Bowel Incision Closure with a Semi-Automated Robot-Assisted Laser Tissue Soldering System

TL;DR

This paper introduces a novel semi-automated laser tissue soldering system for GI incision closure, demonstrating successful in-vivo application in pigs with promising healing outcomes, potentially replacing traditional suturing methods.

Contribution

The study presents the first in-vivo semi-automated contactless closure system for GI incisions, advancing automation in minimally invasive surgery.

Findings

All pigs survived without leaks after the procedure.

Histology showed mucosal regeneration and tissue adhesion.

The system outperformed manual suturing in leak pressure tests.

Abstract

Traditional methods for closing gastrointestinal (GI) surgery incisions, like suturing and stapling, present significant challenges, including potentially life-threatening leaks. These techniques, especially in robot-assisted minimally invasive surgery (RAMIS), require advanced manual skills. While their repetitive and time-consuming nature makes them suitable candidates for automation, the automation process is complicated by the need for extensive contact with the tissue. Addressing this, we demonstrate a semi-autonomous contactless surgical procedure using our novel Robot-assisted Laser Tissue Soldering (RLTS) system on a live porcine bowel. Towards this in-vivo demonstration, we optimized soldering protocols and system parameters in ex-vivo experiments on porcine bowels and a porcine cadaver. To assess the RLTS system performance, we compared the pressure at which the anastomosis leaked between our robotic soldering and manual suturing. With the best setup, we advanced to an in-vivo Heineke Mikulicz closure on small bowel incision in live pigs and evaluated their healing for two weeks. All pigs successfully completing the procedure (N=5) survived without leaks and the histology indicated mucosal regeneration and fibrous tissue adhesion. This marks the first in-vivo semi-automated contactless incision closure, paving the way for automating GI surgery incision closure which has the potential to become an alternative to traditional methods.