Bowel incision closure with a semi-mutomated Robot-assisted laser tissue soldering system

Area of Science:

• Minimally Invasive Surgery
• Biomedical Engineering
• Surgical Technology

Background:

• Traditional gastrointestinal (GI) incision closure methods like suturing and stapling pose risks such as leaks.
• These techniques demand advanced manual dexterity, particularly in robot-assisted minimally invasive surgery (RAMIS).
• Automation of GI closure is challenging due to the necessity for extensive tissue contact.

Purpose of the Study:

• To introduce and evaluate a novel Robot-assisted Laser Tissue Soldering (RLTS) system for semi-autonomous, contactless GI incision closure.
• To optimize RLTS system parameters and soldering protocols through ex-vivo experimentation.
• To assess the in-vivo safety and efficacy of RLTS for bowel anastomosis in a porcine model.

Main Methods:

• Development and optimization of a novel Robot-assisted Laser Tissue Soldering (RLTS) system.
• Ex-vivo experiments on porcine bowels and cadavers to refine soldering protocols and system parameters.
• In-vivo Heineke Mikulicz closure of small bowel incisions in live pigs using the RLTS system, followed by a two-week healing evaluation.

Main Results:

• The RLTS system demonstrated successful contactless closure of GI incisions in a live porcine model.
• Anastomotic leak pressure was evaluated, comparing robotic soldering to manual suturing.
• Histological analysis of healed incisions in pigs showed mucosal regeneration and fibrous tissue adhesion, with no leaks observed in survivors.

Conclusions:

• The study presents the first in-vivo semi-automated contactless incision closure using RLTS.
• The RLTS system shows potential as a viable alternative to traditional GI surgery closure methods.
• This technology paves the way for future automation in GI surgery, potentially enhancing safety and efficiency.