The possibilities and challenges created by “smart” machines replacing humans have been a staple of science fiction for nearly 150 years, beginning with Samuel Butler’s novel Erewhon. Since then, the theme of smart machines has been developed in numerous books and films, some of which portray smart machines as mankind’s helpers like Isaac Asimov’s Robot books.
- Operate autonomously (without direct human supervision) or at least
- Adapt to and learn from changing conditions in real time.
- Communicate with other machines.
While robot-assisted surgery (RAS) has increased in adoption in healthcare settings, the execution of soft tissue surgery has remained entirely manual, largely because the unpredictable, elastic and plastic changes in soft tissues that occur during surgery, requiring the surgeon to make constant adjustments.
HOW STAR’S EFFECTIVENESS COMPARES WITH OTHER SURGICAL PROCEDURES
Intestinal anastomosis was the surgical procedure conducted on the living subjects (in vivo) in the study. The Children's National research team conducted four anastomosis surgeries on living pigs using STAR technology and all subjects survived with no complications. The study compared these results to the same procedure conducted manually by an experienced surgeon using standard surgical tools.
"We chose the complex task of anastomosis as proof of concept because this soft tissue surgery is performed over one million times in the U.S. annually," says Kim.
All surgeries were compared based on the metrics of anastomosis including the consistency of suturing based on average suture spacing, the pressure at which the anastomosis leaked, the number of mistakes that required removing the needle from the tissue, completion time and lumen reduction, which measures any constriction in the size of the tubular opening.
In the comparison using living subjects, the manual control surgery took less time, eight minutes versus 35 minutes for the fastest STAR procedure, however researchers noted that the duration of the STAR surgery was comparable to the average for clinical laparoscopic anastomosis, which ranges from 30 minutes to 90 minutes, depending on complexity of the procedure.
Kim says that since supervised, autonomous robotic surgery for soft tissue procedures has been proven effective, a next step in the development cycle would be further miniaturization of tools and improved sensors to allow for wider use of the STAR system.
He adds that, with the right partner, some or all of the technology can be brought into the clinical space and bedside within the next two years.