In recent years, the demand for surgical robots in the medical market has continued to grow. Many giant companies at home and abroad have deployed the surgical robot market one after another. The monopoly of the original Da Vinci surgical robot has been gradually broken. Driven by capital, surgical robots continue to make new progress in technology, and the technology of thoracic and laparoscopic surgical robots has gradually matured.
Laparoscopic surgical robot is known as the "aircraft carrier in the field of medical devices", and it is one of the research and development directions in the field of surgical robots with extremely complex systems, great technical difficulties, and extremely high clinical and commercial value. In abdominal surgery, the surgery is extremely difficult due to limited access and visibility of the target tissue, coupled with artifacts caused by respiratory motion.
Recently, a research team from Johns Hopkins University has designed an intelligent tissue autonomous robot STAR, which successfully completed soft tissue laparoscopic surgery on a pig without human guidance.
The related research, titled "Autonomous robotic laparoscopic surgery for intestinal anastomosis", was published in the scientific journal Science Robotics.
This study achieves the enhanced autonomy required to perform robotic laparoscopic small bowel anastomosis using the Intelligent Tissue Autonomous Robot (STAR), and is able to perform enhanced fully anastomotic autonomous operation under laparoscopy, marking a step toward robotics toward fully automated human surgery. important step.
Caption: Robot performed laparoscopic surgery on pig soft tissue without human assistance
"Our results show that we can automate one of the most complex and delicate tasks in surgery -- Reconnecting the two ends of the gut. STAR performed the surgery on four animals, and it was significantly better than doctors performing the same surgery."
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The first autonomous surgical robot to perform anastomosis in soft tissue
Surgical robots have been developed for many years, but most of them are assisted surgical systems, such as the world-leading Da Vinci surgical robot, which is controlled by a surgeon to assist in surgery. There are still considerable challenges in achieving autonomous surgery.
Autonomous soft tissue surgery requires the surgical robot to have an accurate and reliable imaging system to detect and track the target tissue. Factors such as the increase in the complexity of the surgery caused by soft tissue deformation also need to be considered, and the robot system has high requirements. Laparoscopic surgery is a typical application scenario. Due to the limited access and visibility of the target tissue, coupled with the artifact interference caused by breathing motion, the operation is extremely difficult. In surgery, anastomosis just happens to be a suitable scenario to investigate an autonomous robotic surgical system for soft tissue surgery. The purpose of this operation is to join the two broken ends of the soft tissue and restore the continuous physiological structure, such as gastrointestinal anastomosis, fallopian tube anastomosis, tendon anastomosis, etc. Technically, it involves the approximation and reconstruction of the cavity structure, which requires extremely high operability and repeatability of the operation. Although existing autonomous surgical robots have made significant progress, most systems still exhibit low autonomy in complex tasks and are highly dependent on doctors. In this study, Axel Krieger et al. designed an enhanced autonomous STAR system for laparoscopic surgical scenarios, equipped with specialized suturing tools and a state-of-the-art imaging system. Using near-infrared markers, the imaging system can track the start and end points of the target tissue suturing process, and has strong robustness to the occlusion of blood and thin tissues during surgery, and the system's autonomy and surgical precision are enhanced.
Legend: Enhanced Autonomous Laparoscopic Soft Tissue Surgery (A: Components of the STAR system, including a medical robotic arm, actuated surgical tools, and dual-channel near-infrared and 3D structured light endoscopic imaging systems; B: Enhanced autonomous control of STAR Policy Control Architecture)
Connecting the two ends of the bowel is arguably the most challenging step in gastrointestinal surgery, requiring surgeons to suture the bowel with precision and consistency, even with the slightest tremor of hands or misplaced sutures during surgery. Both may lead to the leakage of intestinal secretions and bring catastrophic complications to patients.
Researchers used STAR to perform in vivo laparoscopic autonomous surgery on the porcine small intestine. Before surgery, the operator starts STAR through a graphical user interface, and the system autonomously generates suturing algorithms and implements suturing tasks. During the suturing process, the operator fine-tunes the suturing steps through the GUI before STAR executes the suture plan, but much of the workflow is done autonomously.
During laparoscopic surgery, the movement of the target tissue due to the pig's breathing and other tissue movements can make the surgery more difficult. To this end, the researchers developed a machine learning algorithm based on convolutional neural networks and near-infrared camera feedback to track the movement of target tissue during surgery.
"Soft tissue surgery is especially difficult for robots because its unpredictability forces them to adapt quickly to deal with unexpected obstacles," Krieger said. "STAR is a novel control system that adjusts surgical plans in real time like a surgeon." STAR's What makes it special is that it is the first robotic system to autonomously plan, adjust and execute surgical plans in soft tissue with minimal human intervention during surgery."
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Suture technology comparable to surgeons
To test the efficacy of the surgery, the piglets were monitored for 1 week of postoperative survival and a limited necropsy was performed. Survival study results showed that the STAR system was comparable to the performance of expert surgeons in metrics such as leak-free anastomosis and lumen patency, and the system demonstrated even higher levels of agreement.
Legend: In vivo results (A: Representative histological examples of each anastomotic tissue manipulated with STAR (n = 4) and manual laparoscopic control experiments (n = 1); B) PMN cells as the Proxy finger for inflammation; C: Representative example of anastomotic stoma collected at necropsy for STAR and control testing. )
Although the research has made breakthrough progress, there are still some limitations in the surgical technique and effect. For example, the successful implementation of robotic control algorithms depends on factors such as the accessibility of the target tissue in a certain work area. Comparisons of STAR robotics, manual laparoscopic surgery, and remote da Vinci surgery were performed on phantom tissue, whereas in vivo studies It is not possible to use a da Vinci based test arm.
In future studies, the researchers say, label-free tissue tracking technology will be integrated and tested, reducing the camera system to an endoscope and adding tactile sensors to further improve the system's autonomy and speed up the time it takes for the robot to complete surgery.
Although the role of human supervision cannot be eliminated in complex and unpredictable surgical scenarios, the STAR system can effectively reduce surgical risks due to individual differences in medical experience and abilities of doctors, and improve surgical safety and consistency of surgical results .
As the medical field moves toward more laparoscopic surgical approaches, it's important to have an automated robotic system designed for such procedures, Krieger said. "Robot anastomosis is a way to ensure that each patient can perform surgical tasks that require high accuracy and repeatability with greater accuracy and precision, regardless of the skill of the surgeon. We hypothesize that this will lead to patients A democratized surgical approach to care is more predictable and consistent."
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