Engineers build a robot to operate without a doctor

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BALTIMORE — In a high-tech lab on the Homewood campus of Johns Hopkins University in Baltimore, engineers have built a robot that might be able to stitch up broken vessels in your belly and at some point possibly your brain, no doctor needs.

The robot has a high-tech camera on one arm and a high-tech sewing machine on a second arm. It’s already glued together the halves of pig intestines.

“It’s like the parking assist in a car,” said Axel Krieger, assistant professor of mechanical engineering at Hopkins’ Whiting School of Engineering. “Performs the procedure autonomously.”

This type of suturing is performed more than a million times a year in surgeries across the country, said Krieger, a member of a team developing the robot and lead author of a recent paper describing the technology from Science Robotics.

The objective is to develop in the coming years a robot which will make the complex and delicate work of suturing more coherent. Missing a stitch or making a clumsy one could result in a catastrophic complication for a patient. The robotic procedure is also less invasive because it is performed laparoscopically, through small holes in the skin rather than a large opening.

Hopkins engineers expect the robot to be cheaper than existing robot technology and more portable. They want to develop a mobile version that could eventually be used in an ambulance or in the field in an emergency, like stitching up a major artery to stop bleeding.

The robot would advance technology currently widely used in operating rooms. The US Food and Drug Administration calls them robot-assisted surgical devices.

The best known is the da Vinci robot approved by the federal government for general laparoscopic surgical use in 2000. The device has a console where a surgeon can view a 3D image and move multiple arms with surgical instruments, essentially becoming a extension of the doctor.

“The device is not actually a robot because it cannot perform surgery without direct human control,” the FDA said.

The da Vinci robot is now commonly used for gallbladder removal, hysterectomies, and prostate removal because it works best on “complex tasks in confined areas,” according to the FDA.

Other robotic machines helped with surgery before da Vinci’s development, but required much larger incisions.

The new robot developed by Hopkins engineers with collaborators at Children’s National Hospital in Washington, DC, known as the Smart Tissue Autonomous Robot, or STAR, is different. It has computer screens that offer a 3D view, but it doesn’t have a joystick or other controls.

The STAR is managed by a very advanced and adaptable computer program on the fly. The algorithm “sees” and “smells” through cameras that create 3D images with lasers and sensors that detect breathing, bleeding, and soft tissue pressure.

The robot performs approximately one stitch per minute, a conservative rate slightly slower than a human surgeon. So far, tests have shown more consistency than humans.

This has been a problem with robotic technology now in operating rooms. Current robot-assisted technology is better for some surgical tasks than others. And the results are not always an improvement, even if things seem to be going smoothly.

A detail of a robot’s suturing arm working on simulated blood vessels is shown March 17 in Baltimore, Maryland. A team of mechanical engineers from Johns Hopkins University is developing a SMART robot capable of performing soft tissue surgeries such as intestinal reconnections. The robot is fully autonomous and can perform delicate suturing of small vessels and nerves. (Barbara Haddock Taylor/AP)

Such machines also greatly increase surgery expenses as the cost of the equipment runs into the millions, although some of this may be offset by shorter hospital stays and fewer complications. But many small hospitals and those in less wealthy regions or other countries cannot afford the initial cost.

Jin Kang, another STAR developer and professor in the Hopkins Department of Electrical and Computer Engineering, said the STAR requires fewer machines and would be less expensive, although the final cost is undetermined.

It was designed with input from surgeons, who often choose to use technology because it can help them withstand the rigors of their jobs. Long hours of traditional surgery can cause twitching and fatigue in human hands.

He said surgeons and other surgical staff would still perform procedures, such as removing diseased tissue, before handing it over to STAR, and would stay in the room in case of an emergency while the robot reconnects the intestines. or other vessels.

“Doctors are not being replaced,” Kang said.

Dr. Michael Awad, director of the Barnes-Jewish Hospital Comprehensive Robotics Program in St. Louis, was not involved in the development of STAR but followed the work at Hopkins. He did his residency in surgery at Johns Hopkins Hospital and trained there on the first generation of da Vinci robots.

Awad said he was still early in the process, but he thinks autonomous robots are inevitable in the operating room and the work of the Hopkins researchers could be a big step forward.

It remains to be seen how long it will take the public — and surgeons — to accept such technology, he said.

He sees it as those self-driving cars. People are ready to adopt the parking assist technology referenced by Krieger and other technologies to prevent people from drifting into other lanes. Fully self-driving cars will also eventually prove to be trustworthy.

“While driving is a big issue and can lead to injury or death, I think people are even more sheepish when it comes to surgery on the human body,” he said. . “There are many more variables that make the task more difficult in itself. There is a higher bar to jump.

Awad, who is also director of the University of Washington’s Institute for Surgical Education, said there’s been a lot of training on using existing robotic equipment. Physicians must learn to use other senses, such as their eyes on computer screens, rather than the touch of human tissue, when using technology.

He said the machines are particularly useful for reaching narrow and sensitive points on the body such as the esophagus, behind the rib cage and near the heart. An autonomous robot could advance what doctors are able to do for patients.

There may also be less training needed for autonomous robots in the operating room. But that doesn’t mean surgeons won’t have to know how to perform the same procedures, Awad said.

“If a human has to intervene, they have to know how to do it,” he said. “But anything that can reduce the learning curve would be welcome.”

A position paper from the American College of Surgeons says surgeons should be “appropriately trained and their skills assessed” before using any new technology. The group also calls for an assessment to establish the technology’s value and safety before widespread adoption.

Hopkins’ team plans to continue refining the robot and evaluating what it could do beyond connecting the two ends of a blood vessel, intestine or other channels, called anastomosis.

Work on the robot was supported by the National Institute of Biomedical Imaging and Bioengineering. A next step is to seek a business partner to bring the technology through the development process and approvals from federal regulators to begin testing the robot on humans.

“We really want to push the boundaries,” Krieger said.

Meredith Cohn, The Baltimore Sun

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