Esophageal cancer remains a highly aggressive malignancy with low survival rates, requiring advanced surgical interventions like esophagectomy. Traditional manual techniques, including circular staplers, face challenges such as limited precision, prolonged recovery times, and complications like leaks and tissue misalignment. This paper presents a novel robotic circular stapler designed to enhance the dexterity in confined spaces, improve tissue alignment, and reduce post-operative risks. Integrated with a cognitive robot that serves as a surgeon's assistant, the surgical stapler uses three actuators to perform anvil motion, cutter/stapler motion and allows a 75-degree bending of the cartridge (distal tip). Kinematic analysis is used to compute the stapler tip's position, ensuring synchronization with a robotic system.

Vascular anastomosis, the surgical connection of blood vessels, is essential in procedures such as organ transplants and reconstructive surgeries. The precision required limits accessibility due to the extensive training needed, with manual suturing leading to variable outcomes and revision rates up to 7.9%. Existing robotic systems, while promising, are either fully teleoperated or lack the capabilities necessary for autonomous vascular anastomosis. We present the Micro Smart Tissue Autonomous Robot (micro-STAR), an autonomous robotic system designed to perform vascular anastomosis on small-diameter vessels. The micro-STAR system integrates a novel suturing tool equipped with Optical Coherence Tomography (OCT) fiber-optic sensor and a microcamera, enabling real-time tissue detection and classification. Our system autonomously places sutures and manipulates tissue with minimal human intervention. In an ex vivo study, micro-STAR achieved outcomes competitive with experienced surgeons in terms of leak pressure, lumen reduction, and suture placement variation, completing 90% of sutures without human intervention. This represents the first instance of a robotic system autonomously performing vascular anastomosis on real tissue, offering significant potential for improving surgical precision and expanding access to high-quality care.

Axel Krieger is the Head of the Intelligent Medical Robotic Systems and Equipment (IMERSE) Lab at Johns Hopkins University, where Justin Opfermann is pursuing his PhD degree. Below, Axel and Justin tell us more about their work, the methodology, and what they are planning next. Our research is focused on the design and evaluation of medical robots for autonomous soft tissue surgeries. In particular, this paper describes a surgical robot and workflow to perform autonomous anastomosis of the small bowel. Performance of the robot is conducted in synthetic tissues against expert surgeons, followed by experiments in pig studies to demonstrate preclinical feasibility of the system and approach.

A robot has performed laparoscopic surgery on the soft tissue of a pig without the guiding hand of a human--a significant step in robotics toward fully automated surgery on humans. Designed by a team of Johns Hopkins University researchers, the Smart Tissue Autonomous Robot (STAR) is described today in Science Robotics. "Our findings show that we can automate one of the most intricate and delicate tasks in surgery: the reconnection of two ends of an intestine. The STAR performed the procedure in four animals and it produced significantly better results than humans performing the same procedure," said senior author Axel Krieger, an assistant professor of mechanical engineering at Johns Hopkins' Whiting School of Engineering. The robot excelled at intestinal anastomosis, a procedure that requires a high level of repetitive motion and precision.

While robotic laparoscopic surgical systems do make certain procedures safer and less invasive, those systems are still operated by human surgeons. Now, however, a surgical robot has performed a delicate operation entirely on its own. Known as the Smart Tissue Autonomous Robot (STAR), the robotic-arm-equipped device was designed by researchers at Johns Hopkins University. Back in 2016, when operating on pigs, STAR was shown to be equal to or better than experienced surgeons at performing a procedure known as an intestinal anastomosis – this involved painstakingly suturing together the two severed ends of a small intestine. At the time, however, the robot had to access the intestine via a large external incision, and still required some guidance from humans.

A robot has successfully performed "keyhole" intestinal surgery on pigs without any aid from humans, according to a study from John Hopkins University (published in Science Robotics). What's more, the Smart Tissue Autonomous Robot (STAR) handled the tricky procedure "significantly better" than human doctors. The breakthrough marks a significant step towards automated surgery that could one day help "democratize" patient care, the researchers said. Laparoscopic or keyhole surgery requires surgeons to manipulate and stitch intestines and other organs through tiny incisions, a technique that requires high levels of skill and has little margin for error. The team chose to do "intestinal anastomosis" (joining two ends of an intestine), a particularly challenging keyhole procedure.

The Smart Tissue Autonomous Robot (STAR) can autonomously perform 60 percent of bowel anastomosis on pig intestines. Robots are a growing presence in operating rooms throughout the U.S. as surgeons embrace the technology to help them remove damaged organs or cancerous tissue. These systems have improved greatly in recent years but still need hands-on surgeons to guide their instruments and make critical decisions. Turning a robot loose on its own to cut and sew delicate tissue inside a human body would be a massively complex undertaking requiring advanced imaging, sensor and artificial intelligence technologies--not to mention a lot more acceptance from the medical community and federal regulators. But those hurdles have not stopped scientists at Children's National Medical Center's (CNMC) Sheikh Zayed Institute from developing a robotic system that has successfully sutured and reconnected portions of pig intestine in a living animal with little or no human intervention, according to a report in the May 4 Science Translational Medicine. Soft tissue surgeries like this one, which is called intestinal anastomosis, are especially challenging for robotic systems because the tissue changes shape and moves around during the procedures.

In a robotic surgery breakthrough, a bot stitched up a pig's small intestines using its own vision, tools, and intelligence to carry out the procedure. What's more, the Smart Tissue Autonomous Robot (STAR) did a better job on the operation than human surgeons who were given the same task. STAR's inventors don't claim that robots can replace humans in the operating room anytime soon. Instead they see the accomplishment as a proof of concept--both for the specific technologies used and for the general concept of "supervised autonomy" in the OR. Pediatric surgeon Peter Kim, one of the researchers, didn't sound threatened when he spoke to reporters in a press call yesterday.