The current state of autonomous suturing: a systematic review

Benjamin T Ostrander; Daniel Massillon; Leo Meller; Zih-Yun Chiu; Michael Yip; Ryan K Orosco

doi:10.1007/s00464-024-10788-w

The current state of autonomous suturing: a systematic review

Surg Endosc. 2024 May;38(5):2383-2397. doi: 10.1007/s00464-024-10788-w. Epub 2024 Mar 29.

Authors

Benjamin T Ostrander^{1

2}, Daniel Massillon², Leo Meller², Zih-Yun Chiu³, Michael Yip³, Ryan K Orosco⁴

Affiliations

¹ Department of Otolaryngology - Head and Neck Surgery, University of California San Diego Health, San Diego, CA, USA.
² School of Medicine, University of California San Diego, La Jolla, CA, USA.
³ Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, CA, USA.
⁴ Division of Otolaryngology, Department of Surgery, University of New Mexico, 1201 Camino de Salud NE, Albuquerque, NM, 87102, USA. RKOrosco@salud.unm.edu.

PMID: 38553597
DOI: 10.1007/s00464-024-10788-w

Abstract

Background: Robotic technology is an important tool in surgical innovation, with robots increasingly being used in the clinical setting. Robots can be used to enhance accuracy, perform remote actions, or to automate tasks. One such surgical task is suturing, a repetitive, fundamental component of surgery that can be tedious and time consuming. Suturing is a promising automation target because of its ubiquity, repetitive nature, and defined constraints. This systematic review examines research to date on autonomous suturing.

Methods: A systematic review of the literature focused on autonomous suturing was conducted in accordance with PRISMA guidelines.

Results: 6850 articles were identified by searching PubMed, Embase, Compendex, and Inspec. Duplicates and non-English articles were removed. 4389 articles were screened and 4305 were excluded. Of the 84 remaining, 43 articles did not meet criteria, leaving 41 articles for final review. Among these, 34 (81%) were published after 2014. 31 (76%) were published in an engineering journal9 in a robotics journal, and 1 in a medical journal. The great majority of articles (33, 80%) did not have a specific clinical specialty focus, whereas 6 (15%) were focused on applications in MIS/laparoscopic surgery and 2 (5%) on applications in ophthalmology. Several suturing subtasks were identified, including knot tying, suture passing/needle insertion, needle passing, needle and suture grasping, needle tracking/kinesthesia, suture thread detection, suture needle shape production, instrument assignment, and suture accuracy. 14 articles were considered multi-component because they referred to several previously mentioned subtasks.

Conclusion: In this systematic review exploring research to date on autonomous suturing, 41 articles demonstrated significant progress in robotic suturing. This summary revealed significant heterogeneity of work, with authors focused on different aspects of suturing and a multitude of engineering problems. The review demonstrates increasing academic and commercial interest in surgical automation, with significant technological advances toward feasibility.

Keywords: Autonomous surgery; Autonomous suturing; Robotic surgery; Robotics; Surgical innovation; Suturing.

Publication types

Systematic Review
Review

MeSH terms

Humans
Laparoscopy / methods
Robotic Surgical Procedures* / methods
Suture Techniques*
Sutures