According to a study, published in the Science Translational Medicine journal on 4th May, 2016, asurgery performed on a pig’s intestines turned out to be the equivalent in quality toa surgery performed by experienced surgeons.
All experiments were performed by a “Smart TissueAutonomous Robot”(STAR). STAR made surgical stitches on a pig’s intestines using its own smart tools, optics and decision-making capabilities. Skilled surgeons were given the same task of stitching pig’s intestines, in which STAR outperformed them. The researchers believed that by assigning the surgical tasks to autonomous robots,the outcomes of 44.5 million soft tissue surgeries performed each year in the US could be improved.
For this study, the researchers programmed the robot to perform a surgical procedure called intestinal anastomosis, in which a part of intestine that has been cut is sewn back together. The process is similar to stitching a piece of cloth back togetherinsofar as the sutures must be tightly sewn and there should be enough space in the stiches to prevent leaks.
STAR performed the surgery both on living tissue inside the pig and on live tissue samples in the lab while the same tasks were assigned to the team of surgeons. Results showed that STAR’s stiches were more accurate, tightly stitched and more resistant to leaks. One possible reason for this outcome could be that the human hand is more prone to shaking and is less precise than a programmable robotic arm.
STAR was created with the sole objective to reduce human errors, increase efficiency, decrease the time and costs of surgery, and wanted to automate the surgical process so they created STAR. STAR consists of tools for suturing, as well as fluorescent and 3D imaging technologies. The current technology for robotic surgery is the Da Vinci system, from Intuitive Surgical. The Da Vinci system comprises of interactive robotic arms, 3D HD vision system and a console on which the surgeon sits and can control the robotic arms to perform the surgery.Therefore,currently robots are limited in their functionality as they require assistance from surgeons.
STAR required little interference from the surgeons. In 60% of the cases, the robot performed the surgery without any help from the surgeons, while in only 40% of the cases the researchers intervened to assist the robots in making the correct incisions. The researchers were not disheartened by the fact that STAR was not fully autonomous. In fact, they were quite positive on its future applications. The researchers believed that in real world scenarios, STAR would perform quite well, because in operating rooms, surgeons perform many tasks in groups, therefore surgeons’ assistance would actually be quite productive.
On the other hand, surgeons could supervise high risk procedures, trade tasks and assign the routine procedures that were a bit monotonous to the robot. The project’s senior engineer,Ryan Decker said,“You can imagine that if something critical is happening, that would be a point where the surgeon is going to be closely monitoring the robot.I’m sure they wouldn’t feel comfortable just letting it run and going to take a coffee break.”
Many surgical operations today make use of smart technology. Many crucial steps in eye surgeries, hair transplants and knee operations are performed by robots. These procedures are much easier to perform since the target region is immobile. Tissue surgeries, however,can be quite complex since the tissue sample can be difficult to manipulate due to the slippery tissue surface.
The scientists solved this conundrum by incorporating various technologies into the STAR system.Near-infrared fluorescent (NIRF) tags were placed in the intestines that were later tracked by a state of the art NIRF camera. NIRF light offers deeper penetration into the tissue, offers higher contrast and less scattering at deeper tissue layers.
A 3D camera kept a close eye on the whole procedure, by taking pictures of the entire surgical field. By combining all these different techniques, the robot was able to make precise incisions even when the tissue moved.
Future Challenges ForSTAR
The researchers trained STAR on how to perform intestinal anastomosis, based on the leading surgical techniques, physics and scientific advancements. Many robotics experts believe that STAR has brought a revolution in the field of medical technology, but despite being a breakthrough, there are a lot challenges in store for STAR.
Firstly, the NIRF tags were placed in the tissue by humans. So STAR would not have been able to perform the surgery without the tags. Secondly, many of the suturing processes can be done using staplers much quicker.
Leading expert in the field of autonomous robotic surgery at the University of Washington, Blake Hannaford, criticized the use of such expensive equipment on a relatively straightforward procedure.
The scientist said that the surgery was just an experiment to test the capabilities of the robot in real world scenarios. At the moment the robot is not fully capable to perform surgeries on its own. However, researcher Peter Kim hopes that the device will go commercial in a few years.
If robots prove valuable in the field of healthcare, we may see similar rise in popularity as that of automated cars.