Robot performs first solo laparoscopic surgery

Also: Plantar fasciitis, walking and diabetes

It’s a new era when it comes to robotics. Researchers are reporting that a robot has performed laparoscopic surgery without the guiding hand of a human. Designed by a team of Johns Hopkins University researchers, the Smart Tissue Autonomous Robot (STAR) can provide a host of potential benefits.

“Our findings show that we can automate one of the most intricate and delicate tasks in surgery, the reconnection of two ends of an intestine. The STAR performed the procedure in four animals and it produced significantly better results than humans performing the same procedure,” said senior study author Axel Krieger, an assistant professor of mechanical engineering at Johns Hopkins’ Whiting School of Engineering, Baltimore, Maryland.

The robot excelled at intestinal anastomosis, a procedure that requires a high level of repetitive motion and precision. Connecting two ends of an intestine is arguably the most challenging step in gastrointestinal surgery, requiring a surgeon to suture with high accuracy and consistency. Even the slightest hand tremor or misplaced stitch can result in a leak that could have catastrophic complications for the patient.

Soft-tissue surgery is especially hard for robots because of its unpredictability, forcing them to be able to adapt quickly to handle unexpected obstacles, Krieger said. The STAR has a novel control system that can adjust the surgical plan in real-time, just as a human surgeon would. “What makes the STAR special is that it is the first robotic system to plan, adapt and execute a surgical plan in soft tissue with minimal human intervention,” Krieger said.

A structural-light based three-dimensional endoscope and machine learning-based tracking algorithm developed by Kang and his students guides STAR. “We believe an advanced three-dimensional machine vision system is essential in making intelligent surgical robots smarter and safer,” Kang said.

Combating plantar fasciitis with fat injections

A novel technique that transplants a patient’s own fat into the sole of their foot could offer relief to those suffering from a common and painful condition called plantar fasciitis, according to University of Pittsburgh School of Medicine researchers.

In a pilot study, a wife-and-husband team found the fat injection procedure improved symptoms of plantar fasciitis in patients, laying the groundwork for a larger clinical trial.

“We developed this procedure to harness the regenerative properties of fat,” said Dr. Jeffrey Gusenoff, a professor of plastic surgery at Pitt. “In this proof-of-concept study, we showed that fat injections into the foot reduced heel pain, helped patients get back to doing sports and activities and boosted quality of life.”

Plantar fasciitis is one of the most common causes of heel pain, affecting about 2 million people in the United States. It’s caused by inflammation of the plantar fascia, connective tissue that runs from the heel to the toes and supports the foot arch.

“Plantar fasciitis is exceptionally painful,” said Dr. Beth Gusenoff, a clinical assistant professor of plastic surgery at Pitt. “When you get up from a sitting position or from sleeping, it’s a sharp, searing pain that some people describe as being like a nail going right through their heel.”

The acute form of it can be treated with stretching, shoe orthotics or cortisone injections. But about 10% of patients progress to the chronic form in which the foot’s collagen degenerates and the plantar fascia thickens. For these patients, surgical release of the plantar fascia with a small cut can help, but this surgery comes with risks.

Inspired by the regenerative properties of fat stem cells, the Gusenoffs developed a technique that uses fat harvested from a patient’s belly or other body area.

“In fat, there are stem cells and growth factors that help bring in fresh blood supply, which drives a mode of wound healing with reduced scarring,” explained Dr. Jeffrey Gusenoff. “We use a blunt needle to perforate the plantar fascia, which makes a small injury to stimulate the healing process. Then, when we pull the needle back, we inject a little bit of the patient’s fat.”

To test this method, the team recruited 14 patients and split them into two groups. Group 1 participants received the procedure at the beginning of the study and were followed for 12 months, and their Group 2 counterparts received the procedure after a six-month observation period and were followed for an additional six months.

“We found that Group 1 had improvements in quality of life and sports activity, decreased plantar fascia thickness and reduced pain levels,” said Dr. Jeffrey Gusenoff. “And a lot of the measures that were improving six months after the procedure got even better by 12 months.”

Walking away from diabetes

Walking regularly and at greater intensity may help prevent Type 2 diabetes among 70 and 80 year olds, according to one of the first studies measuring steps and pace among this age group. The more steps a person takes, and the more intense, the lower their risk for developing diabetes, report researchers in a study published in the journal Diabetes Care.

“A key figure from our study is that for every 1,000 steps per day, our results showed a 6% lower diabetes risk in this population. What that means is, if the average older adult were to take 2,000 more steps every day in addition to what they were already doing, they might expect a 12% reduction in diabetes risk,” said study author Alexis C. Garduno, with University of California San Diego.

For this study, women 65 and older, who did not have a diabetes diagnosis and who lived independently, were asked to wear a research-grade accelerometer for 24 hours per day over the right hip for one week. Their health was followed for up to seven years.

“We wanted to understand the extent to which stepping, or walking, is related to diabetes. And, is 10,000 steps a day really necessary for people to reduce their risk for diabetes?” said senior author John Bellettiere, who is an assistant professor of epidemiology at the Herbert Wertheim School of Public Health and Human Longevity Science at UC San Diego.

Of the 4,838 women in the study, 395 or 8% developed diabetes. According to the American Diabetes Association, 1.5 million people are diagnosed with diabetes every year.

“If we estimate that one third of that population are older adults, that’s 500,000 older individuals who are newly diagnosed with diabetes every year. If all of them increase their steps by 2,000 steps per day and our 12% estimate is proven to be causal, we would expect 60,000 people each year to not get diabetes due to that increase in steps,” said Bellettiere.

John Schieszer is an award-winning national journalist and radio and podcast broadcaster of The Medical Minute. He can be reached at

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John Schieszer is an award-winning national journalist and radio and podcast broadcaster of The Medical Minute.

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