The OR black box in urology: A survey on patient acceptance and confidence in AI-assisted surgery.

OBJECTIVES: This study aims to assess patient acceptance of intraoperative video recording with Operating Room (OR) black box technology, characterise consent conditions and use-case preferences, and identify predictors of patient confidence in artificial intelligence (AI)-assisted surgery in urological patients. PATIENTS AND METHODS: This prospective cross-sectional survey was conducted at the urology department of a university hospital from March 2024 to March 2025. Consecutive adults scheduled for elective procedures were enrolled (322 enrolled; 316 completed the binary consent item). A standardised questionnaire assessed consent to operative video storage and attitudes across four Likert-scaled domains (29 items: consent conditions, use cases, data access and AI confidence). The primary outcome was confidence in AI-assisted surgery for the full procedure. Analysis included Wilson 95% confidence intervals, between-group comparisons and multivariable linear regression. RESULTS: Of 316 patients (82.9% male, mean age 65.4 years), 304 (96.2%, 95% CI 93.5-97.8%) consented to operative video storage, with universal acceptance among oncological patients (181/181, 100%). Nonconsenters (n = 12) were younger, without oncological diagnosis and reported lower AI confidence. All 29 attitudinal items received majority endorsement. Patient confidence in AI-assisted surgery was expressed by 55.2% for the full procedure, 63.5% for simple steps and 53.9% for complex steps (p < 0.001). Older patients expressed greater confidence (rₛ = -0.21, p < 0.001). Age and three attitudinal composites independently predicted AI confidence (adjusted R 2 = 0.308), whereas demographic and clinical characteristics accounted for only 5.8% of variation. CONCLUSION: Urological patients broadly accept intraoperative recording and AI-assisted surgery when transparent governance is ensured. Attitudinal factors outweigh demographic and clinical characteristics, supporting patient-centred consent frameworks for OR black box implementation in urological practice.