This paper describes a novel tissue positioning system with an integrated suturing robot and demonstrates its ability to perform semi-automatic anastomoses of synthetic blood vessels. We began with a finite element analysis-based design consideration for achieving adequate grasping of blood vessels to demonstrate robust performance under expected clinical forces. We then conducted standardized positioning tests to measure the repeatability of the system and incorporated a high-resolution optical coherence tomography (OCT) fiber imaging sensor within the tip of the suturing tool to provide position feedback of the robot during a suturing task. Using the microvascular positioner and OCT sensor, the system performed semi-automatic suturing of synthetic 5 mm diameter blood vessels ($\mathrm{N}=4$), and the suture quality was evaluated for consistency in spacing, bite depth, percent lumen reduction, and maximum suture strength. The system completed the task in an average time of 31.75 minutes. The samples had zero missed stitches, average spacing of 1.64 mm, an average bite depth of 2.14 mm, an average lumen reduction of 57.98%, and an average suture strength of 3.13 N.

This article introduces a novel suture managing device (SMD) and new suture management controller to enable single-arm suture management during autonomous suturing with the Smart Tissue Autonomous Robot (STAR). The primary function of the SMD is to tension and manage the suture thread, a task that was previously carried out by a second manipulator or a human assistant. The SMD and its controller are integrated into STAR's autonomous suturing workflow. Experiments were conducted to quantify the tensioning force of SMD and to evaluate the suture quality of the new single-arm system. The prototype of SMD achieves 1.67N tensioning force with suturing time of 29.1±0.42 seconds per stitch. Our study results demonstrate that the single-arm STAR system with SMD achieves equivalent performance to our previous works in suturing efficiency where suture management was performed with either a dual-armed robotic system or by a human surgical assistant. The study's findings contribute to the field of medical robotics and to our knowledge represent the first known instance of single-arm suturing with suture management during autonomous anastomosis.

Surgical resection is the current clinical standard of care for treating squamous cell carcinoma. Maintaining an adequate tumor resection margin is the key to a good surgical outcome, but tumor edge delineation errors are inevitable with manual surgery due to difficulty in visualization and hand-eye coordination. Surgical automation is a growing field of robotics to relieve surgeon burdens and to achieve a consistent and potentially better surgical outcome. This paper reports a novel robotic supervised autonomous electrosurgery technique for soft tissue resection achieving millimeter accuracy. The tumor resection procedure is decomposed to the subtask level for a more direct understanding and automation. A 4-DOF suction system is developed, and integrated with a 6-DOF electrocautery robot to perform resection experiments. A novel near-infrared fluorescent marker is manually dispensed on cadaver samples to define a pseudotumor, and intraoperatively tracked using a dual-camera system. The autonomous dual-robot resection cooperation workflow is proposed and evaluated in this study. The integrated system achieves autonomous localization of the pseudotumor by tracking the near-infrared marker, and performs supervised autonomous resection in cadaver porcine tongues (N=3). The three pseudotumors were successfully removed from porcine samples. The evaluated average surface and depth resection errors are 1.19 and 1.83mm, respectively. This work is an essential step towards autonomous tumor resections.

Autonomous robotic suturing has the potential to improve surgery outcomes by leveraging accuracy, repeatability, and consistency compared to manual operations. However, achieving full autonomy in complex surgical environments is not practical and human supervision is required to guarantee safety. In this paper, we develop a confidence-based supervised autonomous suturing method to perform robotic suturing tasks via both Smart Tissue Autonomous Robot (STAR) and surgeon collaboratively with the highest possible degree of autonomy. Via the proposed method, STAR performs autonomous suturing when highly confident and otherwise asks the operator for possible assistance in suture positioning adjustments. We evaluate the accuracy of our proposed control method via robotic suturing tests on synthetic vaginal cuff tissues and compare them to the results of vaginal cuff closures performed by an experienced surgeon. Our test results indicate that by using the proposed confidence-based method, STAR can predict the success of pure autonomous suture placement with an accuracy of 94.74%. Moreover, via an additional 25% human intervention, STAR can achieve a 98.1% suture placement accuracy compared to an 85.4% accuracy of completely autonomous robotic suturing. Finally, our experiment results indicate that STAR using the proposed method achieves 1.6 times better consistency in suture spacing and 1.8 times better consistency in suture bite sizes than the manual results.

Trauma is among the leading causes of death in the United States with up to 29% of pre-hospital trauma deaths attributed to uncontrolled hemorrhages. This paper reports a semi-autonomous robotic system capable of assessing trauma using 2D and 3D image analysis and enabling remote focused assessment with sonography for trauma (FAST) en route to the hospital for earlier trauma diagnosis and faster initialization of life saving care. The system was able to accurately calculate FAST scan positions of patient specific phantoms using the measured phantom sizes and positions of the umbilicus. The system was capable of accurately classifying and localizing wounds, so they can be avoided during the ultrasound scan. These objects were localized with an accuracy of 0.94 ± 0.179cm and FAST exam locations were estimated with an accuracy of 2.2 ± 1.88cm. A radiologist successfully completed a remote FAST scan of the phantom using the system with improved image quality over manual scans, demonstrating feasibility of the system.

This paper reports a robotic laparoscopic surgery system performing electro-surgery on porcine cadaver kidney, and evaluates its accuracy in an open loop control scheme to conduct targeting and cutting tasks guided by a novel 3D endoscope. We describe the design and integration of the novel laparoscopic imaging system that is capable of reconstructing the surgical field using structured light. A targeting task is first performed to determine the average positioning error of the system as guided by the laparoscopic camera. The imaging system is then used to reconstruct the surface of a porcine cadaver kidney, and generate a cutting trajectory with consistent depth. The paper concludes by using the robotic system in open loop control to cut this trajectory using a multi degree of freedom electro-surgical tool. It is demonstrated that for a cutting depth of 3 mm, the robotic surgical system follows the trajectory with an average depth of 2.44 mm and standard deviation of 0.34 mm. The average positional accuracy of the system was 2.74±0.99 mm.

Autonomous robotic assisted surgery (RAS) systems aim to reduce human errors and improve patient outcomes leveraging robotic accuracy and repeatability during surgical procedures. However, full automation of RAS in complex surgical environments is still not feasible and collaboration with the surgeon is required for safe and effective use. In this work, we utilize our Smart Tissue Autonomous Robot (STAR) to develop and evaluate a shared control strategy for the collaboration of the robot with a human operator in surgical scenarios. We consider 2D pattern cutting tasks with partial blood occlusion of the cutting pattern using a robotic electrocautery tool. For this surgical task and RAS system, we i) develop a confidence-based shared control strategy, ii) assess the pattern tracking performances of manual and autonomous controls and identify the confidence models for human and robot as well as a confidence-based control allocation function, and iii) experimentally evaluate the accuracy of our proposed shared control strategy. In our experiments on porcine fat samples, by combining the best elements of autonomous robot controller with complementary skills of a human operator, our proposed control strategy improved the cutting accuracy by 6.4%, while reducing the operator work time to 44% compared to a pure manual control.