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Without the assistance of a human, a robot conducts the first laparoscopic surgery

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A robot has done laparoscopic surgery on a pig’s soft tissue without the assistance of a human, marking a huge step forward in robotics toward fully automated human surgery. The Smart Tissue Autonomous Robot (STAR), developed by a team of Johns Hopkins University researchers, was published today in Science Robotics Without the assistance of a human, a robot conducts the first laparoscopic surgery.

“Our results suggest that one of the most complex and sensitive procedures in surgery, reconnection of two ends of an intestine, may be automated. The technique was done on four animals by the STAR, and the results were much better than those obtained by humans conducting the identical process “Axel Krieger, an assistant professor of mechanical engineering at Johns Hopkins’ Whiting School of Engineering, is the senior author.

The robot performed very well at intestinal anastomosis, a technique that requires a high degree of accuracy and repeated movements. The most difficult stage 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 missed stitch might cause a leak, which can lead to life-threatening problems for the patient.

Krieger assisted in the development of the robot, a vision-guided device intended particularly to suture soft tissue, with researchers at the Children’s National Hospital in Washington, D.C. and Jin Kang, a Johns Hopkins professor of electrical and computer engineering. Their new version improves on a 2016 model that correctly restored a pig’s intestines but needed a huge incision to get access to the bowel and additional human direction.

The researchers added additional capabilities to the STAR for more autonomy and surgical accuracy, including as specialized suturing tools and cutting-edge imaging systems that offer more precise representations of the surgical area.

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Because of the unpredictability of soft-tissue surgery, robots must be able to adapt fast to overcome unanticipated barriers, according to Krieger. The STAR features a unique control system that allows it to make real-time adjustments to the surgical plan, exactly like a human surgeon.

“What distinguishes the STAR is that it is the first robotic system capable of planning, adapting, and executing a surgical plan in soft tissue with minimum human interaction,” Krieger said.

STAR is guided by a three-dimensional endoscope based on structural light and a machine learning-based tracking system created by Kang and his students. “An sophisticated three-dimensional machine vision system, we feel, is critical in making intelligent surgical robots smarter and safer,” Kang added.

As the medical community evolves toward more laparoscopic surgical methods, Krieger believes that having an automated robotic system tailored for such operations would be critical.

“Robotic anastomosis is one method to assure that high-precision, repeatable surgical operations may be completed with more accuracy and precision in every patient, regardless of surgeon competence,” Krieger said. “We believe this will result in a more democratized surgical approach to patient care, with more predictable and consistent patient results,” says the team.

Hamed Saeidi, Justin D. Opfermann, Michael Kam, Shuwen Wei, and Simon Leonard were also on the Johns Hopkins team. Michael H. Hsieh, director of Children’s National Hospital’s Transitional Urology, also participated to the study.

The National Institute of Biomedical Imaging and Bioengineering sponsored the research with grants 1R01EB020610 and R21EB024707 from the National Institutes of Health.

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