Robot performs first laparoscopic surgery without human help
Johns Hopkins University
Designed by a team of Johns Hopkins University
researchers, the Smart Tissue Autonomous Robot (STAR) is described today
in Science Robotics.
"Our
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 robot excelled at intestinal anastomosis, a procedure that requires a high level of repetitive motion and precision. Connecting two ends of an intestine is arguably the most challenging step in gastrointestinal surgery, requiring a surgeon to suture with high accuracy and consistency. Even the slightest hand tremor or misplaced stitch can result in a leak that could have catastrophic complications for the patient.
Working
with collaborators at the Children's National Hospital in Washington, D.C. and
Jin Kang, a Johns Hopkins professor of electrical and computer engineering,
Krieger helped create the robot, a vision-guided system designed specifically
to suture soft tissue. Their current iteration advances a 2016 model that
repaired a pig's intestines accurately, but required a large incision to access
the intestine and more guidance from humans.
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 said.
A
structural-light based three-dimensional endoscope and machine learning-based
tracking algorithm developed by Kang and his students guides STAR. "We
believe an advanced three-dimensional machine vision system is essential in
making intelligent surgical robots smarter and safer," Kang said.
As
the medical field moves towards more laparoscopic approaches for surgeries, it
will be important to have an automated robotic system designed for such
procedures to assist, Krieger said.
"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," Krieger said. "We
hypothesize that this will result in a democratized surgical approach to
patient care with more predictable and consistent patient outcomes."
The
team from Johns Hopkins also included Hamed Saeidi, Justin D. Opfermann,
Michael Kam, Shuwen Wei, and Simon Leonard. Michael H. Hsieh, director of
Transitional Urology at Children's National Hospital, also contributed to the
research.
The
work was supported by the National Institute of Biomedical Imaging and
Bioengineering of the National Institutes of Health under award numbers
1R01EB020610 and R21EB024707.
