PD23-04 AN EXPERIMENTAL COMPARISON OF AUTONOMOUS ROBOTIC AND MANUAL LAPAROSCOPIC SUTURING

Abstract

You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology II (PD23)1 Apr 2020PD23-04 AN EXPERIMENTAL COMPARISON OF AUTONOMOUS ROBOTIC AND MANUAL LAPAROSCOPIC SUTURING Michael Hsieh*, Hamed Saeidi, Michael Kam, Shuwen Wei, Justin Opfermann, Simon Leonard, Jin Kang, and Axel Krieger Michael Hsieh*Michael Hsieh* More articles by this author , Hamed SaeidiHamed Saeidi More articles by this author , Michael KamMichael Kam More articles by this author , Shuwen WeiShuwen Wei More articles by this author , Justin OpfermannJustin Opfermann More articles by this author , Simon LeonardSimon Leonard More articles by this author , Jin KangJin Kang More articles by this author , and Axel KriegerAxel Krieger More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000873.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The inconsistency and difficulty of suturing in minimally invasive surgeries stem from the limitations in tool motion and visualization. In pelvic surgery, difficulty is amplified since the tool access is restricted by anatomy. Using an open surgical approach, we previously demonstrated superior suture precision and retention via the smart tissue anastomosis robot (STAR) guided by near infrared (NIR) and 3D imaging systems that reconstruct bowel. Here we demonstrate extensions to laparoscopic conditions in preparation for preclinical studies. METHODS: A KUKA LBR Med lightweight robot was equipped with a motorized commercial suture tool with pitch and roll controls. NIR and 3D cameras were used to reconstruct the 3D model of the tissue and enable robotic suture planning. We tested the STAR in two tasks, i) suturing on a 4-cm straight line on suture pads assuming a static target tissue with a one-time suture planning (STAR-S, n = 5), ii) and a vaginal cuff closure on synthetic tissues with 5 cm diameter and 5 mm wall thickness under dynamic motion and deformation and replanning after each stitch (STAR-D, n = 2). STAR-S/STAR-D includes 1/1 knot at the beginning and 3/10 running stitches. Based on the number of stiches and tissue size, a high-level planner determines ideal suture locations. A similar task as STAR-D but in a manual mode was completed by a surgeon in laparoscopic trainers (Manual, n= 4). RESULTS: Standard deviation between consecutive sutures, and suture bite was 0.42mm/1.03mm (p < 0.005), and 0.84mm/1.63mm (p = 0.19) for STAR-S and STAR-D, respectively. STAR-S is 2.45 times more consistent in suture spacing since it represents an easy suturing task while STAR-D is closer to the clinical cases due to continuous deformations and irregular tissue shapes. The standard deviation between consecutive sutures and bite size for Manual are respectively 2.75 mm (STAR-D is 2.67 times more consistent, p <0.05) and 3.17 mm (STAR-D is 1.94 times better, p < 0.05). However, average task completion time for STAR-D is 719.5clip_image002.png">12.5 sec (p < 0.001). This happened due to low motor speeds of the suture tool and safety velocity limits imposed on the robot by the control algorithms. CONCLUSIONS: Autonomous robotics is a promising solution for ensuring consistent laparoscopic suturing in spatially constrained surgeries. Using 3D imaging and improved planning methods, STAR performs laparoscopic suturing with higher consistency than an expert surgeon. Speed can be improved by relaxing safety speed limits. Future work will consider tests in preclinical studies on porcine animal models. Source of Funding: NIH R01EB020610 © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e465-e465 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Hsieh* More articles by this author Hamed Saeidi More articles by this author Michael Kam More articles by this author Shuwen Wei More articles by this author Justin Opfermann More articles by this author Simon Leonard More articles by this author Jin Kang More articles by this author Axel Krieger More articles by this author Expand All Advertisement PDF downloadLoading ...