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

Abstract 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 ( r ₛ = −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.