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The use of digital technology is increasing rapidly across surgical specialities, yet there is no consensus for the term 'digital surgery'. 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 >70% of the panel deemed the statement important and <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. Future research into these issues must involve all digital surgery stakeholders including patients.
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Introduction The United Kingdom (UK) left the European Union (EU) on 31 January 2020. Brexit will impact many sectors of the economy, including the dental sector.Methods and analysis This policy analysis evaluates UK and EU legislation and planning documents, as well as the published literature, to analyse the impact of two scenarios relating to the UK's exit from the EU on the dental sector: a free trade agreement based on the jointly agreed Political Declaration (the 'FTA') and a 'no-deal' scenario.Conclusion An FTA could cause price increases of medicines and medical devices, and cause some disruption to the ability of regulating authorities in this area, while a no-deal would additionally risk shortages of medicines and medical devices as well as more dramatic price increases. In both an FTA and a 'no-deal scenario', with EU law no longer applicable to the UK, more innovative policy in the area of tobacco control could be developed. An FTA could exacerbate existing workforce shortages and would likely cause a reduction in EU research funding, as well as posing issues with data transfers, with these all likely to be more severe under a no-deal scenario.