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Smart Machines in Surgery: STAR’s Rise in the Robotic Revolution

In a groundbreaking advancement of smart machines in surgery, a Smart Tissue Autonomous Robot (STAR) successfully stitched up a pig’s small intestines using its own vision, tools, and intelligence. Surprisingly, STAR outperformed human surgeons in the same task.

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While STAR’s creators do not claim that robots will replace human surgeons anytime soon, they view this achievement as a proof of concept for both the specific technologies utilized and the concept of “supervised autonomy” in the operating room.

During a recent press call, Pediatric surgeon Peter Kim, one of the researchers, expressed enthusiasm rather than concern about the robot’s capabilities. He stated, “Having a machine that collaborates with us to improve outcomes and safety would be a tremendous benefit, despite us surgeons taking pride in our craft of performing procedures.”

For the study, published in the journal Science Translational Medicine, the researchers programmed STAR to perform intestinal anastomosis, a procedure involving stitching together a piece of cut intestine. This task requires tight and regularly spaced sutures to prevent leaks, much like repairing a garden hose. STAR accomplished this on both ex vivo tissue in the lab and in vivo tissue in an anesthetized pig. Human surgeons experienced in the procedure were also tasked with the same operations. The comparison of resulting sutures revealed that STAR’s stitches were more consistent and leak-resistant.

Smart Machines in Surgery
Smart Machines in Surgery

Of course, the robot received some assistance during approximately 40 percent of its trials. Human researchers intervened to provide guidance when needed, as seen in the accompanying GIF where a human hand holds the thread. However, in the remaining 60 percent of trials, STAR completed the task entirely on its own.

The researchers stand by their claim of autonomy, asserting that the setup replicates potential shared control scenarios suitable for real operating rooms. In such scenarios, human surgeons could supervise procedures or delegate certain tasks to the robot, allowing the machine to handle routine or tedious portions of the operation. For critical moments, the surgeon would closely monitor the robot, ensuring optimal performance. The goal is not to replace human expertise but to enhance surgical capabilities through collaboration with advanced technology.

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Today, smart machines already play a role in certain surgical procedures. Robots take on critical steps in surgeries like orthopedic knee replacements, Lasik eye surgery, and hair transplants. However, these surgeries share a common characteristic: their targets remain stationary during the procedure, making automation feasible. On the other hand, soft tissue surgeries present a greater challenge due to the shifting nature of the body’s soft and slippery components, making automation more difficult.

Currently, the leading robot for soft tissue surgery is the da Vinci system from Intuitive Surgical, but it operates through teleoperation rather than automation. In this system, the surgeon manipulates controls from a console, and the robot mimics these movements with tiny tools inside the patient’s body.

STAR integrated various technologies to overcome the complexities of soft tissue surgery. It utilized a vision system with near-infrared fluorescent (NIRF) tags embedded in the intestinal tissue. A specialized NIRF camera tracked these markers, while a 3D camera recorded images of the entire surgical field. By combining this data, STAR maintained focus on its target and adapted its suturing plan as tissues moved during the operation.

The researchers exclusively trained STAR for this specific intestinal suturing procedure, programming the machine with the best surgical techniques based on consensus and physics.

While an external surgical robotics expert considered this study a breakthrough, they also acknowledged its limitations, suggesting that fully autonomous robots in the operating room may not be imminent. One limitation was that the robot relied on NIRF tags placed by humans. Moreover, the expert questioned the significance of the chosen task, as staplers routinely perform much of such suturing in a matter of seconds.

The STAR team clarified that their intention was to demonstrate that autonomous robots could handle the challenges of soft tissue surgery. Although the robot might not be prepared to take over surgical procedures entirely, the lead researcher, Kim, hopes that the technology will be integrated into commercial devices within the next few years.

If robotic systems can prove their worth in enhancing safety and patient outcomes, medicine might follow the trajectory of the automobile industry, starting with assisting human surgeons and, eventually, potentially taking over certain aspects of surgery. Kim drew a parallel with the evolution of driverless cars, starting with features like self-parking and lane guidance, eventually leading to fully autonomous vehicles. In a similar manner, surgical robots could begin by supporting human surgeons and, perhaps, advance to a more dominant role in the future.

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