  Autonomous robotic surgery has the potential to provide efficacy, safety, and
consistency independent of individual surgeons skill and experience. Autonomous
soft-tissue surgery in unstructured and deformable environments is especially
challenging as it necessitates intricate imaging, tissue tracking and surgical
planning techniques, as well as a precise execution via highly adaptable
control strategies. In the laparoscopic setting, soft-tissue surgery is even
more challenging due to the need for high maneuverability and repeatability
under motion and vision constraints. We demonstrate the first robotic
laparoscopic soft tissue surgery with a level of autonomy of 3 out of 5, which
allows the operator to select among autonomously generated surgical plans while
the robot executes a wide range of tasks independently. We also demonstrate the
first in vivo autonomous robotic laparoscopic surgery via intestinal
anastomosis on porcine models. We compared the criteria including needle
placement corrections, suture spacing, suture bite size, completion time, lumen
patency, and leak pressure between the developed system, manual laparoscopic
surgery, and robot-assisted surgery (RAS). The ex vivo results indicate that
our system outperforms expert surgeons and RAS techniques in terms of
consistency and accuracy, and it leads to a remarkable anastomosis quality in
living pigs. These results demonstrate that surgical robots exhibiting high
levels of autonomy have the potential to improve consistency, patient outcomes,
and access to a standard surgical technique.
