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Med."],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The use of digital technology is increasing rapidly across surgical specialities, yet there is no consensus for the term \u2018digital surgery\u2019. This is critical as digital health technologies present technical, governance, and legal challenges which are unique to the surgeon and surgical patient. We aim to define the term digital surgery and the ethical issues surrounding its clinical application, and to identify barriers and research goals for future practice. 38 international experts, across the fields of surgery, AI, industry, law, ethics and policy, participated in a four-round Delphi exercise. Issues were generated by an expert panel and public panel through a scoping questionnaire around key themes identified from the literature and voted upon in two subsequent questionnaire rounds. Consensus was defined if &gt;70% of the panel deemed the statement important and &lt;30% unimportant. A final online meeting was held to discuss consensus statements. The definition of digital surgery as the use of technology for the enhancement of preoperative planning, surgical performance, therapeutic support, or training, to improve outcomes and reduce harm achieved 100% consensus agreement. We highlight key ethical issues concerning data, privacy, confidentiality and public trust, consent, law, litigation and liability, and commercial partnerships within digital surgery and identify barriers and research goals for future practice. Developers and users of digital surgery must not only have an awareness of the ethical issues surrounding digital applications in healthcare, but also the ethical considerations unique to digital surgery. 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J.M.B. receives honoraria for lectures and educational events from Johnson & Johnson. R.A.C. receives NIH funding royalties from GE Healthcare, and is a co-Founder of BeeKeeperAI, Inc. J.W.C. is a Consultant for Medtronic and a Consultant and Associate Medical Director for CMR Surgical. M.G.N. is a Consultant, proctor, and Scientific Advisory Board member of GI dynamics, Faculty in training courses, consultant and proctor for Apollo EndoSurgery, consultant and proctor for USGI, Consultant for Colubris Mx, Scientific Advisory Board for Keyron, Speaker at Medtronic, Olympus and Erbe. G.D.H. is an advisor to Theater.io. A.L. is an equity holder at ExplORer Surgical Corp. R.K.M. is a consultant and faculty for training courses for Stryker and receives speaking honoraria from Baxter. F.R. is Director of AI at Surgical Safety Technologies Inc. D.S. is a shareholder in Odin Vision and Digital Surgery Ltd. A.D. is Chair of the Health Security initiative at Flagship Pioneering UK Ltd. J.M.K. provides consultations for Verb Robotics, SafeHeal, YSOPIA Bioscience, and Universal Diagnostics (UDX). J.M.K. also received equity from Mangetoo (teledietetics), OneWelbeck Day Surgery (Hospital), 1 World Medical (personal protective equipment), and Medical iSight (augmented reality). S.P. provides consultations for Medtronic, T.M.L.E. Ltd., and Roche. S.P. is also the cofounder and director of Mangetoo, 1 World Medical, and the London General Surgery Clinic. S.P. is also a partner of OneWelbeck Hospital. All other authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"100"}}