For the first time, a surgical robot has autonomously performed a long phase of gallbladder removal, learning directly from video recordings of real surgeries. During the operations, conducted on highly realistic simulated models (“lifelike patients”), with human-like characteristics, the machine not only demonstrated dexterity and precision, but was also able to respond to voice commands from the surgeons present in the room, just like a junior resident would...
These results were described in Science Robotics by surgeons and engineers from Johns Hopkins University in Baltimore (USA), one of the international reference centers for experimenting with so-called autonomous surgery. “This is an important step forward,” explained the researchers, “bringing surgical robots beyond merely executing decisions made by human surgeons, toward systems capable of adapting in real time, following procedures independently, and self-correcting.”
“Thanks to this evolution, robots truly understand surgical procedures,” confirms Axel Krieger, study coordinator. “This way, we are moving increasingly toward autonomous and clinically valid surgical systems, capable of operating in the often chaotic and unpredictable reality of actual patient care.”
The new system, called Surgical Robot Transformer-Hierarchy (SRT-H), is based on the same machine learning architecture that powers language models like ChatGPT. Interactivity is one of its strengths: it can respond to voice commands such as “grasp the neck of the gallbladder” or corrections like “move the left arm one centimeter.” Thanks to continuous interaction, the robot learns and refines its abilities.
A sophisticated joystick to control the robot
At this point, however, we need to take a small step back and quickly explain how surgical robots work, increasingly present in hospitals in advanced countries. The name “robot” should not be misleading... Usually, it is the human who operates, using special, highly sophisticated “joysticks” that control the mechanical arms and probes of the robot, inserted into the patient’s body. The “machine” allows movements impossible with standard laparoscopy, improving outcomes for certain types of procedures (especially those involving the prostate, liver, and rectum), and also has a micro-camera that provides the surgeon with a 3D image of the surgical field, magnified about ten times.
But then - if everything works so well - why do Johns Hopkins University and other centers want to delegate everything to the robot, without human assistance? Surgical robots, the researchers suggest, could play a very useful role in case of staff shortages or emergencies. But that is not all: for some specific procedures, or for part of certain operations (for example, the initial preparation), the robot, when self-learning reaches maximum levels and is certified, could work even with greater precision and effectiveness than humans.
Fully autonomous surgery on a pig three years ago
This isn’t the first time that Krieger’s team has conducted trials on autonomous surgery. In 2022, the STAR – Smart Tissue Autonomous Robot – prototype performed a laparoscopic surgery on a pig. In that study, though, the conditions were strictly controlled: the tissue to be removed was specially marked and the robot followed a predetermined plan, a bit like driving along a pre-mapped route. But with SRT-H, the approach is much more ambitious: "It is like teaching a robot to navigate any road, in any condition, responding intelligently to whatever it encounters,” said Krieger.
The experiments also showed the system's ability to deal with unexpected scenarios. For example, the researchers changed the robot’s starting position and even altered the appearance of the organs using blood-like dyes: in all these circumstances, SRT-H adapted, working “unflappably” and without errors. “This work represents a major leap from prior efforts because it tackles some of the fundamental barriers to deploying autonomous surgical robots in the real world,” said the study’s lead author Ji Woong “Brian” Kim, who’s now with Stanford University.
However, there’s still a long way to go before a completely autonomous procedure is possible in the operating theatre. The researchers want to extend the training to other types of operations and expand the system's capabilities to perform a fully autonomous robotic surgery one day, from start to finish. But for now the message is clear: surgical robots are emerging from experimental laboratories to replace – at least in part – human activities. It’s only a matter of time.
