STAR of the Show in Laparoscopic Surgery

Spring 2022

A robot designed by a Johns Hopkins team has performed laparoscopic surgery on the soft tissue of a pig without the guiding hand of a human—a significant step toward fully automated surgery on humans. The researchers described the Smart Tissue Autonomous Robot, or STAR, recently 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,” says senior author Axel Krieger, PhD ’08, an assistant professor of mechanical engineering at the Whiting School and a member of the Laboratory for Computational Sensing and Robotics. “The STAR performed the procedure in four animals, and it produced significantly better results than humans performing the same procedure.” 

The robot excelled at intestinal anastomosis, a procedure that requires a high level of repetitive motion and precision. Connecting two ends of an intestine is arguably the most challenging step in gastrointestinal surgery, requiring a surgeon to suture with high accuracy and consistency. Even the slightest hand tremor or misplaced stitch can result in a leak that could have catastrophic complications for the patient. 

Working with collaborators at Children’s National Hospital in Washington, D.C., and Jin Kang, the Jacob Suter Jammer Professor of Electrical Engineering, Krieger helped create the robot, a vision-guided system designed specifically to suture soft tissue. Their current iteration advances a 2016 model that repaired a pig’s intestines accurately but required a large incision to access the intestine and more guidance from humans. 

The team equipped the STAR with new features for enhanced autonomy and improved surgical precision,

Axel Krieger

including specialized suturing tools and state-of-the-art imaging systems that provide more accurate visualizations of the surgical field. 

Soft tissue surgery is especially hard for robots because of its unpredictability, forcing them to be able to adapt quickly to handle unexpected obstacles, Krieger says. The STAR has a novel control system that can adjust the surgical plan in real time, just as a human surgeon would. 

“What makes the STAR special is that it is the first robotic system to plan, adapt, and execute a surgical plan in soft tissue with minimal human intervention,” says first author Hamed Saeidi, a visiting research scientist in mechanical engineering. 

What guides STAR is a structural, light– based, three-dimensional endoscope and machine learning–based tracking algorithm developed by Kang and his students. 

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