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Autonomous robotic laparoscopic surgery for intestinal anastomosis

Autonomous robotic surgery systems can improve efficiency, safety, and consistency. A recent paper proposes a method to perform autonomous robotic laparoscopic surgery for small bowel anastomosis.

A laparoscopic operating theatre. Image credit: Dr. Jayesh Amin via Wikipedia, CC-BY-SA-3.0

Firstly, the enhanced autonomy necessary to perform this operation is achieved using the Smart Tissue Autonomous Robot. The operator only has to select among suggested suture plans and monitor the robot for repeating a stitch as needed.

Also, the laparoscopic implementation of the enhanced autonomous strategy is created. Machine learning, computer vision, and advanced control techniques are used to track the target tissue movement in response to patient breathing, detect the tissue deformations between different suturing steps, and operate the robot under motion constraints.

Experiments show that the developed system could match the performance of expert surgeons and at the same time exhibit an elevated level of consistency.

Autonomous robotic surgery has the potential to provide efficacy, safety, and consistency independent of individual surgeon’s skill and experience. Autonomous anastomosis is a challenging soft-tissue surgery task because it requires intricate imaging, tissue tracking, and surgical planning techniques, as well as a precise execution via highly adaptable control strategies often in unstructured and deformable environments. In the laparoscopic setting, such surgeries are even more challenging because of the need for high maneuverability and repeatability under motion and vision constraints. Here we describe an enhanced autonomous strategy for laparoscopic soft tissue surgery and demonstrate robotic laparoscopic small bowel anastomosis in phantom and in vivo intestinal tissues. This enhanced autonomous strategy allows the operator to select among autonomously generated surgical plans and the robot executes a wide range of tasks independently. We then use our enhanced autonomous strategy to perform in vivo autonomous robotic laparoscopic surgery for intestinal anastomosis on porcine models over a 1-week survival period. We compared the anastomosis quality criteria—including needle placement corrections, suture spacing, suture bite size, completion time, lumen patency, and leak pressure—of the developed autonomous system, manual laparoscopic surgery, and robot-assisted surgery (RAS). Data from a phantom model indicate that our system outperforms expert surgeons’ manual technique and RAS technique in terms of consistency and accuracy. This was also replicated in the in vivo model. These results demonstrate that surgical robots exhibiting high levels of autonomy have the potential to improve consistency, patient outcomes, and access to a standard surgical technique.

Research article: H. Saeidi, J. D. Opfermann, M. Kam, S. Wei, S. Leonard, M. H. Hsieh, J. U. Kang, A. Krieger. Autonomous robotic laparoscopic surgery for intestinal anastomosis. Science Robotics, 2022; 7 (62). Link: https://www.science.org/doi/10.1126/scirobotics.abj2908

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