An autonomous robot for smart tissue surgery (Smart Tissue Autonomous Robot - STAR) at the Sheikh Ziad Institute for Pediatric Surgical Innovation in Washington, recently performed surgery on a pig to prove the ability of remote surgeries
Surgeons and scientists from the Sheikh Ziad Institute for Pediatric Surgical Innovation in Washington have shown that it is possible to analyze soft tissues under robotic supervision on a living body.
The institute's scientists are the first to show that supervised, autonomous robotic soft tissue surgery on a live patient (in vivo) in an open surgical environment is superior in performance to normal clinical techniques in a dynamic clinical environment (on a living body).
The study, published this week in the journal Translational Science, reports the results of soft tissue surgeries conducted on dead and live pig tissue using robotic surgical technology developed at the institute. This technology removes the surgeon's hands from the procedure, and instead he acts as a supervisor, when the suturing of the soft tissues is planned and performed autonomously by the STAR robotic system.
Soft tissues are the tissues that connect, support or surround other structures and organs in the body such as tendons, ligaments, skin, lipid tissues, fat, muscles, nerves and blood vessels. Today, more than 44.5 million soft tissue surgeries are performed in the US every year.
"Our results demonstrate the potential of using autonomous robots to improve the efficiency, consistency, outcomes and functional accessibility of surgical techniques," said Dr. Peter Kim, associate vice president and chief surgeon, Sheikh Ziad Institute for Pediatric Surgical Innovation in Washington. "The intention in proving this ability is not to replace surgeons, but to expand human ability through improved vision, talent and machine intelligence to improve surgical results."
Hard tissue surgery with robotic technologies is already a procedure that is adopted in many healthcare settings, however, the soft tissue part of the surgery is completely manual, mainly due to unexpected changes in the elasticity of the soft tissues that occur during surgery, which require the surgeon to make constant adjustments.
To overcome this challenge, STAR uses a near-infrared and plenoptic fluorescent marker tracking system that captures the information in the light field and provides the robot with XNUMXD images. This system allows accurate and delay-free tracking of the change in tissue movement throughout the entire surgical procedure. This monitoring is combined with another innovation of STAR: a smart algorithm that guides the surgical plan and makes adjustments independently to the plan in real time according to the changes in the tissues and other changes in real time. In addition, the system has sophisticated sensing capability, sub-millimeter stabilization and powered surgical tools. A light robotic arm is at the side of the bed and contains laparoscopic suturing tools designed for the robot that incorporates eight degrees of freedom.
"Until now, autonomous robot surgery has been limited to applications with hard tissues, such as cutting bone, because they are simpler to predict," said Axel Krieger PhD, technical lead of the project for smart tools at the Sheikh Zayed Institute. "Using tissue tracking and force measurement applications and combined with automated suturing software, our robotic system can detect arbitrary tissue movements in real time and adjust itself automatically."
To compare the effectiveness of STAR to other available surgical procedures, the study included two different surgeries performed on dead porcine tissue, which involved linear suturing of the intestines from end to end including connection to the tubular loops of the intestine. The results of each surgery were compared with the same surgical procedure performed manually by an experienced surgeon, by laparoscopy, and by RAS (Robot-assisted surgery) with the DaVinci surgical system, which has been used for twenty years (while developing new generations) for robotic surgeries.
Four such surgeries were then performed on live pigs (in vivo) using the STAR technology and all the pigs survived it without complications. The study compared these results to the same procedure performed manually by an experienced surgeon using standard surgical tools.
"We chose the complex task of bowel surgery because this surgery is performed over a million times in the US every year," said Dr. Kim.
All surgeries were compared according to the values of the indices in the surgery, including the consistency of suturing based on average suture spacing, the pressure at which the suture leaked, number of mistakes that caused the needle to be removed from the tissue, completion time and lumen reduction - a measure of shrinking the size of the tube opening.
The comparison showed that autonomous robotic procedures supervised by STAR proved superior to surgeries performed by experienced surgeons and RAS techniques both on static porcine tissues and on live samples in areas such as consistent suture spacing, which helps accelerate healing, and high resistance to pressures that cause leakage. Leaks can be a significant complication in such an operation. Errors requiring needle removal were minimal and lumen reduction in STAR surgeries was within the acceptable range.
However, the manual control surgery took less time, eight minutes compared to 35 minutes for the rapid STAR procedure, but researchers note that the duration of the STAR surgery was similar to the average of a standard laparoscopic surgery ranging from 30 to 90 minutes, depending on the complexity of the procedure.
Dr. Kim said that autonomous robotic surgery of soft tissues has been proven effective, the next step in the development cycle will be further miniaturization of the sensors and their improvement to enable wider use of the STAR system. According to him, with the right commercial partner, some or all of the technology can be brought to clinical use in the coming years.
The Sheikh Zayed Institute of Surgical Innovation in Pediatric Surgery is a center of innovation in pediatric surgeries with the aim of making them less invasive and painless. It was founded in 2010 with a donation of 150 million dollars from the government of Abu Dhabi. Today, the institute employs over 20 researchers and 70 technical and scientific staff members, including graduate students and colleagues.
The institute is supported by over 600 doctors and clinical scientists from the National Institute for Pediatric Surgery Research.
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A hospital named after a Muslim sheikh dissected a pig?!