Cutting Edge: Robo Surgeons

When health concerns become medical emergencies, surgery has historically been a common treatment method. Simple biopsies to complex thoracic procedures have provided a solid foundation for treating medical conditions, but there are still some cases in which surgical intervention is necessary but nearly impossible for humans to carry out. Certain surgical procedures are extremely difficult, with surgeons performing surgery on concealed territories within the body. For example, some forms of lung cancer require the removal of intricate tumors from lung tissue. Though these surgical procedures can be performed, it is grueling for surgeons to repair damage without harming other vital physical structures within the body. If a surgical instrument is off by even a few millimeters, it could be the difference between life and death. In a recent paper published in Scientific Robots, Professor Ron Altervotiz and Dr. Jason Akulian at the University of North Carolina described the autonomous robot they built, which can successfully perform complex surgeries with extreme precision.

This unique robot is controlled by a mechanical device that accurately dictates the motions that need to occur in different procedures. A special needle is attached to the robot—it is different from a surgical scalpel in that it is made from nickel-titanium alloy and laser etched. These properties allow for flexibility between the vital organ spaces, unlike scalpels. Alongside flexibility, the needle is also accurate, predicting the calculated area down to eight millimeters in diameter. This is possible due to the magnetic coils within the needle, which allow doctors to track its position in real-time. Other attachments can be added to the robot, including catheters. Catheters can be inserted into the body to add or remove fluids, which further the robot’s function beyond just repairing damaged organs. Other attachments, like chest tubes, can be employed by the robot to remove air from the lungs.

In order to test the effectiveness of the robot, the researchers looked at CT scans and x-ray images based on a real patient’s thoracic cavity and created a 3D model of their lungs, airways, and blood vessels. From there, the researchers programmed the robot’s computer system to simultaneously perform procedures on a specific, invisibly marked body area and avoid important structures. Eventually, the team decided to test the robotic model on two patient dummies in a laboratory similar to an operating room.

The team began with a bronchoscopy, a surgery used to observe a patient’s airway and lungs for malformations. Similar to real life, the lab model performed intermittent breath holding, which increased the simulation’s accuracy. Every time the patient held a breath, the robot moved forward with its procedure to mimic a real-life surgery. The insertion of the bronchoscope, a tube used to observe the throat, was done manually by a physician, but the second stage, which required a much more in-depth scan of a complex, inaccessible target area, was performed via robot. The first experiment was a success, as doctors could observe the lungs and airways thoroughly. In the second research project, researchers conducted an in vivo experiment (a trial carried out on living organisms), which took biopsies from complex areas of porcupine lungs, full of tiny blood vessels. This procedure, which involved carefully cutting out parts of the lung, was performed entirely by a robot and was successful in extracting specific lung tissue. Researchers concluded that the robotic needle was successful in these two anatomically complex surgeries.

Though experiments with this type of nearly-independent robotic surgery were successful, there are other factors to consider before it debuts in hospitals. Firstly, as with all technological devices, there is the possibility of robotic malfunctions. In case of a malfunction, the robot has a key that allows the arm to lock up, but this lock only activates after the robot has already malfunctioned. There is always the possibility of a robotic error during surgery, which could endanger a patient's life. The surgeon would need to fix the issue manually, which could be more time-consuming and dangerous than the original surgical procedure. Secondly, visual supervision of the body structures is important in this type of robotic surgery; in cases in which there is no time to map these structures, such as traumatic incidents requiring emergency surgery, the robot is not usable. 

 Furthermore, this robot has not performed surgery on living human patients, so there is still further testing required. Every patient has a different medical history, from underlying anatomical differences to preexisting organ damage. These factors could potentially lead to complications preventing the robots from working effectively, whereas surgeons have training that allows them to plan for unexpected situations and adapt accordingly based on the circumstances. 

Despite some of these shortcomings, the potential of robotic procedures could be beneficial for the medical field. Barring any intense complications, robotic surgery could standardize independent patient care. Also, surgeons could take a more relaxed stance in the operating room, overlooking a robot surgeon and stepping in only in emergencies or unexpected circumstances. Some patients may even feel safer with a tested, precise robot rather than an overworked surgeon performing their surgery. For current robotic surgeries, patient recovery is less painful since there are more precise, isolated cuts. All these factors point to robotic surgery as an advantageous tool for the surgical industry. 

Looking towards the future, autonomous steerable needles in robotic surgery could be used in other clinical applications, such as brain biopsies. Surgical application of the independent robot surgeon could morph the scope of the surgical field, ranging from simple substandard surgeries to fast-paced complex surgeries that were never thought possible.