The Smart Magazine About Medical Technology Innovations

#18 – Minimally Invasive Robotic Systems

New Autonomous Robot Sutures Soft Tissue by Itself


The STAR autonomous robot (Courtesy of Children’s National Hospital Center)

Look ma, no hands! Imagine a robot suturing up soft tissue in the operating room without human guidance. That’s precisely what a U.S. research team reported in the May 4 issue of the journal Science Translational Medicine.


Called “Smart Tissue Autonomous Robot” or STAR for short, the robot is the first in the world to autonomously sew together soft tissue with more precision than the most skilled surgeons.

The autonomous robot stitched pigs’ bowels back together uniformly and tight, leaving no leakage. The research team was cautiously optimistic that with further refinements, they will be able to bring the robot to clinical trials in a few years.

Developed at Children’s National Hospital Center in Washington, D.C., the robot was able to overcome technologic limitations. “We were able to model soft tissue with innovative vision technology, advanced ability to follow soft tissue movement in 3D space,” said Peter C. Kim, pediatric surgeon at Children’s, and the study’s senior author.

Robot Sutures Soft Tissue

Triangulating the exact position of every pixel in an image is doable with a variety of microlenses. Surgeons use luminescent markers to tag tissue before surgery and stand by. “The robot is able to adapt to any movement, offer end-to-end anastomosis, providing the best clinical outcome and safety,” said Kim.

Superior to the Da Vinci in Sewing

Axel Krieger, the program lead for Smart tools at Children’s, described the suturing tool as “very dexterous, with seven degrees of freedom and an extra sensor that permits operating in tight spaces with consistent tension for each stitch.”

The robot proved superior to laparoscopy and the da Vinci on several metrics in sewing.

The robot was tested against manual surgery, laparoscopy, and robot-assisted surgery with the da Vinci system. In all comparisons, the autonomous robot proved superior on several metrics in sewing and reconnecting bowel segments. The four pigs had no complications.

What sets the robot apart technologically are tools that use plenoptic 3-D and near-infrared fluorescent (NIRF) imaging, force sensing, and submillimeter positioning. An autonomous suturing algorithm programs the robot, according to the best practices of the best surgeons. “If you can stop the gut from leaking, which ups the risk of a patient dying after an operation by five-to-ten fold, you have value added,” explained Kim.

The Robot Adds Intelligence

Compared with robotic-assisted surgery where the clinical outcomes depend on the surgeon’s capability, the autonomous robot is consistent and adds intelligence, the authors contended. Dr. Kim said that worldwide, 1.2 million surgeries of the gallbladder, appendix, and abdomen are performed each year. On the horizon, he sees the robot adding value to these surgeries.

The da Vinci surgical system (Courtesy of Intuitive Surgical)

One downside to the technique was that the robot stitched slowly, taking on average about 50 minutes to stitch an anastomosis, far slower than a surgeon, who does it in about 8 minutes. Kim contended that at this stage, they were trying to prove a principle. With further advancements, they expect that they will be able to speed the stitching up substantially. Because “if you can save a half-hour to an hour of time in the operating room doing a hysterectomy, you added value,” he explained. Kim stressed that the surgeon will be overseeing the operation and hardly leaving the robot unsupervised.

Surgeons Need Not Look for Other Work

In a follow-up email with MedicalExpo e-magazine, Kim wrote: “These intelligent machines are not sentient beings, but with narrow, but deep intelligence in specific functionality.” He stressed that surgeons need not look for other work.

These intelligent machines are not sentient beings, but with narrow, but deep intelligence in specific functionality.

“For surgeons, why would I not want a technology that would expand my capacity and capability? For health systems and society, if you add value by reducing complications, it will save health care costs.” Kim sees it as a win from the patient perspective too. “Imagine if your surgeon is equipped with the best practice techniques of the best surgeons.”

Kim took pains to stress: “We are working with the robot, not away from it.” He sees a future where the “robot will come into more places where it is needed” with a much cheaper pricetag. “It’s too early for precise cost estimates because the robot is not ready for market,” he said. However, based on current capital costs of minimally invasive surgery of approximately $80,000, Kim sees enormous savings over the da Vinci robot, costing $1.5- $2 million.

About the Author

Laura Newman is a New York-based medical writer that writes frequently about medical technological advances and health policy. She writes for the medical trade press, national health entities, and health care insurers.

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