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Recently, the House of Instruments learned that the robot designed by researchers at Johns Hopkins University performed extremely complex surgeries on pigs without human help. This is the world's first autonomous laparoscopic operation performed by a surgical robot, and it may only be the future of laparoscopic surgery.
The Intelligent Tissue Autonomous Robot (STAR) performed four very tricky gastrointestinal surgeries to demonstrate its surgical capabilities. While existing robotic laparoscopic surgical systems do make certain procedures safer and less invasive, these systems are still operated by human surgeons. Now, however, the surgical robot has completed a delicate operation entirely on its own.
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The first autonomous surgical robot
Autonomous robotic surgery has the potential to provide efficacy, safety, and consistency independent of the skills and experience of an individual surgeon. Autonomous anastomosis is a challenging soft tissue surgical task because it requires sophisticated imaging, tissue tracking, and surgical planning techniques, as well as precise execution of highly adaptive control strategies, often in unstructured and deformable environments. In a laparoscopic setting, this type of surgery is more challenging because of the need for high operability and reproducibility due to movement and vision limitations.
Autonomous robotic surgical systems, such as Intuitive Surgical Inc., have significant potential for efficiency, safety, and consistency compared to current remotely controlled robotic surgery (RAS). Autonomous robotic systems are designed to provide standard surgical solutions independent of individual experience and daily performance variations. Mature examples of autonomous surgical robotic systems include TSolution One (1) (THINK Surgical) for rigid bone tissue surgery, ARTAS (2) (Restoration Robotics Inc.) for hair repair, and Veebot (3) (Veebot LLC) sampling for autonomous blood.
Currently, state-of-the-art autonomous capabilities are implemented in the Cyber Knife robot (4) (Accuracy Inc.), which performs radiosurgery on brain and spine tumors under human supervision. However, the robot uses a non-contact treatment for tissues enclosed in rigid bone structures. Despite these efforts, autonomous soft tissue surgery still faces considerable challenges.
Autonomous soft tissue surgery in unstructured environments requires accurate and reliable imaging systems to detect and track target tissue, complex task planning strategies that consider tissue deformation, and precise execution of planning through dexterous robotic tools and control algorithms for dynamic surgery.
In this highly variable environment, preoperative surgical planning, such as in rigid tissue, is not a viable solution. In the case of laparoscopic surgery, the difficulty is further increased due to limited proximity and visibility of the target tissue and interference with respiratory movement artifacts. Anastomosis is a soft tissue surgical task that involves the approximation and reconstruction of luminal structures, requiring high operability and reproducibility, and is therefore a suitable candidate for examining autonomous robotic surgical systems in soft tissue surgical scenarios.
The robot platform consists of a KUKA LBR Med lightweight robot equipped with an electric commercial Endo 360 stitching tool with pitch control. The camera system allows the measurement of tissue geometry at a distance of 5 to 8 cm from the tissue. The system enables dynamic position control of the camera system via a linear platform to prevent collisions between the camera system and the stitching tool when STAR performs the suture plan.
It also built a customized laparoscopic imaging system for in vivo animal studies through STAR. The projector and monochrome camera are used to reconstruct the 3D point cloud of the sample, and the NIR light source and NIR camera are used for fluorescently labeled imaging, enabling both cameras simultaneously through the non-overlapping imaging spectral window.
In addition, white light sources were added to monitor the environment in the animals when necessary, and NIR and 3D cameras enabled the robot to reconstruct a 3D model of the tissue and plan the robot's suture line planning. Detailed specifications of the imaging system are provided in the complementary method, in which in practice the camera is placed 5 to 8 cm from the target tissue for collecting 3D point clouds, while the suture tool retracts from the field of view to prevent occlusion and collision with the surgical area.
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Complete animal experiments
Bowel anastomosis is the process by which the surgeon reconnects two previously disconnected ends of the intestine. It is worth noting that it requires very high precision during the suturing process. Sounds simple, right? It's not that simple. A Johns Hopkins press release suggests that anything imperfect can have devastating (and potentially fatal) results for patients.
It's pretty remarkable, so to speak, that robots are able to do that. STAR did it not only once, but four times. And performing better than humans when performing the same procedure, it sounds like robot surgery may soon appear on the surgical method selection column.
This is especially noteworthy given the sensitivity of soft tissue surgery. As Axel Kreiger, an assistant professor of mechanical engineering at Johns Hopkins University, points out in a press release from Hopkins University, this is a surgery that requires surgeons to adapt and think quickly to prevent complications. Of course, robots aren't inherently known for their ability to think quickly. But thanks to its novel control system, STAR undoubtedly proves an exception to this rule.
"Robotic anastomosis is one way to ensure that every patient can perform surgical tasks that require high precision and repeatability with greater accuracy and precision, regardless of the surgeon's skill," Krieger said. "We hypothesize that this will lead to a more predictable and consistent surgical approach to patient care."
The STAR project is a collaboration between Krieger, a professor of electrical and computer engineering at Hopkins University, and Jin Kang, and the National Children's Hospital in Washington, D.C. This particular model is an update of their 2016 robot, which can repair pig intestines, but not without human help. Their current iteration advances the 2016 model, which accurately repairs the intestines of pigs but requires large incisions to get into the intestines and requires more human guidance.
The team equipped STAR with new features to enhance autonomy and improve surgical accuracy, including specialized suture tools and state-of-the-art imaging systems that provide more accurate visualization of the surgical area.
As the medical field moves toward more laparoscopic surgical approaches, it will be important to have an automated robotic system designed for this type of surgery to help. Robotic anastomosis is one way to ensure that every patient can perform surgical tasks that require high precision and repeatability with greater accuracy and precision, regardless of the surgeon's skill. This will lead to a democratized surgical approach to patient care with more predictable and consistent patient outcomes.
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Soft tissue surgery is particularly difficult for autonomous robots because its unpredictability forces robots to adapt quickly to deal with unexpected obstacles. The STAR robot performed laparoscopic surgery on the soft tissues of pigs without human guidance, an important step towards fully automated human surgery.
Frankly, the idea of more automated surgery sounds a bit unrealistic, but given star's success, we're optimistic. In the future, there will be many automated robots entering the medical field, not limited to the experience of doctors, providing consistent surgical diagnosis and treatment, and exerting their advantages, and the device house will continue to pay attention.