Does Level Five Autonomy Already Exist in Surgery?

The chapter explores the historical trajectory and challenges of integrating autonomous actions, artificial intelligence (AI), and robotics in surgery. It highlights the levels of autonomy, emphasizing the distinctions between direct control, shared control, supervised autonomy, and full autonomy. The discussion covers the unique issues arising from the application of AI in surgery, such as the complexity of defining autonomous movement in dynamic surgical procedures. The article also examines the current state of autonomous functions on rigid versus soft tissues, addressing the limited options for soft tissue surgeries. It concludes by exploring the role of reinforcement learning, phase recognition, and situation awareness in achieving full autonomy.