral preference alignment, surgical workflow perception, seamless human–robot information exchange, and skill transfer within shared workspaces. Following the PRISMA guidelines, we systematically reviewed 32 studies from IEEE Xplore, Scopus, and Web of Science, covering both teleoperated and direct-interaction collaborative paradigms. Results indicate that current advances are largely confined to endoscope-guided scenarios, with nascent tool-level autonomy emerging. Crucially, we propose a novel three-layer technical framework—“Cognition–Alignment–Collaboration”—and identify three key future research directions: explainable decision-making, dynamic intent recognition, and adaptive shared control. This framework provides both theoretical grounding and empirical support for the evolution of ASARs from passive assistance toward proactive, intelligent human–robot collaboration.

Technology Category

• Intelligent Robots: Multi-Robot Systems
• Multiagent Systems: Coordination and Collaboration
• Humans and AI: Planning and Decision Support for Human-Machine Teams

Application Category

• Responsible Web: Machine-in-the-loop, human agency and autonomy
• Search and Retrieval-Augmented AI: Assisted, interactive, and conversational search
• Systems and Infrastructure for Web, Mobile and WoT: Web applications in cross-disciplinary domains and verticals such as mixed reality, smart cities, and digital health

Abstract

Human-robot collaboration in surgery represents a significant area of research, driven by the increasing capability of autonomous robotic systems to assist surgeons in complex procedures. This systematic review examines the advancements and persistent challenges in the development of autonomous surgical robotic assistants (ASARs), focusing specifically on scenarios where robots provide meaningful and active support to human surgeons. Adhering to the PRISMA guidelines, a comprehensive literature search was conducted across the IEEE Xplore, Scopus, and Web of Science databases, resulting in the selection of 32 studies for detailed analysis. Two primary collaborative setups were identified: teleoperation-based assistance and direct hands-on interaction. The findings reveal a growing research emphasis on ASARs, with predominant applications currently in endoscope guidance, alongside emerging progress in autonomous tool manipulation. Several key challenges hinder wider adoption, including the alignment of robotic actions with human surgeon preferences, the necessity for procedural awareness within autonomous systems, the establishment of seamless human-robot information exchange, and the complexities of skill acquisition in shared workspaces. This review synthesizes current trends, identifies critical limitations, and outlines future research directions essential to improve the reliability, safety, and effectiveness of human-robot collaboration in surgical environments.

Problem

• Advancing autonomous robotic systems for surgical assistance
• Addressing challenges in human-robot collaboration during surgery
• Improving reliability and safety of surgical robotic assistants

Innovation

• Teleoperation-based assistance for surgical robots
• Direct hands-on interaction in human-robot collaboration
• Autonomous tool manipulation in surgical procedures