Putting surgery one step closer into the realm of self-driving cars and intelligent machines, researchers show for the first time that a supervised autonomous robot can successfully perform soft tissue surgery. The results appear in the 4 May issue of Science Translational Medicine.
The robot outperformed expert surgeons and current robot-assisted surgical techniques in open bowel surgery in pigs. By taking human intervention out of the equation, autonomous robots could potentially reduce complications and improve care for patients undergoing soft tissue surgeries, about 45 million of which are performed in the U.S. each year.
“This is an early stage, an early era in autonomous surgery,” said Peter Kim of Children’s National Medical Center at a 3 May press teleconference. “The goal again is not to replace surgeons, but by having a tool like this and by making the procedures more intelligent, we can ensure sort of better outcomes for patients.”
Robot-assisted surgery currently relies on the surgeon to manually control it, and outcomes can vary depending on the individual’s training and experience. Efforts in automating surgery have made headway for hard tissues, such as in bone cutting, but have proven challenging for soft tissues, which are malleable and mobile and, thus, more unpredictable.
Dr. Azad Shademan and Ryan Decker during supervised autonomous in-vivo bowel anastomosis performed by the Smart Tissue Autonomous Robot (STAR). | Axel Krieger
Kim and colleagues designed and programmed Smart Tissue Autonomous Robot (STAR) to perform complex surgical tasks. Equipped with a robotic arm and surgical tools, STAR combines smart imaging technologies and fluorescent markers to navigate and adapt to the complexities of soft tissue.
The researchers tested their robot against manual surgery by expert surgeons, laparoscopy, and robot-assisted surgery with the da Vinci Surgical System. Under supervision, STAR proved superior to all approaches in suturing and reconnecting bowel segments, known as intestinal anastomosis, both ex vivo and in vivo in pigs.
“Surprisingly, when you add intelligence to it [surgery], the outcome is better,” said Kim. The robot performed about 60% of the procedure fully autonomously and 40% with minor adjustments by the researchers. The animals survived the operation with no complications.
Many components of STAR, including the robotic arm and imaging tools, are readily available, which could help bypass regulatory hurdles and speed up development, according to Kim. The robot could potentially tackle tumor surgery, gallbladder operations, appendix removal, and many other soft tissue surgeries.
“We should be able to apply this beneficial technology into clinical space in the not too distant future,” said Kim. “I expect that at some point this could be available to anybody and everybody.”