An AI-guided robot sewed a bowel on its own in pigs

Why is sewing a bowel hard for a robot?

An anastomosis joins two sections of bowel after a diseased part has been removed. The stitching must be even and watertight, otherwise the contents of the bowel can leak. It is delicate work, because soft tissue moves, deforms and is not always easy to see.

In laparoscopy, surgery is done through small cuts, with a camera and long instruments. Movements are limited and the view is restricted, which makes the task harder still for a robot.

A leak at the join can be dangerous, which is why the quality of every stitch matters.

What did the researchers do?

They developed what they call an "enhanced autonomous" strategy for laparoscopic soft-tissue surgery. The robot locates the tissue with imaging, follows it as it moves and prepares its own suturing plans. The operator picks among the plans offered, then the robot carries out a wide range of tasks on its own.

The system was first tested on artificial bowel models, then on live pigs, with a one-week survival period after the operation. The team compared suture quality between the autonomous robot, manual laparoscopic surgery and robot-assisted surgery.

The authors argue that autonomous robotic surgery has the potential to provide efficacy, safety and consistency that do not depend on an individual surgeon's skill and experience. This is the main reason they are exploring it.

What were the results?

Six quality criteria were examined: needle placement corrections, spacing of the stitches, size of the tissue bite, completion time, lumen patency (whether the bowel stays open) and leak pressure.

On the artificial model, the data indicate that the system does better than expert surgeons' manual technique and robot-assisted surgery, in consistency and accuracy. The authors write that this was also seen in the live animal model.

What could this mean for patients?

The authors see highly autonomous robots as a way to bring more consistency, better outcomes for patients and wider access to a standard technique, whatever the experience of the surgeon.

But this is a prospect, not an established fact. Today this robot is not available in operating rooms and no patient has been operated on this way.

Any step towards the operating room would first need larger animal studies and a safety review by regulators.

What are the limits of this study?

It is a study in animals and on artificial models. A pig's bowel does not pose all the challenges of a human patient, with disease, fat, scars or bleeding.

Follow-up lasted only a week, which says nothing about how well the suture holds in the long run. Larger trials, then safety assessment and regulatory approvals, would be needed before any use in people.