Anticipating the future robotic surgeon: rethinking surgical expertise and education in an era of automation

Increasing automation and artificial intelligence (AI) integration in robot-assisted surgery may reshape surgical expertise, professional responsibility, and education. This study explored how surgical expertise might evolve over the next ten years and identified educational priorities robust across multiple plausible futures. A qualitative Technology Foresight approach combined (1) 24 semi-structured interviews with surgeons and experts in robotics, AI, augmented reality, law, and medical technology; (2) observations of 18 surgical procedures (approximately 85 h); and (3) a six-participant expert workshop. Thematic analysis identified drivers, barriers, anticipated changes in surgical work, and critical uncertainties. These findings informed a scenario framework appraised and refined during the workshop. Technological autonomy and societal acceptance emerged as the two critical uncertainties, producing four scenarios: Augmented Surgery, Autonomous Surgery, Selective Adoption, and Capability Without Trust. In most scenarios, participants anticipated a shift in surgeons’ roles from direct operators towards supervisors and coordinators of complex sociotechnical systems, while expecting responsibility for patient care to remain human. Four proposed educational priorities remained relevant across futures: maintaining low-frequency, safety–critical operative competencies; learning when to trust, challenge, or override intelligent systems; managing technological dependencies and multidisciplinary interactions; and developing adaptive expertise to evaluate and integrate emerging technologies throughout surgical careers. Automation may redefine rather than simply expand surgical expertise by separating direct action from professional responsibility. Surgical education should therefore extend beyond technical robotic proficiency to cultivate judgement, oversight, systems thinking, and adaptability. Professional societies, regulators, educators, and technology developers must align curricula, governance, and standards with these changing responsibilities.