Robots could perform heart and cancer surgery
Scientists have shown for the first time a supervised autonomous robot can successfully perform soft tissue surgery.
Although robots have been used in British hospitals for 16 years, they can only be worked by surgeons.
Now a supervised autonomous robot has been able to successfully perform soft tissue surgery, outperforming experts in open bowel surgery in pigs.
By taking human intervention out of the equation, they could potentially reduce complications and improve the safety and efficacy of operations.
Dr Peter Kim, of the Children’s National Medical Centre, Washington DC, said: “Probably the most surprising part was when you compare it to current standards of practise, the machine does it better.
“Just imagine having the best technology and technique available and having these intelligent systems. It will ultimately have better outcomes and save lives.”
He said with further development, autonomous robotic surgery may one day take human error out of the operating room, improving care for patients undergoing bowel surgery, tumour removal and other soft tissue surgery.
His researchers designed and programmed Smart Tissue Autonomous Robot (STAR) to perform complex surgical tasks.
Equipped with a robotic arm and surgical tools, STAR combines smart imaging technologies and fluorescent markers to navigate and adapt to the complexities of soft tissue.
The researchers tested their robot against manual surgery by expert surgeons, carrying out a simple bowel procedure called a laparoscopy, and robot-assisted surgery with the da Vinci Surgical System.
Under supervision, STAR proved superior to all approaches in suturing and reconnecting bowel segments, known as intestinal anastomosis, in experiments on pigs.
The animals survived the operation with no complications, reports Science Translational Medicine.
Dr Alex Krieger, also of the Children’s Medical National Centre, said: “Current robotic surgery is tele-operated. The robot is directed by the surgeon.
“Our innovation is really to make it more autonomous, so you do not have to direct every motion.
“You program in what is the ideal spacing between sutures, what is the perfect tension and how many sutures should be placed and then the robot executes this suturing plan.”
Efforts in automating surgery have made headway for hard tissues, such as in bone cutting, but have proven challenging for soft tissues, which are malleable and mobile and, thus, more unpredictable.
Dr Kim said: “It is not enough a human being does 19 out of 20 stitches. You have to do all 20 of them well so you have a good outcome. The machine will consistently throw in 20 perfect sutures.
He explained for the purpose of the study it was about 60 percent autonomous, and 40 percent supervised.
Explained Dr Kim: “We made some adjustments. If you look at our results these were minor, very like when you are seeing your little baby learning to walk!
“We were a little nervous about it, to make sure it did it the right way. But it can be fully autonomous for the task we were doing.”
Since the first surgical robot arrived at St Mary’s Hospital, London, in 2000, the number of them in UK hospitals has multiplied rapidly. Most common is the da Vinci robot, a set of three or four robotic arms controlled by a human surgeon sitting a few feet away.
There are currently 58 of these surgical systems in the NHS, undertaking operations for a variety of common complaints, from the removal of kidney and bladder cancers to basic heart surgery - though their main use is in surgical removal of the prostate gland and surrounding tissue in men with prostate cancer.
In 2012, 1,595 of these operations were carried out using robots - 29 per cent of the total performed.
In future there could be many more robot operations. Earlier this year, Bristol Royal Hospital for Children used a Neuro-Mate robot to drill into the brain of a teenager with epilepsy and implant electrodes to detect the area triggering his seizures. Once located, this scrap of tissue was removed.
But safety concerns have been raised in the US, where several lawsuits have been filed against Intuitive Surgical, which makes the da Vinci robot.