The Future of Sustainable Neurosurgery: Is a Moonshot Plan for Artificial Intelligence and Robot-Assisted Surgery Possible in Japan?

Japanese neurosurgery faces challenges such as a declining number of neurosurgeons and their concentration in urban areas. Particularly in rural areas, access to neurosurgical care for patients with conditions, such as stroke, is limited, raising concerns about the collapse of regional healthcare. Robot-assisted surgical technologies have advanced in recent years, contributing to the improved precision and safety of deep brain surgery. This study proposes the "Artificial Intelligence (AI) and Robot-Assisted Surgery Moonshot Plan" for Japan, comprising 5 pillars: 1) establishment of regional medical centers, 2) development of remote surgery systems, 3) enhancement of robotic-assisted surgery training programs, 4) integration of AI technologies, and 5) promotion of industry-academia-government collaboration. In addition, strengthening the approach to spinal surgery is expected to revitalize regional medical centers, optimize the number of neurosurgeons, improve surgical skills, and promote minimally invasive surgery. This study analyzed the current status and challenges of Japanese neurosurgery through a literature review and statistical analysis. AI is used in various aspects of neurosurgery, including diagnostic support, surgical planning and navigation, treatment outcome prediction, intraoperative monitoring, robot-assisted surgery, and rehabilitation. However, challenges, such as data bias, ethical issues, costs, and regulations, remain. In Japan, issues such as the uneven distribution and decline of neurosurgeons, collapse of regional healthcare, and increase in the number of patients with spinal disorders due to aging have been highlighted. The "AI and Robot-Assisted Surgery Moonshot Plan" serves as a guide to overcome the challenges of neurosurgery in Japan and establish a sustainable medical system.