Pediatric surgeons weigh AI benefits against ethical challenges and practical barriers

Although artificial intelligence (AI) is rapidly advancing across modern medicine, its role in pediatric surgery remains limited and ethically complex. This study reveals that although surgeons recognize the potential of AI to improve diagnostic accuracy, streamline planning, and support clinical decision-making, its practical application remains rare and largely academic. Pediatric surgeons expressed strong concerns about accountability in the event of AI-related harm, the difficulty of obtaining informed consent for children, the risk of data privacy violations, and the potential for algorithmic bias. By exploring the experiences and perceptions of pediatric surgeons, this study highlights important barriers that must be addressed before AI can be safely and responsibly incorporated into pediatric surgical care.

Around the world, AI is currently reshaping the way we interpret medical data, predict risk, and support complex decision-making. However, pediatric surgery faces unique ethical challenges due to limitations on children's autonomy, the need for parental decision-making, and increased sensitivity to surgical risks. In low-resource environments, concerns about infrastructure, data representativeness, and regulatory readiness further complicate implementation. Pediatric surgeons must balance innovation with the obligation to protect vulnerable patients and maintain trust. These pressures are fueling debates over transparency, fairness, and accountability in the use of AI tools. Given these challenges, deeper research is needed to guide the ethical and practical integration of AI in pediatric surgical care.

A national team of pediatric surgeons at the Federal Medical Center in Umuahia, Nigeria, has published the first comprehensive survey examining how clinicians perceive the ethical and practical implications of incorporating AI into pediatric surgical care. Published October 20, 2025 (DOI: 10.1136/wjps-2025-001089) World Journal of Pediatric Surgery According to (WJPS), the study collected responses from surgeons in all six geopolitical zones to assess AI awareness levels, usage patterns, and key ethical concerns. The findings reveal that experts are carefully weighing the potential benefits of AI against unresolved issues around accountability, informed consent, data privacy, and regulatory readiness.

This study analyzed responses from 88 pediatric surgeons. Most were experienced consultants actively practicing in a variety of clinical settings. Despite the global momentum for AI-powered surgical innovation, only one-third of respondents had ever used AI, and its use was primarily limited to tasks such as literature searching and documentation, rather than clinical applications. Few reported using AI for diagnostic support, image interpretation, or surgical simulation, highlighting a significant gap between emerging technological capabilities and daily pediatric surgical practice.

Ethical concerns were nearly universal. Surgeons cited accountability for AI-related errors, the complexity of securing informed consent from parents and guardians, and the vulnerability of patient data as key reasons for their hesitation. Concerns also extend to algorithmic bias, reduced human oversight, and unclear legal liability in the event of harm. Opinions were divided on transparency with families. Although many supported informing parents about AI involvement, others believed that disclosure was unnecessary if AI did not directly influence clinical decisions.

Most respondents expressed low confidence in the existing legal framework governing the use of AI in healthcare. Many called for stronger regulatory leadership, clearer guidelines, and standardized training to prepare pediatric surgeons for future AI integration. Taken together, these findings highlight the urgent need for structured governance and capacity building.

“These results show that pediatric surgeons are not opposed to AI, but simply want to ensure that it is safe, fair, and well-regulated,” the research team explained. “Ethical challenges such as accountability, informed consent, and data protection need to be addressed before clinicians can confidently rely on AI in settings involving vulnerable children. Clear national guidelines, practical training programs, and transparent standards are essential to ensure that AI becomes a supporting tool rather than a source of uncertainty in pediatric surgical care.”

This study highlights the need for pediatric-specific ethical frameworks, clearer consent procedures, and clearly defined accountability mechanisms for AI-assisted care. Strengthening data governance, improving digital infrastructure, and expanding AI literacy among clinicians and families are essential to building trust. As AI continues to enter surgical practice, these measures provide a practical roadmap for integrating innovation while protecting child safety and public trust.