Pediatric surgeons weigh benefits of artificial intelligence against ethical challenges and practical barriers

Artificial intelligence (AI) is advancing rapidly in modern healthcare, yet its role in pediatric surgery remains limited and ethically complex. This study reveals that although surgeons recognize the potential of artificial intelligence to improve diagnostic accuracy, modernize planning and support clinical decision-making, its practical use is still rare and mostly academic. Pediatric surgeons expressed strong concerns about accountability for AI-related harm, the difficulty of obtaining informed consent for children, the risk of data privacy violations, and the potential for algorithmic bias. By examining the experiences and perceptions of pediatric surgeons, this study highlights the critical barriers that must be addressed in order to safely and responsibly integrate artificial intelligence into pediatric surgical care.

Currently, around the world, artificial intelligence is reshaping how medical data is interpreted, how risks are predicted, and how complex decisions are supported. However, pediatric surgery faces unique ethical challenges due to children’s limited autonomy, the need for parental decision-making, and the heightened sensitivity of surgical risks. In a low-resource setting, concerns about infrastructure, data representativeness, and regulatory readiness further complicate adoption. Pediatric surgeons must balance innovation with the obligation to protect vulnerable patients and maintain trust. These pressures intensify debates around transparency, fairness and accountability in the use of AI tools. With these challenges, deeper research is needed to guide the ethical and practical integration of artificial intelligence into pediatric surgical care.

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

The study analyzed responses from 88 pediatric surgeons, most of whom were experienced consultants actively practicing in a variety of clinical settings. Despite global momentum in AI-enabled surgical innovation, only a third of respondents had ever used AI, and their use was largely limited to tasks such as literature search and documentation rather than clinical applications. Very few reported using AI for diagnostic support, image interpretation, or surgical simulation, highlighting a significant gap between emerging technological capabilities and everyday pediatric surgical practice.

Moral concerns were almost universal. Surgeons identified liability for AI-related errors, the complexity of securing informed consent from parents or guardians, and the vulnerability of patient data as major sources of hesitation. Concerns also extended to algorithmic bias, reduced human oversight, and unclear legal responsibilities in the event of harm. Opinions on transparency with families are divided. While many supported informing parents about AI involvement, others felt that disclosure was not necessary when the AI ​​did not directly influence clinical decisions.

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

“The results show that pediatric surgeons are not opposed to artificial intelligence – they just want to ensure that it is safe, fair and well regulated,” explained the research team. “Ethical challenges such as accountability, informed consent and data protection must 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 supportive tool rather than a source of uncertainty in pediatric surgical care.”

The study highlights the need for pediatric-specific ethical frameworks, clearer consent processes and well-defined accountability mechanisms for AI-assisted care. Strengthening data governance, improving digital infrastructure, and expanding AI literacy among clinicians and families will be essential to building trust. As artificial intelligence continues to enter surgical practice, these measures offer a practical roadmap for incorporating innovation while protecting children’s safety and public trust.