Imagine this scenario: You are about to undergo an important and delicate surgical procedure. You’re lying on the operating table, waiting to be anesthetized. The room is sterile and quiet. In the past, you would expect to see nurses and surgeons setting up equipment and instruments for the operation, their movements bustling around in busy but well-practiced ways. But those days are gone. Today, you can see the only tool that matters – a sleek robotic system with extended arms ready to operate. Your surgeon greets you, explains the procedure, and then leaves your view, because, at the end of the day, why would they need to be near you during this operation?
This may sound like something from a sci-fi story, but it is a rough approximation of how some operations may function in the future. That’s because robotic surgery is no distant possibility; it’s already here and it’s been making a significant difference within the medical world for some time. But now, new systems are being developed that take things to the next step.
The past of a future technology
Although surgical robotics may sound like a futuristic idea, it really isn’t. In fact, these advanced machines have existed, in one form or another, for decades.
This first major development was the Robodoc, an orthopedic-image-guided system created for prosthetic hip replacement in the late 1980s. Soon after this, Probot, a urologic robot for prostate surgery, was created. At the same time, several computer-assisted systems were emerging to help with neurosurgery. Although these systems were not “robots” per se, they were nevertheless valuable contributions to the advancing technology.
But while these robots were created to assist surgeons in their operating theaters, others were being designed for far more ambitious purposes. As early as the late 1960s, during the age of spaceflight, some surgeons started conceptualizing robots that could operate on someone hundreds or thousands of miles away. At the same time, others wanted systems that could provide open surgery on the battlefield. Soon, it was realized that robots would be especially suited to perform laparoscopic procedures (keyhole surgery) and could help improve surgeon performance with stereoscopic vision, improved dexterity, and, most importantly, reduced hand tremors.
This was the birth of telesurgery, and in the following decades, NASA and the US Army investigated ways to build machines that could operate on an individual at a distance.
As with most new technologies, it was not long before the idea passed into the civilian world. In September 2001, the world witnessed the first transatlantic operation where a team of surgeons in New York operated on a patient in France. This marked a significant development for this type of technology, but news of its success was dampened by the unfortunate events of 9/11.
Today, robots are a part of hospitals across the world, with the famous Da Vinci system being the most common one in use. According to Intuitive Surgical, the manufacturer, this surgical robot has been used in over 10 million minimally invasive surgeries since its creation over 21 years ago.
These established systems have transformed many surgical procedures, especially laparoscopy. They have made complicated procedures safer and quicker for patients, allowing them to recover faster. But there is a new generation of surgical robots on the horizon that will, to varying degrees, operate autonomously in some of the most delicate surgical procedures.
Autonomous surgical robots
In recent years, there have been significant advancements made possible by the progressive integration of artificial intelligence (AI) and machine learning in various fields. This is perhaps most noticeable in the realm of autonomous (self-driving) vehicles. This is a broad area but essentially covers the development of technologies that permit a vehicle to sense conditions and obstacles around it and react to them in real-time, sometimes without any human intervention.
Now, engineers and the medical community are trying to learn from these technologies and to integrate them into the operating theater.
“Our interest in autonomous surgical robotics stemmed from observing the precision of industrial robots and the advancements in autonomous driving”, Dr Jiawei Ge, a PhD student at Johns Hopkins University’s Whiting School of Engineering, explained to IFLScience. These advancements, he explained, “contrasted with the limited autonomy level in surgical robotics, especially on soft tissues.”
We design our autonomous surgical plans to closely replicate human surgeons’ decision-making processes, learned and adapted from observations and predefined into a step-by-step workflow.
Dr Jiawei Ge
“We also observed high complication rates of current surgical procedures. Despite the difficulties, we recognized the transformative potential of autonomous surgery in enhancing healthcare outcomes and pursued this challenging yet novel area of research.”
Ge, along with his supervisor Dr Axel Krieger, assistant professor of mechanical engineering, and other colleagues, have been collaborating with clinical teams to identify project ideas that address actual clinical needs. In particular, they seek to create robots that can perform some of the most challenging surgical procedures; the types of complex operations that require hours of mental and physical concentration and can result in burnout and fatigue.
In 2022, the team used the Smart Tissue Autonomous Robot (STAR), which performed the first fully autonomous laparoscopic procedure in the world – it connected two ends of a pig intestine together. The procedure was replicated four times on four different pigs that were under anesthetic. The robot, the team argued, operated better than a human surgeon could have.
Then, earlier this year, the same team tested its new Autonomous System for Tumor Resection (ASTR) system, which can remove tumors with accuracy that possibly exceeds that of a living surgeon. This procedure is commonly performed but can be extremely difficult, especially if the tumor is somewhere delicate, like on a tongue. Any surgeon conducting a resection on the tongue has to be sure to remove the tumor and any traces of cancer cells in the flesh, while also limiting the overall damage to the organ itself.
How autonomous is this autonomy?
So far these developments are demonstrating the potential that autonomous robots can have in surgery, but what do we mean by “autonomy” in this context? If we return to autonomous vehicles, for instance, we know that the word “autonomy” is a broad one that can be applied to various systems that go from driver-assisted forms of control to systems where humans are not required at all in any decision-making processes. So how does this compare to surgical robots?
“In our current work with STAR and ASTR, AI assists in medical image analysis, enhancing surgical target localization over conventional computer vision techniques”, Ge explained. “We design our autonomous surgical plans to closely replicate human surgeons’ decision-making processes, learned and adapted from observations and predefined into a step-by-step workflow.”
Importantly, the use of AI within these existing systems does not operate independently, nor does it alter procedure plans or how they are carried out.
“[I]ts role is supportive, not directive”, Ge added. “Autonomy in this context means the system operates under strict parameters, always under the supervision of an experienced surgeon who can immediately halt the operation and assume manual control if necessary.”
This is one of the ways that autonomous surgical robotics differs from its autonomous vehicle counterparts. Although they are both fields that require regulation and management, the former is subject to a greater set of challenges because of the stringent regulation reviews from bodies like the US Food And Drug Administration, as well as the need for extensive long-term animal and human trials.
As a consequence, widespread deployment of these systems remains a distant prospect despite the promise shown by examples like STAR and ASTR. But they are still coming.
“The future of autonomous surgical technology is likely to follow a trajectory similar to that of autonomous driving”, Ge explained, “with gradual deployment from simpler to more complex tasks.”
“Initially, robots may assist with specific parts of a surgical procedure before eventually taking on full procedures. Once the technology is available in hospitals, patients will benefit from consistently precise surgeries, free from the influence of individual surgeon performance or fatigue. Surgeons will experience less burden, allowing better focus on crucial care aspects, ultimately enhancing surgical outcomes and healthcare delivery.”
So, while the reality of fully autonomous surgery is yet to arrive, it seems robots are already making surgery more efficient, effective, and safer for both surgeons and patients alike.
