Mini-review on human-centered assurance in robot-assisted orthopedics and neurosurgery

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.