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Not even the surest surgeon’s hand is quite as steady and consistent as a robotic arm
built of metal and plastic, programmed to perform the same motions over and over.
So could it handle the slippery stuff of soft tissues during a surgery?
A Team including a Johns Hopkins University computer scientist just published research
showing that a robot surgeon can indeed adjust to the subtle movement and deformation of
soft tissue to execute precise and consistent suturing. The research promises to improve
results for patients and make the best surgical techniques more widely available.
Limited robotic automation is already used in surgeries involving rigid structures such
as bones, which are much easier to hold still during the procedure. Soft tissue can move
and change shape in complex ways as stitching goes on, requiring a surgeon’s skill to
respond to these changes to keep suturing as tightly and evenly as possible.
According to the researchers, more than 44.5 million soft-tissue surgeries are performed
in the United States each year.
The published results involved suturing two structures. This procedure called anastomosis,
meaning joining two tubular structures such as blood vessels is performed over a million
times a year in the United States. According to the researchers, complications such as
leakage along the seams occur nearly 20 percent of the time in colorectal surgery and 25 to
30 percent of the time in abdominal surgery.
Robotic soft tissue surgery promises substantial benefits through improved safety from reduction
of human errors and increased efficiency due to procedure time reduction. This surgery,
however, could present a challenge in that it can be tricky for a robot to adjust to
the soft tissue’s slips and squirms during suturing.
To perform the experiment, the researchers developed a robotic surgical system called
the Smart Tissue Automation Robot (STAR). It features a 3D imaging system and a near-infrared
sensor to spot fluorescent markers along the edges of the tissue to keep the robotic suture
needle on track. Unlike most other robot-assisted surgical systems, it operates under the surgeon’s
supervision, but without hands-on guidance
The STAR robotic sutures were compared with the work of five surgeons completing the same
procedure using three methods: open surgery, laparoscopic and robot assisted surgery. Researchers
compared consistency of suture spacing, pressure at which the seam leaked, mistakes that required
removing the needle from the tissue or restarting the robot, and completion time.
The robot’s time was longer than open and robot assisted surgery, but comparable to
the laparoscopic procedure. The robotic procedure lasted 35 to 57 minutes, while the open surgery
took eight minutes. By all other measures, the robot’s performance was comparable or
better than the surgeons.’