Toward autonomous robotic-assisted and microrobotic surgery

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: Not applicable — no quantitative effect sizes reported; all outcomes are qualitative and forward-looking

• Primary Outcome: Conceptual roadmap identifying key technological innovations required for autonomous RAS and μ-RAS across endovascular, endoluminal, laparoscopic, ophthalmic, and orthopedic surgical domains

• Nnt Or Sensitivity: Not applicable — no clinical trial data, diagnostic accuracy data, or prognostic modelling presented

• Confidence Interval: Not reported — no statistical analysis performed

Clinical Application

Clinical implementation of fully autonomous surgical systems remains a medium-to-long-term prospect. Current robotic surgical platforms (e.g., da Vinci system) are operator-dependent and not autonomous. Microrobotic systems described are largely pre-clinical. Significant regulatory, safety validation, workforce training, and infrastructure investment barriers exist before clinical translation. Feasibility in routine practice is low in the near term (5–10 years). Australia has established robotic surgery programs in major metropolitan centres, with the da Vinci Surgical System used across urology, gynaecology, and colorectal surgery. The TGA would need to evaluate and approve any autonomous surgical system under the Medical Devices framework (ARTG registration), with particular scrutiny under the Software as a Medical Device (SaMD) pathway. The RACGP and relevant surgical colleges (RACS, RANZCOG, RANZCO) have not yet issued guidelines on autonomous surgical robotics. PBS implications are indirect at this stage — procedural MBS item numbers for robotic surgery are limited and contested. The paper's roadmap is relevant to Australian health technology assessment bodies (MSAC, ACSQHC) for horizon scanning. Equity of access concerns are particularly salient in Australia given the concentration of advanced surgical robotics in metropolitan private and public tertiary hospitals, with minimal rural and remote access. Patients requiring minimally invasive surgery across the five identified domains. Most directly relevant to tertiary and quaternary surgical centres with existing robotic surgery infrastructure. Current applicability is limited to informing research priorities and institutional planning rather than guiding individual patient care decisions.

Abstract

Autonomous robotic-assisted surgery (RAS) has emerged as a promising objective in biomedical technology, further enhanced by miniaturization toward microrobotic-assisted surgery (μ-RAS). This reduction in scale promises minimally invasive, partially or fully automated surgical procedures, with the potential to reduce patient recovery times, lower medical costs, and enable previously unavailable procedural options. This perspective highlights the specific advances in RAS that potentially map to the microscale (μ-RAS), organized across five surgical domains: endovascular, endoluminal, laparoscopic, ophthalmic, and orthopedic. We examine both clinical demands and technological advances in surgical robotics and identify the key innovations required for progress across these surgical fields. Our contribution is distinct in combining the perspectives of both surgical experts and bioengineering innovators, outlining a roadmap for the advancement and eventual integration of autonomous RAS and μ-RAS into mainstream surgical practice.

References

1. 1.Yang, S., Kang, B. H., Min, H., Wachs, J. P., Alambeigi, F., Desai, J. P., Dupont, P. E., Yaeger, K., Anderson, K., Kuntz, A., Alterovitz, R., Webster, R. J., Hata, N., Reisenauer, J. S., Clinch, M., Abramson, A., Wu, J. Y., Ranzani, T., Kim, P. C., Huang, A. S., Sun, C., Zhang, H. F., Riviere, C. N., Henderson, E. R., Yip, M., Dong, X., Wollin, D. A., Gracias, D. H., Mair, L. O., Karpelson, M., Wood, R. J., Cohen, I., & Strano, M. S. (2026). Toward autonomous robotic-assisted and microrobotic surgery. Science Advances. https://doi.org/10.1101/2024.07.24.604989