Breaking Barriers in Robotic Soft Tissue Surgery: Conditional Autonomous Intestinal Anastomosis

TL;DR

This paper presents the first in vivo autonomous robotic laparoscopic intestinal anastomosis, demonstrating high autonomy, improved consistency, and superior surgical outcomes compared to manual and assisted methods in porcine models.

Contribution

It introduces a novel autonomous robotic system for laparoscopic soft tissue surgery with a level 3 autonomy and demonstrates its effectiveness in live animal models.

Findings

Outperforms manual and RAS in accuracy and consistency

Achieves high-quality anastomosis in vivo

Enhances surgical safety and reliability

Abstract

Autonomous robotic surgery has the potential to provide efficacy, safety, and consistency independent of individual surgeons skill and experience. Autonomous soft-tissue surgery in unstructured and deformable environments is especially challenging as it necessitates intricate imaging, tissue tracking and surgical planning techniques, as well as a precise execution via highly adaptable control strategies. In the laparoscopic setting, soft-tissue surgery is even more challenging due to the need for high maneuverability and repeatability under motion and vision constraints. We demonstrate the first robotic laparoscopic soft tissue surgery with a level of autonomy of 3 out of 5, which allows the operator to select among autonomously generated surgical plans while the robot executes a wide range of tasks independently. We also demonstrate the first in vivo autonomous robotic laparoscopic surgery via intestinal anastomosis on porcine models. We compared the criteria including needle placement corrections, suture spacing, suture bite size, completion time, lumen patency, and leak pressure between the developed system, manual laparoscopic surgery, and robot-assisted surgery (RAS). The ex vivo results indicate that our system outperforms expert surgeons and RAS techniques in terms of consistency and accuracy, and it leads to a remarkable anastomosis quality in living pigs. These results demonstrate that surgical robots exhibiting high levels of autonomy have the potential to improve consistency, patient outcomes, and access to a standard surgical technique.