Researchers at Children's National Health System explain how the Smart Tissue Autonomous Robot (STAR) is now outperforming human surgeons in operations on pig intestinal tissue. (Carla Schaffer/AAAS)

Your loved one needs surgery, stat — but what if your local hospital does not have a surgeon who can perform the procedure? One day soon, there may be a solution: After years of robot-assisted surgeries, where skilled doctors pilot robotic instruments to increase their own dexterity and precision, we may be getting close to having robots that can actually perform these procedures unaided. In a study published Wednesday in Science Translational Medicine, scientists from Johns Hopkins University and the Children's National Health System's Sheikh Zayed Institute announced the first successful, totally robotic soft-tissue surgeries in pigs. By some metrics, they say, their robot actually outperformed human doctors.

For now, the robot completes one kind of task: It can suture together two tubular structures, a process known as anastomosis.

"Why anastomosis? Because laparoscopic anastomosis is very difficult. It requires guiding a small needle at the end of long stick tools precisely through delicate tissue," study co-author Axel Krieger said during an embargoed press conference held on Tuesday. And the process comes up in several difficult surgeries, when arteries or intestines need to be reconnected. The researchers believe it's a good proof-of-concept, showing that a robotic surgeon could one day perform all sorts of procedures.


(Sheikh Zayed Institute)

The Smart Tissue Autonomous Robot (STAR) actually outperformed expert surgeons and current robot-assisted surgical techniques in open bowel surgery in pigs by several measures. For now, the robot is much slower than a human surgeon (though the researchers say they can speed up the robot's movements whenever they feel comfortable doing so), and it doesn't always suture the soft tissue together perfectly. But overall, their trials have shown smaller, more consistent stitches from the robotic arm than from human hands, or even from robot-assisted surgical tools. In the case of anastomosis — where blood or fecal matter has to flow through the delicate, sutured tissue — that kind of precision and consistency translates to a better outcome for the patient.

STAR, which is built using an arm from KUKA Robotics, is able to see in infrared, which allows it to track glowing biomarkers instead of having to constantly differentiate between tissues of the same color and texture. It can also see in 3-D, allowing it to move through and respond to internal structures. The robot's programming directs its suture placement based on choices made during technically perfect (human-performed) surgeries.

"As a surgeon, we only do four things," co-author Peter Kim said during the press conference. "We spend a little bit of time to get to a problem, we spend most of our time getting rid of the problem, and then putting it together as in the case of anastomosis. So let's say you've got a tumor in your colon, he takes out a little piece and puts the ends together. And then at the end, phase four, we close the incision."

In theory, he added, a robot could be programmed to do all of those things — for any procedure — based on the techniques of the most seasoned surgeons. But STAR would still be monitored by a human, who could step in should disaster strike. During the study, the supervising surgeon approved each and every suture placement before allowing the robot to proceed. The surgeon signed off on an average of 60 percent of the suggested sutures.

"We were like parents with young child that was about to walk," Kim told the Verge. "We were looking at it carefully."

So there are definitely some kinks to work out — and that's before asking how much such a system would cost, let alone whether any patient would feel comfortable going under a totally robotic knife. But one day, a robot might have a better track record for certain procedures than your local surgeon does.

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