Will robots take over in surgery?

The STAR robot suturing intestinal tissue. Credit: Azad Shademan et al./Science Translational Medicine

Robots are now a common presence in surgery. The Da Vinci robot is now present in over 3000 surgery rooms around the world and it is estimated that the number of surgeries performed every year exceeds 200,000.

However, Da Vinci, as the many other robots used in surgery rooms, is an assistant to the surgeon. It is up to the surgeon to operate it. Da Vinci provides finer granularity (like the possibility of cutting a tissue by a tenth of a mm, something that would be impossible to do by hand) and also stabilise the operating field (by creating an instruments movement that is synchronous with the movement of a patient organ, like a beating heart) thus allowing the surgeon to operate as if the operating field were completely still.

Moving to an autonomous robot that performs the surgery requires a robot that understands what is going on and what should be done. This is a big step.

A practical, and common situation, is a surgery performed on a soft tissue, like the gut. An anastomoses of the gut (cutting out a segment and the joining the stubs) is tricky for a robot because as it manipulates the tissue the tissue changes its shape and the robot needs to see this deformation and act to compensate for it.

A team of researchers at Sheikh Zayed Institute, in Abu Dhabi, developed STAR, a robotic system that can operate autonomously on soft tissue. At John Hopkins researchers decided to test the performances of STAR and are reporting the result in an article on  Science Translational Medicine. They show that the robot can indeed perform the suture of soft tissue with systematic and consistent high quality result. The "consistency" is very important, since statistics show that some 20% of sutures of soft tissues fail somehow. Moving to a 100% success is a great step forward considering that in just the USA there are over 1 million anastomoses performed every year (200,000 of which result in complications because of faulty sutures).

The crucial component in STAR is its advances vision system based on a plenoptic three dimensional near infrared image system and a related software that "understands" what the images captured mean. To help the software understand the deformation of the soft tissues the surgeon prepares it by inserting markers that are used as reference points by the image system.

It is an amazing result, and it also shows that innovation happens everywhere in the world.

Of course we are just starting in this autonomous robot surgeon, and, at least myself, we may not be psychologically prepared to a robot taking over... 

Author - Roberto Saracco

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