Background: Robot-assisted surgery has been widely adopted in recent years. However, compared to other health technologies operating in close proximity to patients in a vulnerable state, ethical issues of robot-assisted surgery have received less attention. Against the background of increasing automation that are expected to raise new ethical issues, this systematic review aims to map the state of the ethical debate in this field. Methods: A protocol was registered in the international prospective register of systematic reviews (PROSPERO CRD42023397951). Medline via PubMed, EMBASE, CINHAL, Philosophers' Index, IEEE Xplorer, Web of Science (Core Collection), Scopus and Google Scholar were searched in January 2023. Screening, extraction, and analysis were conducted independently by two authors. A qualitative narrative synthesis was performed. Results: Out of 1,723 records, 66 records were included in the final dataset. Seven major strands of the ethical debate emerged during analysis. These include questions of harms and benefits, responsibility and control, professional-patient relationship, ethical issues in surgical training and learning, justice, translational questions, and economic considerations. Discussion: The identified themes testify to a broad range of different and differing ethical issues requiring careful deliberation and integration into the surgical ethos. Looking forward, we argue that a different perspective in addressing robotic surgical devices might be helpful to consider upcoming challenges of automation.

翻译：背景：近年来，机器人辅助手术已得到广泛应用。然而，与其他在患者处于脆弱状态下近距离操作的医疗技术相比，机器人辅助手术的伦理问题受到的关注较少。在自动化程度不断提高、预计将引发新伦理问题的背景下，本系统性综述旨在梳理该领域伦理讨论的现状。方法：研究方案已在国际前瞻性系统综述注册库（PROSPERO CRD42023397951）注册。我们于2023年1月检索了PubMed平台的Medline、EMBASE、CINHAL、Philosophers' Index、IEEE Xplorer、Web of Science（核心合集）、Scopus及Google Scholar数据库。筛选、数据提取与分析由两位作者独立完成，并进行了定性叙事性综合。结果：在1,723条记录中，最终纳入66条记录。分析过程中浮现出伦理讨论的七大主题，包括：伤害与获益问题、责任与控制问题、医患关系问题、外科培训与学习中的伦理问题、公正性问题、转化性问题以及经济考量。讨论：所识别的主题表明存在广泛而各异的伦理议题，需要审慎考量并融入外科伦理体系。展望未来，我们认为采用不同视角来探讨机器人手术设备，可能有助于应对自动化带来的新兴挑战。