Supervised autonomous robotic soft tissue surgery

TLDR

Robot‑assisted surgeries rely solely on a surgeon’s manual skill, and soft‑tissue procedures have remained non‑autonomous due to insufficient vision and intelligent algorithms. The study aims to develop autonomous robotic surgery that eliminates manual intervention to improve efficacy, safety, and access to optimized techniques. The authors performed in vivo supervised autonomous soft‑tissue surgery using a plenoptic 3‑D and near‑infrared fluorescent imaging system coupled with an autonomous suturing algorithm that plans complex tasks on deformable tissue, and they compared anastomosis metrics against manual laparoscopic and conventional RAS approaches. The supervised autonomous system achieved superior outcomes compared to expert surgeons and conventional RAS in ex vivo porcine tissues and live pigs, demonstrating its potential to enhance efficacy, consistency, functional outcome, and accessibility of surgical techniques.

Abstract

The current paradigm of robot-assisted surgeries (RASs) depends entirely on an individual surgeon's manual capability. Autonomous robotic surgery-removing the surgeon's hands-promises enhanced efficacy, safety, and improved access to optimized surgical techniques. Surgeries involving soft tissue have not been performed autonomously because of technological limitations, including lack of vision systems that can distinguish and track the target tissues in dynamic surgical environments and lack of intelligent algorithms that can execute complex surgical tasks. We demonstrate in vivo supervised autonomous soft tissue surgery in an open surgical setting, enabled by a plenoptic three-dimensional and near-infrared fluorescent (NIRF) imaging system and an autonomous suturing algorithm. Inspired by the best human surgical practices, a computer program generates a plan to complete complex surgical tasks on deformable soft tissue, such as suturing and intestinal anastomosis. We compared metrics of anastomosis-including the consistency of suturing informed by the average suture spacing, the pressure at which the anastomosis leaked, the number of mistakes that required removing the needle from the tissue, completion time, and lumen reduction in intestinal anastomoses-between our supervised autonomous system, manual laparoscopic surgery, and clinically used RAS approaches. Despite dynamic scene changes and tissue movement during surgery, we demonstrate that the outcome of supervised autonomous procedures is superior to surgery performed by expert surgeons and RAS techniques in ex vivo porcine tissues and in living pigs. These results demonstrate the potential for autonomous robots to improve the efficacy, consistency, functional outcome, and accessibility of surgical techniques.