{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T17:03:08Z","timestamp":1789578188762,"version":"build-2803163510"},"reference-count":14,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"National University Ireland, Galway"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Surg Endosc"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Artificial intelligence is entering surgical practice not as an extension of the surgeon's hand, eyes, or dexterity, but of surgical judgment itself. This creates a growing informational asymmetry between well-resourced and under-resourced operative environments, with implications for training, competence, accountability, and equity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This commentary, derived from the Karl Storz Lecture delivered at the SAGES 2026 Annual Meeting, proposes the Digital Scalpel: a five-layer conceptual architecture (data infrastructure, connected systems, computational vision, cognitive augmentation, and human judgment) for understanding AI-enabled surgical practice. The current evidence base for each layer is appraised, with particular reference to AI assessment of the Critical View of Safety in laparoscopic cholecystectomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Computational vision is the most mature layer, with deep-learning systems demonstrating high concordance with expert assessment of the Critical View of Safety, though validation remains largely confined to elective, uninflamed, single-centre cases. Three risks are identified: automation complacency, an unresolved accountability gap, and a digital inverse care law under which AI-augmented capability tracks existing resource inequities. The most evidence-supported entry point for most institutions is routine operative video capture and structured review, not real-time guidance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The surgeon of 2035 will require four attributes: preserved technical excellence, data literacy as a core competency, ethical fluency, and institutionalised clinician-engineer collaboration. The Digital Scalpel demands active, critical, and equitable engagement rather than passive technological adoption.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00464-026-13131-7","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T16:33:49Z","timestamp":1785774829000},"page":"7267-7271","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The digital scalpel: navigating the future of surgical innovation"],"prefix":"10.1007","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8501-2382","authenticated-orcid":false,"given":"Derek T.","family":"O\u2019Keeffe","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"issue":"1","key":"13131_CR1","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1097\/SLA.0000000000002693","volume":"268","author":"DA Hashimoto","year":"2018","unstructured":"Hashimoto DA, Rosman G, Rus D, Meireles OR (2018) Artificial intelligence in surgery: promises and perils. 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O\u2019Keeffe has nothing to disclose.","order":1,"name":"Ethics","label":"Disclosures","group":{"name":"EthicsHeading","label":"Declarations"}}]}}