Robotic assistance in minimally invasive surgery can greatly enhance surgical precision and reduce surgeon fatigue. This paper presents a focused investigation on the kinematic and ergonomic design principles for a laparoscopic surgical robotic arm aimed at high-precision tasks. We propose a 7-degree-of-freedom (7-DOF) robotic arm system that incorporates a remote center of motion (RCM) at the instrument insertion point and ergonomic considerations to improve surgeon interaction. The design is implemented on a general-purpose robotic platform, and a series of simulated surgical tasks were performed to evaluate targeting accuracy, task efficiency, and surgeon comfort compared to conventional manual laparoscopy. Experimental results demonstrate that the optimized robotic design achieves significantly improved targeting accuracy (error reduced by over 50%) and shorter task completion times, while substantially lowering operator muscle strain and discomfort. These findings validate the importance of kinematic optimization (such as added articulations and tremor filtering) and human-centered ergonomic design in enhancing the performance of robot-assisted surgery. The insights from this work can guide the development of next-generation surgical robots that improve surgical outcomes and ergonomics for the operating team.

Abstract--Vision-based Proximal Policy Optimization (PPO) struggles with visual observation-based robotic laparoscopic surgical tasks due to the high-dimensional nature of visual input, the sparsity of rewards in surgical environments, and the difficulty of extracting task-relevant features from raw visual data. We introduce a simple approach integrating MedFlamingo, a medical domain-specific Vision-Language Model, with PPO. Our method is evaluated on five diverse laparoscopic surgery task environments in LapGym, using only endoscopic visual observations. MedFlamingo PPO outperforms and converges faster compared to both standard vision-based PPO and OpenFlamingo PPO baselines, achieving task success rates exceeding 70% across all environments, with improvements ranging from 66.67% to 1114.29% compared to baseline. By processing task observations and instructions once per episode to generate high-level planning tokens, our method efficiently combines medical expertise with real-time visual feedback. Our results highlight the value of specialized medical knowledge in robotic surgical planning and decision-making.

Robotic laparoscopic surgery has gained increasing attention in recent years for its potential to deliver more efficient and precise minimally invasive procedures. However, adoption of surgical robotic platforms remains largely confined to high-resource medical centers, exacerbating healthcare disparities in rural and low-resource regions. To close this gap, a range of solutions has been explored, from remote mentorship to fully remote telesurgery. Yet, the practical deployment of surgical robotic systems to underserved communities remains an unsolved challenge. Humanoid systems offer a promising path toward deployability, as they can directly operate in environments designed for humans without extensive infrastructure modifications -- including operating rooms. In this work, we introduce LapSurgie, the first humanoid-robot-based laparoscopic teleoperation framework. The system leverages an inverse-mapping strategy for manual-wristed laparoscopic instruments that abides to remote center-of-motion constraints, enabling precise hand-to-tool control of off-the-shelf surgical laparoscopic tools without additional setup requirements. A control console equipped with a stereo vision system provides real-time visual feedback. Finally, a comprehensive user study across platforms demonstrates the effectiveness of the proposed framework and provides initial evidence for the feasibility of deploying humanoid robots in laparoscopic procedures.

In this study, we present an implementation strategy for a robot that performs peg transfer tasks in Fundamentals of Laparoscopic Surgery (FLS) via imitation learning, aimed at the development of an autonomous robot for laparoscopic surgery. Robotic laparoscopic surgery presents two main challenges: (1) the need to manipulate forceps using ports established on the body surface as fulcrums, and (2) difficulty in perceiving depth information when working with a monocular camera that displays its images on a monitor. Especially, regarding issue (2), most prior research has assumed the availability of depth images or models of a target to be operated on. Therefore, in this study, we achieve more accurate imitation learning with only monocular images by extracting motion constraints from one exemplary motion of skilled operators, collecting data based on these constraints, and conducting imitation learning based on the collected data. We implemented an overall system using two Franka Emika Panda Robot Arms and validated its effectiveness.

In laparoscopic robot-assisted minimally invasive surgery, the kinematic control of the robot is subject to the remote center of motion (RCM) constraint at the port of entry (e.g., trocar) into the patient's body. During surgery, after the instrument is inserted through the trocar, intrinsic physiological movements such as the patient's heartbeat, breathing process, and/or other purposeful body repositioning may deviate the position of the port of entry. This can cause a conflict between the registered RCM and the moved port of entry. To mitigate this conflict, we seek to utilize the interaction forces at the RCM. We develop a novel framework that integrates admittance control into a redundancy resolution method for the RCM kinematic constraint. Using the force/torque sensory feedback at the base of the instrument driving mechanism (IDM), the proposed framework estimates the forces at RCM, rejects forces applied on other locations along the instrument, and uses them in the admittance controller. In this paper, we report analysis from kinematic simulations to validate the proposed framework. In addition, a hardware platform has been completed, and future work is planned for experimental validation.

Recent advances in reinforcement learning (RL) have increased the promise of introducing cognitive assistance and automation to robot-assisted laparoscopic surgery (RALS). However, progress in algorithms and methods depends on the availability of standardized learning environments that represent skills relevant to RALS. We present LapGym, a framework for building RL environments for RALS that models the challenges posed by surgical tasks, and sofa env, a diverse suite of 12 environments. Motivated by surgical training, these environments are organized into 4 tracks: Spatial Reasoning, Deformable Object Manipulation & Grasping, Dissection, and Thread Manipulation. Each environment is highly parametrizable for increasing difficulty, resulting in a high performance ceiling for new algorithms. We use Proximal Policy Optimization (PPO) to establish a baseline for model-free RL algorithms, investigating the effect of several environment parameters on task difficulty. Finally, we show that many environments and parameter configurations reflect well-known, open problems in RL research, allowing researchers to continue exploring these fundamental problems in a surgical context. We aim to provide a challenging, standard environment suite for further development of RL for RALS, ultimately helping to realize the full potential of cognitive surgical robotics.

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.

The robot surgeon will see you now. For years, the world of medicine has been steadily advancing the art of robot-assisted procedures, enabling doctors to enhance their technique inside the operating theatre. Now US researchers say a robot has successfully performed keyhole surgery on pigs all on its own – without the guiding hand of a human. Furthermore, they add, the robot surgeon produced "significantly better" results than humans. The breakthrough is another step towards the day when fully automated surgery can be performed on patients. The Smart Tissue Autonomous Robot (Star) carried out laparoscopic surgery to connect two ends of an intestine in four pigs.

Learn more about what comes next. In 2016, Dr. Peter Kim, founder of Activ Surgical, a digital surgery company, demonstrated a proof of concept of fully autonomous robotic surgery on soft tissue, suturing, or stitching up a wound. Since then, Activ Surgical has been working on harnessing machine learning, augmented reality, and other advanced technologies to develop new ways of collaborating with surgeons. "We want to keep surgeons in the loop, to give them more data than they ever had before," says CEO Todd Usen. Usen likens Activ Surgical's work in surgery to crossing goalposts in the drive toward autonomous driving: It might take a while to get there, but the industry is ramping up systematically.