On 30 November 2022, ChatGPT, a state-of-the-art natural language-processing model was developed by OpenAI (San Francisco, CA, USA).1 It elicits human-like conversations and can comprehend and respond to complex queries in natural language. These conversations range from casual exchanges to in-depth discussions about recent scientific breakthroughs. Large datasets using advanced machine-learning algorithms are used in training ChatGPT to understand the context of conversations and generate meaningful responses across a broad range of content.

This report describes the use of ChatGPT with questions exploring the potential of artificial intelligence (AI) in surgery. We describe the history of AI in surgery, the current state of the field, and potential future developments. We also examine the limitations and challenges with effective AI and robotic implementation in surgery and ethical issues that must be considered. Finally, we consider the potential impacts of AI on the surgical workforce and the ability of ChatGPT to engage in questions related to patient care. By understanding the perspective of ChatGPT on the current state of AI in surgery and its potential opportunities and challenges, we can better understand its potential role in surgery.

Methods

A review of articles describing AI use in surgery led us to develop itemized questions. Conversations with ChatGPT were conducted via a text-based interface, with ChatGPT-generated responses recorded for analysis and inclusion in this report. These responses were analyzed and synthesized to produce a comprehensive overview of AI’s potential in surgery. Text-based responses were presented via a video-based avatar using Synthesia, IO (London, UK). No ChatGPT remarks reflected the views of Synthesia or the authors.

Results

We generated 15 questions (Table 1) focused on the history and future potential of AI in surgery, limitations for its effective implementation, issues related to its widespread applications, its unintended and intended consequences, its impact on the surgical workforce, and AI model accountability and autonomy. Furthermore, we included questions related to clinical patient care and surgical innovation. Transcribed video-based avatar responses generated by ChatGPT are shown in Video 1.

Table 1 Itemized questions and corresponding ChatGPT video-based avatar responses time

Discussion

ChatGPT is a new and rapidly evolving technology. As with any emerging technology, its full potential and impact on the field remain uncertain. Although ChatGPT has already demonstrated impressive abilities in understanding and generating natural language, its applications in surgery are still in the early stages of development. As such, it is important to continue evaluating the technology's potential, limitations, and ethical implications as it evolves and is integrated into surgical practice.

This report aims to provide a comprehensive overview of the current state of ChatGPT in surgery and to highlight the need for continued research and evaluation of its potential applications and impacts. In response to a question about the future potential of AI in the field, ChatGPT listed several ways AI is expected to shape surgery, including improved surgical accuracy and precision, increased efficiency, predictive analytics, training and education, and new treatments and technologies. These points are consistent with current research and developments in surgery and provide a comprehensive overview of AI’s potential in surgery.2,3,4,5

Furthermore, ChatGPT provided a brief but comprehensive history of AI in surgery, highlighting key milestones and developments during the past few decades. This helps to provide context and understanding of AI’s progression in surgery, allowing readers to better understand its current state and potential future developments.4,6

In addition, ChatGPT identified several challenges and limitations in effective implementation of AI in surgery, including limited data availability, ethical concerns, complexity of surgery, resistance to change, and cost. These are consistent with current research and discussions in the field and provide a thorough overview of the potential barriers to successful AI implementation in surgery.4,7 Additionally, ChatGPT identified several issues that may arise from widespread AI use in surgery, including job displacement, ethical concerns, liability issues, reliance on technology, and cost. These issues emphasize the importance of carefully considering the potential impacts and implications of AI in surgery and developing strategies to address potential challenges.

ChatGPT clearly and accurately described the relationship between the computer-based and mechanical components of surgical robots.8 It described their roles, with the computer component providing control and processing power and the mechanical components performing actual surgical procedures. The response also raised the possibility of the mechanical components eventually catching up with the computer components regarding capabilities but noted that this is unlikely owing to the complex processing and information analysis tasks the computer component performs. Overall, ChatGPT effectively conveyed the importance of both component types in surgical robots and their mutual relationship in enabling robots to perform surgery with precision and control. It also provided a nuanced understanding of the limitations of surgical robots and their intended role in assisting rather than replacing human surgeons.

Currently, the two main surgical robot types are command/control or operator/effector systems and preprogrammed robots that follow a computer-assisted design.9 The former allows for greater precision and flexibility in movements and is of greater interest to soft tissue surgeons, whereas the latter has limited capabilities but is useful for repetitive tasks. These two robot types are expected to converge to create semi-autonomous robots that can adapt in real time, which would open new possibilities for improving patient outcomes.

In our examination, ChatGPT demonstrated a thorough understanding of both the intended and unintended potential consequences of AI in surgery. It emphasized the potential benefits of AI in terms of improved accuracy, efficiency, and cost savings and the potential for new treatments and procedures. It also recognized the potential limitations and challenges of AI in surgery, such as risk of errors, bias, and malicious use. Furthermore, ChatGPT offered a nuanced perspective on the potential role of AI in replacing surgeons, stating that AI may be able to assist with certain tasks but is unlikely to fully replace human surgeons anytime soon. It also emphasized the significance of carefully considering AI use in scientific writing and the importance of transparency and ethics in this process. Regarding accountability for AI model errors, ChatGPT acknowledged that the ultimate responsibility may lie with human surgeons or health care providers but recognized the role of AI developers and operators in ensuring its reliability and safety.

We examined ChatGPT’s performance with patient care-related questions. First, ChatGPT offered a comprehensive approach to optimizing abdominal wall reconstruction outcomes for a patient with a contaminated defect, including the importance of cleaning the wound, selecting an infection-resistant mesh material, using a tension-free repair technique, securing the mesh with nonabsorbable sutures, and potentially using a prophylactic antimicrobial agent.10 Second, AI provided strategies for dealing with a difficult patient, including active listening, open and honest communication, empathy, patience, and setting boundaries. Third, ChatGPT identified several factors driving surgical innovation, including the desire to improve patient outcomes, the need to reduce costs, the availability of new technologies, and changing health care trends and needs.

These findings demonstrate the excellent performance of ChatGPT and its potential to revolutionize surgery by automating certain tasks and assisting surgeons in generating important documents and materials. ChatGPT may be used to generate surgical reports by automatically completing sections of them based on the surgeon’s input, saving time and allowing surgeons to focus on other tasks.

Another potential application of ChatGPT in surgery is generation of surgical consent forms by inserting relevant information about specific surgical procedures into a template form, ensuring inclusion of all necessary information and making the form easy for patients to understand. Additionally, ChatGPT can be used to create surgical educational materials. Inserting relevant educational information about surgical procedures into a template document could help ensure that materials are accurate and up to date and save time for those who create them. Regarding surgical planning and simulation, ChatGPT can examine patient data and recommend the best surgical approach based on the patient's requirements and characteristics, improving the accuracy and precision of surgical planning and reducing the likelihood of complications.

Finally, ChatGPT can be used to analyze patient data, including vital signs and imaging findings, and make decisions in real time during surgery. It can then advise the surgeon on the best course of action. As a result, the procedure may be more effective and efficient, and complications may be less likely.

Although ChatGPT has the potential to revolutionize surgery in many positive ways, its use also carries inherent risks, particularly in the areas of ethics and misuse. The technology’s potential for bias and perpetuation of inequalities in health care is a major concern, as is the potential for the misuse of ChatGPT in the wrong hands. The surgical community must therefore carefully consider the ethical implications of ChatGPT use in the field and develop strategies to prevent and address any misuse of the technology. Ensuring that the data used to train the algorithm are unbiased and diverse also is crucial to prevent clinicians from making inaccurate and potentially harmful decisions in the surgical setting. It is essential that the risks associated with the use of ChatGPT in surgery are fully understood and addressed to ensure that the potential benefits of the technology are realized while minimizing any potential harm to patients or the surgical community.

Although this report focuses specifically on ChatGPT in the context of surgery, we acknowledge that other important technologies in the field, such as Bard from Google, also may play an important role in shaping the future of surgery. It is important to note that the purpose of this report is not to promote or endorse any specific technology, but rather to provide a balanced discussion of the potential applications and challenges associated with AI in surgery.

In conclusion, ChatGPT demonstrated a strong understanding of the potential applications and consequences of AI in surgery and robotics. It identified several ways in which AI may shape the future of surgery, including improved accuracy and efficiency, predictive analytics, training and education, and new treatments and technologies. It also recognized the potential limitations and challenges of AI in surgery, including risk of errors, bias, and malicious use, as well as the potential impact on the surgical workforce and the importance of transparency and ethics in using AI in scientific writing. Furthermore, ChatGPT provided detailed responses to specific questions about optimizing abdominal wall reconstruction outcomes, dealing with difficult patients, and driving surgical innovation, demonstrating its ability to provide practical and relevant insights on patient care-related topics. Overall, ChatGPT’s performance suggests that it can be a valuable tool in surgery, although careful consideration of the potential impacts and implications of its use is important.