A Robot Surgeon Without Human Assistance

A robot has performed laparoscopic surgery on a pig’s soft tissue without the assistance of a human, marking a significant step forward in robotics toward fully automated human surgery. Researchers at Johns Hopkins University (Baltimore, MD, USA) developed the Smart Tissue Autonomous Robot (STAR), which excelled at suturing two ends of the intestine, one of the most intricate and delicate tasks in abdominal surgery. Intestinal anastomosis, or joining two ends of an intestine, is arguably the most difficult step in gastrointestinal surgery, requiring a surgeon to suture with extreme precision and consistency. Even the tiniest hand tremor or misplaced stitch can cause a leak, which can be life-threatening for the patient.

The robot performed exceptionally well at intestinal anastomosis, a procedure that necessitates a high level of precision and repetitive motion. The most difficult step in gastrointestinal surgery is connecting two ends of an intestine, which requires a surgeon to suture with extreme precision and consistency. Even the tiniest hand tremor or misplaced stitch can cause a leak, which can lead to life-threatening complications for the patient.

Krieger assisted in the development of the robot, a vision-guided system designed specifically to suture soft tissue, with collaborators at the Children’s National Hospital in Washington, D.C. and Jin Kang, a Johns Hopkins professor of electrical and computer engineering. Their current version improves on a 2016 model that accurately repaired a pig’s intestines but required a large incision to access the intestine and other complications.

Their findings show that we can automate one of the most intricate and delicate tasks in surgery: the reconnection of two ends of an intestine. The STAR performed the procedure in four animals and it produced significantly better results than humans performing the same procedure,” said senior author Axel Krieger, an assistant professor of mechanical engineering at Johns Hopkins’ Whiting School of Engineering.

The design and development

The team equipped the STAR with new features for enhanced autonomy and improved surgical precision, including specialized suturing tools and state-of-the-art imaging systems that provide more accurate visualizations of the surgical field.

Soft-tissue surgery is especially hard for robots because of its unpredictability, forcing them to be able to adapt quickly to handle unexpected obstacles, Krieger said. The STAR has a novel control system that can adjust the surgical plan in real-time, just as a human surgeon would.

“What makes the STAR special is that it is the first robotic system to plan, adapt, and execute a surgical plan in soft tissue with minimal human intervention,” – Krieger at Sceince daily

STAR is guided by a three-dimensional endoscope based on structural light and a machine learning-based tracking algorithm developed by Kang and his students. As the medical field moves toward more laparoscopic surgical approaches, having an automated robotic system designed for such procedures will be critical.

“Robotic anastomosis is one way to ensure that surgical tasks that require high precision and repeatability can be performed with more accuracy and precision in every patient independent of surgeon skill,” added Krieger. “We hypothesize that this will result in a democratized surgical approach to patient care with more predictable and consistent patient outcomes.”

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