MINI REVIEW article
Front. Robot. AI
Sec. Biomedical Robotics
This article is part of the Research TopicRobotics in Orthopedics and NeurosurgeryView all 3 articles
Mini-review on Human-centered Assurance in Robot-assisted Orthopedics and Neurosurgery
Provisionally accepted
- Johns Hopkins University, Baltimore, United States
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As artificial intelligence (AI) drives the development of next-generation robotic platforms and navigation systems that operate with increasing levels of autonomy in orthopedic and neurosurgical procedures, the methods by which human operators verify and validate these systems' operations become critically important. While significant effort has been spent on advancing technological capabilities and autonomy, comparatively little thought has been put into understanding how surgeons may effectively maintain oversight and assurance of these complex systems–despite retaining full legal and ethical responsibility for surgical outcomes. This mini-review synthesizes assurance mechanisms following the Sense-Think-Act framework: spatial intelligence (navigation and registration), cognitive assistance (AI-driven planning and adaptation), and physical operation (robot motion and force interaction). We highlight human-centered assurance as an opportunity to enable safe adoption of increasingly autonomous surgical systems. Finally, we outline essential research directions for developing assurance frameworks that scale with increasing autonomy while maintaining human responsibility and control in orthopedic and neurosurgical procedures.
Keywords: Autonomous Systems, human-robot interaction, medical robotics, Safety validation, Surgical automation
Received: 27 Nov 2025; Accepted: 10 Feb 2026.
Copyright: © 2026 Cho, Zou, Fleig and Unberath. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Sue Min Cho
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