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Haltaufderheide J, Pfisterer-Heise S, Pieper D, Ranisch R. The ethical landscape of robot-assisted surgery: a systematic review. J Robot Surg 2025; 19:102. [PMID: 40050538 PMCID: PMC11885409 DOI: 10.1007/s11701-025-02228-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2024] [Accepted: 01/29/2025] [Indexed: 03/09/2025]
Abstract
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 is expected to raise new ethical issues, this systematic review aims to map the state of the ethical debate in this field. 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. Out of 1723 records, 66 records were included in the final dataset. Seven major strands of the ethical debate emerged during the 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. The identified themes testify to a broad range of different 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.
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Affiliation(s)
- Joschka Haltaufderheide
- Juniorprofessorship for Medical Ethics with a focus on Digitization, Faculty for Health Sciences Brandenburg, University of Potsdam, Am Mühlenberg 9, Potsdam, 14476, Brandenburg, Germany.
| | - Stefanie Pfisterer-Heise
- Institute for Health Services and Health System Research, Center for Health Services Research Brandenburg, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane (MHB), Potsdam, Germany
| | - Dawid Pieper
- Institute for Health Services and Health System Research, Center for Health Services Research Brandenburg, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane (MHB), Potsdam, Germany
| | - Robert Ranisch
- Juniorprofessorship for Medical Ethics with a focus on Digitization, Faculty for Health Sciences Brandenburg, University of Potsdam, Am Mühlenberg 9, Potsdam, 14476, Brandenburg, Germany
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Esperto F, Testa A, Territo A, Faiella E, Papalia R, Scarpa RM. Applications of augmented reality in urology: expanding its potentials and fields of usage. Minerva Urol Nephrol 2024; 76:252-253. [PMID: 38742558 DOI: 10.23736/s2724-6051.24.05888-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Affiliation(s)
| | - Antonio Testa
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | - Angelo Territo
- Department of Urology, Autonomous University of Barcelona, Barcelona, Spain
| | - Eliodoro Faiella
- Department of Radiology, Campus Bio-Medico University, Rome, Italy
| | - Rocco Papalia
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | - Roberto M Scarpa
- Department of Urology, Campus Bio-Medico University, Rome, Italy
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Sadri H, Fung-Kee-Fung M, Shayegan B, Garneau PY, Pezeshki P. A systematic review of full economic evaluations of robotic-assisted surgery in thoracic and abdominopelvic procedures. J Robot Surg 2023; 17:2671-2685. [PMID: 37843673 PMCID: PMC10678817 DOI: 10.1007/s11701-023-01731-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 09/24/2023] [Indexed: 10/17/2023]
Abstract
This study aims to conduct a systematic review of full economic analyses of robotic-assisted surgery (RAS) in adults' thoracic and abdominopelvic indications. Authors used Medline, EMBASE, and PubMed to conduct a systematic review following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 guidelines. Fully published economic articles in English were included. Methodology and reporting quality were assessed using standardized tools. Majority of studies (28/33) were on oncology procedures. Radical prostatectomy was the most reported procedure (16/33). Twenty-eight studies used quality-adjusted life years, and five used complication rates as outcomes. Nine used primary and 24 studies used secondary data. All studies used modeling. In 81% of studies (27/33), RAS was cost-effective or potentially cost-effective compared to comparator procedures, including radical prostatectomy, nephrectomy, and cystectomy. Societal perspective, longer-term time-horizon, and larger volumes favored RAS. Cost-drivers were length of stay and equipment cost. From societal and payer perspectives, robotic-assisted surgery is a cost-effective strategy for thoracic and abdominopelvic procedures.Clinical trial registration This study is a systematic review with no intervention, not a clinical trial.
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Affiliation(s)
- Hamid Sadri
- Department of Health Economic and Outcomes Research, Medtronic ULC, 99 Hereford St., Brampton, ON, L6Y 0R3, Canada.
| | - Michael Fung-Kee-Fung
- Champlain Regional Cancer Program Depts OB/GYN, Surgery, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Bobby Shayegan
- Division of Urology, Department of Surgery, McMaster University, 50 Charlton Ave., Hamilton, ON, L8N 4A6, Canada
| | - Pierre Y Garneau
- Surgical Department, Hôpital du Sacré-Coeur de Montréal, 5400 Boul Gouin O, Montréal, QC, H4J 1C5, Canada
| | - Padina Pezeshki
- Department of Clinical Research, Medtronic ULC, 99 Hereford St., Brampton, ON, L6Y 0R3, Canada
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Napolitano L, Maggi M, Sampogna G, Bianco M, Campetella M, Carilli M, Lucci Chiarissi M, Civitella A, DE Vita F, DI Maida F, DI Mauro M, Ercolino A, Fasulo V, Felici G, Gheza A, Guzzardo C, Loizzo D, Mazzone E, Parodi S, Piramide F, Rabito S, Rizzetto R, Romantini F, Scarcella S, Tedde M, Checcucci E, Esperto F, Claps F, Falagario U. A survey on preferences, attitudes, and perspectives of Italian urology trainees: implications of the novel national residency matching program. Minerva Urol Nephrol 2023; 75:718-728. [PMID: 37350584 DOI: 10.23736/s2724-6051.23.05257-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
BACKGROUND Since 2014, a new residency program selection process has been established with a national examination. The aim of this study was to assess characteristics, career goals, and practice preferences of current Italian urology residents. METHODS A web-based survey of 25 items performed from May 2021 to September 2021 was sent to 585 Italian urology residents. Descriptive analyses were conducted to describe the surveys' domains: demographics characteristics, studies, plans for fellowship training, interest in the urology field, and career expectations. RESULTS Four hundred and one residents completed the online survey (response rate 68.5%). Most residents were male (70.3%), with a median of 29 (IQR 28-31) years. Urology was the first chosen School in 325 (81.0%) cases, and 174 (43.4%) trainees have chosen to remain in the same University. Uro-oncology was the main field, and endourology the main subspeciality of interest, respectively. More than 40.0% of residents expressed a good level of satisfaction for the training urological course. 232 (57.2%) residents were strongly interested in seeking a hospital career, followed by private career (43.4%) and academic career (20%). CONCLUSIONS After the introduction of the novel national residency matching program the Italian Urology trainees showed a good satisfaction level. Further improvements of the Italian residency programs should be focused on the training network within and outside the main School of Urology.
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Affiliation(s)
- Luigi Napolitano
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Martina Maggi
- Department of Urology, Sapienza University, Rome, Italy -
| | - Gianluca Sampogna
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marta Bianco
- Department of Urology, University of Padua, Padua, Italy
| | | | - Marco Carilli
- Unit of Urology, Tor Vergata Polyclinic Foundation, Rome, Italy
| | | | - Angelo Civitella
- Department of Medicine and Surgery, Campus Bio-Medico University, Rome, Italy
| | | | - Fabrizio DI Maida
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, Florence, Italy
| | - Marina DI Mauro
- Section of Urology, Department of Surgery, University of Catania, Catania, Italy
| | | | - Vittorio Fasulo
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Graziano Felici
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Alberto Gheza
- Department of Urology, University of Brescia, Brescia, Italy
| | | | - Davide Loizzo
- Unit of Transplantation, Department of Urology, Andrology and Kidney, University of Bari, Bari, Italy
| | - Elio Mazzone
- Unit of Urology, Division of Oncology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Stefano Parodi
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genoa, Genoa, Italy
| | - Federico Piramide
- Division of Urology, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Salvatore Rabito
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Riccardo Rizzetto
- Department of Urology, AOUI Verona, University of Verona, Verona, Italy
| | - Federico Romantini
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Matteo Tedde
- Department of Clinical and Experimental Medicine, Urologic Clinic, University of Sassari, Sassari, Italy
| | - Enrico Checcucci
- Division of Urology, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Francesco Esperto
- Department of Medicine and Surgery, Campus Bio-Medico University, Rome, Italy
| | - Francesco Claps
- Urology Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Ugo Falagario
- Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti, Foggia, Italy
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Prata F, Raso G, Ragusa A, Iannuzzi A, Tedesco F, Cacciatore L, Civitella A, Tuzzolo P, D’Addurno G, Callè P, Basile S, Fantozzi M, Pira M, Prata SM, Anceschi U, Simone G, Scarpa RM, Papalia R. Robot-Assisted Renal Surgery with the New Hugo Ras System: Trocar Placement and Docking Settings. J Pers Med 2023; 13:1372. [PMID: 37763140 PMCID: PMC10532520 DOI: 10.3390/jpm13091372] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/18/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
The current literature relating to the novel HugoTM RAS System lacks consistent data concerning the bedside features of robot-assisted partial nephrectomy (RAPN). To describe the trocar placement and docking settings for RAPN with a three-arm configuration to streamline the procedure with HugoTM RAS, between October 2022 and April 2023, twenty-five consecutive off-clamp RAPNs for renal tumors with the HugoTM RAS System were performed. We conceived a trouble-free three-arm setting to ease and standardize RAPN trocar placement and docking settings with HugoTM RAS. Perioperative data were collected. Post-operative complications were reported according to the Clavien-Dindo classification. The eGFR was calculated according to the CKD-EPI formula. Continuous variables were presented as the median and IQR, while frequencies were reported as categorical variables. Off-clamp RAPNs were successfully performed in all cases without the need for conversion or additional port placement. The median age and BMI were 69 years (IQR, 60-73) and 27.3 kg/m2 (IQR, 25.7-28.1), respectively. The median tumor size and R.E.N.A.L. score were 32.5 mm (IQR, 26-43.7) and 6 (IQR, 5-7), respectively. Two patients were affected by cT2 renal tumors. The median docking and console time were 5 (IQR, 5-6) and 90 min (IQR, 68-135.75 min), respectively, with slightly progressive improvements in the docking time achieved. No intraoperative complications occurred alongside clashes between instruments or with the bed assistant. In experienced hands, this simplified three-instrument configuration of the HugoTM RAS System for off-clamp RAPN resulted in feasible and safe practice, providing patient-tailored trocar placement and docking with non-inferior peri-perioperative outcomes to other robotic platforms.
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Affiliation(s)
- Francesco Prata
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Gianluigi Raso
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Alberto Ragusa
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Andrea Iannuzzi
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Francesco Tedesco
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Loris Cacciatore
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Angelo Civitella
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Piergiorgio Tuzzolo
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Giuseppe D’Addurno
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Pasquale Callè
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Salvatore Basile
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Marco Fantozzi
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Matteo Pira
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Salvatore Mario Prata
- Simple Operating Unit of Lower Urinary Tract Surgery, SS. Trinità Hospital, Sora, 03039 Frosinone, Italy;
| | - Umberto Anceschi
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (U.A.); (G.S.)
| | - Giuseppe Simone
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (U.A.); (G.S.)
| | - Roberto Mario Scarpa
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
| | - Rocco Papalia
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (G.R.); (A.R.); (A.I.); (F.T.); (L.C.); (A.C.); (P.T.); (G.D.); (P.C.); (S.B.); (M.F.); (M.P.); (R.M.S.); (R.P.)
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Esperto F, Cacciatore L, Tedesco F, Brassetti A, Testa A, Raso G, Iannuzzi A, Papalia R, Scarpa RM. Video Consensus and Radical Prostatectomy: The Way to Chase the Future? J Pers Med 2023; 13:1013. [PMID: 37374002 DOI: 10.3390/jpm13061013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/16/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
In the age of information, new platforms are consulted by patients to acquire consciousness about medical treatments. The aim of this study was to assess the level of understanding and feasibility of video consensus (VC) administration in patients scheduled for radical prostatectomy (RP), comparing it with standard informed consensus (SIC). According to the European Association of Urology Patient Information, we set up a video content for RP that was translated in Italian and implemented with information about possible perioperative and postoperative complications, days of hospitalization etc. From 2021 to 2022, all patients undergoing RP at our institution were prospectively included in this study. Patients received an SIC and after that, a VC about RP. After two consensuses were administered, patients received a preformed Likert 10 scale and STAI questionnaires. On the RP dataset, 276 patients were selected and 552 questionnaires for both SIC and VC were evaluated. Out of these, the median age was 62 years (IQR 60-65). Patients reported a higher overall satisfaction for VC (8.8/10) compared to the traditional informed consent (6.9/10). Therefore, VC may play a role in the future of surgery, improving the consciousness and satisfaction of patients and reducing preoperative anxiety.
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Affiliation(s)
- Francesco Esperto
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Loris Cacciatore
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Francesco Tedesco
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Aldo Brassetti
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, 00128 Rome, Italy
| | - Antonio Testa
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Gianluigi Raso
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Andrea Iannuzzi
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Rocco Papalia
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Roberto Mario Scarpa
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, 00128 Rome, Italy
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Oliva A, Grassi S, Vetrugno G, Rossi R, Della Morte G, Pinchi V, Caputo M. Management of Medico-Legal Risks in Digital Health Era: A Scoping Review. Front Med (Lausanne) 2022; 8:821756. [PMID: 35087854 PMCID: PMC8787306 DOI: 10.3389/fmed.2021.821756] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/20/2021] [Indexed: 12/11/2022] Open
Abstract
Artificial intelligence needs big data to develop reliable predictions. Therefore, storing and processing health data is essential for the new diagnostic and decisional technologies but, at the same time, represents a risk for privacy protection. This scoping review is aimed at underlying the medico-legal and ethical implications of the main artificial intelligence applications to healthcare, also focusing on the issues of the COVID-19 era. Starting from a summary of the United States (US) and European Union (EU) regulatory frameworks, the current medico-legal and ethical challenges are discussed in general terms before focusing on the specific issues regarding informed consent, medical malpractice/cognitive biases, automation and interconnectedness of medical devices, diagnostic algorithms and telemedicine. We aim at underlying that education of physicians on the management of this (new) kind of clinical risks can enhance compliance with regulations and avoid legal risks for the healthcare professionals and institutions.
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Affiliation(s)
- Antonio Oliva
- Legal Medicine, Department of Health Surveillance and Bioethics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Simone Grassi
- Legal Medicine, Department of Health Surveillance and Bioethics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Vetrugno
- Legal Medicine, Department of Health Surveillance and Bioethics, Università Cattolica del Sacro Cuore, Rome, Italy
- Risk Management Unit, Fondazione Policlinico A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Riccardo Rossi
- Legal Medicine, Department of Health Surveillance and Bioethics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gabriele Della Morte
- International Law, Institute of International Studies, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Vilma Pinchi
- Department of Health Sciences, Section of Forensic Medical Sciences, University of Florence, Florence, Italy
| | - Matteo Caputo
- Criminal Law, Department of Juridical Science, Università Cattolica del Sacro Cuore, Milan, Italy
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