Interview with Axel Krieger and Justin Opfermann: autonomous robotic laparoscopic surgical procedure for intestinal anastomosis

Axel Krieger is the Head of the Clever Medical Robotic Techniques and Gear (IMERSE) Lab at Johns Hopkins College, the place Justin Opfermann is pursuing his PhD diploma. Along with H. Saeidi, M. Kam, S. Wei, S. Leonard , M. H. Hsieh and J. U. Kang, they lately printed the paper ‘Autonomous robotic laparoscopic surgical procedure for intestinal anastomosis‘ in Science Robotics. Under, Axel and Justin inform us extra about their work, the methodology, and what they’re planning subsequent.

What’s the matter of the analysis in your paper?

Our analysis is targeted on the design and analysis of medical robots for autonomous mushy tissue surgical procedures. Specifically, this paper describes a surgical robotic and workflow to carry out autonomous anastomosis of the small bowel. Efficiency of the robotic is carried out in artificial tissues in opposition to skilled surgeons, adopted by experiments in pig research to show preclinical feasibility of the system and strategy.

May you inform us concerning the implications of your analysis and why it’s an fascinating space for research?

Anastomosis is a necessary step to the reconstructive section of surgical procedure and is carried out over 1,000,000 instances annually in the US alone. Surgical outcomes for sufferers are extremely depending on the surgeon’s ability, as even a single missed sew can result in anastomotic leak and an infection within the affected person. In laparoscopic surgical procedures these challenges are much more tough on account of area constraints, tissue movement, and deformations. Robotic anastomosis is a technique to make sure that surgical duties that require excessive precision and repeatability will be carried out with extra accuracy and precision in each affected person unbiased of surgeon ability. Already there are autonomous surgical robots for exhausting tissue surgical procedures akin to bone drilling for hip and knee implants. The Good Tissue Autonomous Robotic (STAR) takes the autonomous robotic ability one step additional by performing surgical duties on mushy tissues. This allows a robotic to work with a human to finish extra difficult surgical duties the place preoperative planning isn’t attainable. We hypothesize that this can end in a democratized surgical strategy to affected person care with extra predictable and constant affected person outcomes.

May you clarify your methodology?

Till this paper, autonomous laparoscopic surgical procedure was not attainable in mushy tissue because of the unpredictable motions of the tissue and limitations on the dimensions of surgical instruments. Performing autonomous surgical procedure required the event of novel suturing instruments, imaging techniques, and robotic controls to visualise a surgical scene, generate an optimized surgical plan, after which execute that surgical plan with the very best precision. Combining all of those options right into a single system is difficult. To perform these objectives we built-in a robotic suturing instrument that simplifies wristed suturing motions to the press of a button, developed a 3 dimensional endoscopic imaging system primarily based on structured mild that was sufficiently small for laparoscopic surgical procedure, and applied a conditional autonomy management scheme that permits autonomous laparoscopic anastomosis. We evaluated the system in opposition to skilled surgeons performing finish to finish anastomosis utilizing both laparoscopic or da Vinci tele-operative strategies on artificial small bowel throughout metrics akin to consistency of suture spacing and suture chew, sew hesitancy, and general surgical time. These experiments have been adopted by preclinical feasibility exams in porcine small bowel. Restricted necropsy was carried out after one week to guage the standard of the anastomosis and immune response.

What have been your foremost findings?

Comparability research in artificial tissues indicated that sutures positioned by the STAR system had extra constant spacing and chew depth than these utilized by surgeons utilizing both a guide laparoscopic method or robotic help with the da Vinci surgical system. The improved precision afforded by the autonomous strategy led to a better high quality anastomosis for the STAR system which was qualitatively verified by laminar 4 dimension MRI circulation fields throughout the anastomosis. The STAR system accomplished the anastomosis with a primary sew success price of 83% which was higher than surgeons in both group. Following the ex-vivo exams, STAR carried out laparoscopic small bowel anastomosis in 4 pigs. All animals survived the process and had a median weight acquire over the 1 week survival interval. STAR’s anastomoses had comparable burst energy, lumen space discount, and therapeutic as manually sewn samples, indicating the feasibility of autonomous mushy tissue surgical procedures.

What additional work are you planning on this space?

Our group is researching marker-less methods to trace tissue place, movement, and plan surgical duties with out the necessity for fiducial markers on tissues. The power to a few dimensionally reconstruct the surgical discipline on a pc and plan surgical duties with out the necessity for synthetic landmarks would simplify autonomous surgical planning and allow collaborative surgical procedure between an autonomous robotic and human. Utilizing machine studying and neural networks, we have now demonstrated the robotic’s capacity to determine tissue edges and monitor pure landmarks. We’re planning to implement fail-safe strategies and hope to carry out first in human research within the subsequent few years.

Concerning the interviewees

Justin Opfermann (MS) is a PhD robotics pupil within the Division of Mechanical Engineering at Johns Hopkins College. Justin has ten years of expertise within the design of autonomous robots and instruments for laparoscopic surgical procedure, and can be affiliated with the Laboratory for Computational Sensing and Robotics. Earlier than becoming a member of JHU, Justin was a Challenge Supervisor and Senior Analysis and Design Engineer on the Sheikh Zayed Institute for Pediatric Surgical Innovation at Youngsters’s Nationwide Hospital.

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