Dear Editor,
We commend Prigg and Vimalachandran for stimulating discussion on the potential risks of automation‐induced deskilling in colorectal surgery [1]. However, we believe the article presents a predominantly cautionary perspective that underrepresents the growing evidence supporting artificial intelligence (AI) as an adjunct rather than a substitute for surgical expertise.
The discussion relies heavily on analogies from aviation and AI‐assisted colonoscopy, whereas direct evidence demonstrating clinically meaningful surgical deskilling remains limited [1]. Contemporary reviews consistently show that AI improves diagnostic accuracy, lesion detection, workflow efficiency and decision support, while emphasizing that clinician oversight remains indispensable [2]. Likewise, a recent comprehensive review in gastrointestinal endoscopy concluded that AI enhances adenoma detection and diagnostic precision, but highlighted that successful implementation requires clinician training, transparent governance and the preservation of human judgement rather than the replacement of the endoscopist [3].
Similarly, recent evidence mapping AI applications for anal fistula shows that most remain in the early IDEAL stages (1–2b), supporting AI as a decision‐support tool while emphasizing the need for multicentre validation before routine clinical adoption [4].
Finally, the article devotes relatively little attention to equally important challenges, including algorithmic bias, transparency, medicolegal accountability and ethical governance, which may ultimately carry greater implications than theoretical concerns about deskilling. Rather than asking whether AI causes deskilling, future research should define how surgical training can preserve independent operative competence while safely integrating AI to improve patient outcomes.
AUTHOR CONTRIBUTIONS
Pankaj Garg: Methodology; supervision; visualization; validation; writing – original draft; writing – review and editing. Vipul D. Yagnik: Conceptualization; methodology; formal analysis; supervision; writing – original draft; writing – review and editing; validation.
FUNDING INFORMATION
The authors have nothing to report.
CONFLICT OF INTEREST STATEMENT
The authors declare no conflict of interest.
ACKNOWLEDGEMENTS
The authors have nothing to report.
DATA AVAILABILITY STATEMENT
Data sharing not applicable to this article as no datasets were generated or analysed during the current study.
REFERENCES
- 1. Prigg AR, Vimalachandran D. The surgeon in the loop: automation, deskilling and the limits of the machine in colorectal surgery. Color Dis. 2026;28(6):e70533. 10.1111/codi.70533 [DOI] [PubMed] [Google Scholar]
- 2. Tafti F, Thorat R, Mhatre S, Srichand R, Savant SC, Sachdev SS. The utility of artificial intelligence in dentistry: advancing Frontiers. Glob J Med Pharm Biomed Update. 2024;19:8. 10.25259/GJMPBU_9_2024 [DOI] [Google Scholar]
- 3. Yagnik VD, Choudhary PR, Garg P. Artificial intelligence in gastrointestinal endoscopy: current advances, clinical integration, and future directions: a narrative review. Clin Exp Gastroenterol. 2026;19:573930. 10.2147/CEG.S573930 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4. Yagnik VD, Choudhary PR, Garg P. Artificial intelligence in anal fistula: mapping evidence to IDEAL stages. Ann Coloproctol. 2026;42(3):264–272. 10.3393/ac.2025.01494.0213 [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Data sharing not applicable to this article as no datasets were generated or analysed during the current study.