The Role of the Cardiothoracic Surgeon in the Age of AI—Are the Robots Going to Take Our Jobs?

Introduction: Artificial intelligence (AI) and robot-assisted platforms are increasingly influencing cardiothoracic surgery. AI enhances risk prediction, imaging interpretation, and early complication detection, while robotics improves visualization, dexterity, and minimally invasive access. This systematic review evaluates the current evidence supporting these technologies and their implications for clinical practice. Methods: A systematic literature search was conducted across PubMed, Embase, Scopus, Web of Science, and Google Scholar (January 2000–May 2025) following PRISMA 2020 guidelines. After screening and eligibility assessment, 67 studies met predefined inclusion criteria and were incorporated into the qualitative synthesis. Additional high-impact reviews and consensus documents were consulted for contextual interpretation. Results: Machine learning models demonstrated modest but consistent improvements in predictive performance compared with EuroSCORE II and STS scores, particularly in high-risk cohorts. Robot-assisted mitral and coronary procedures showed reduced postoperative pain, blood loss, ICU stay, and recovery time in experienced centers, though early learning phases were associated with longer operative, cross-clamp, and bypass times. AI-enabled intraoperative tools, such as video analysis, workflow recognition, and real-time anatomical segmentation, emerged as promising adjuncts for surgical precision. Structured robotic training programs, especially simulation-based and dual-console pathways, accelerated proficiency acquisition. Conclusions: AI and robotic systems act as augmentative technologies that enhance rather than replace the surgeon’s role. Their safe and effective adoption requires standardized training, transparent AI decision pathways, and clear ethical and medico-legal governance.