Researchers at Children’s National Hospital are developing supervised autonomous robotic surgery to make expert kidney tumor removal accessible in rural areas, combining robotics, AI and surgeon oversight for safer, more precise outcomes.

Imagine a robot capable of planning and executing the intricate removal of a cancerous kidney tumor — a concept that might sound like science fiction. Yet this groundbreaking work is underway at the Sheikh Zayed Institute (SZI) for Pediatric Surgical Innovation at Children’s National Hospital.

Called Supervised Autonomous Robotic Renal Tumor Surgery (SARRTS), the project aims to prove that a supervised autonomous kidney resection is feasible. Its goal is to enable general surgeons in rural hospitals to oversee robots performing complex resections, democratizing access to specialized surgical care. Backed by a $1 million contract from the Advanced Research Projects Agency for Health (ARPA-H), the initiative represents new opportunities in medical innovation.

“The hope is that, someday, patients will no longer have to travel to major oncology centers to get the best possible surgical outcome when faced with renal tumors,” said Kevin Cleary, PhD, associate director of engineering at SZI. “We hope to combine the precision of robotics with a surgeon’s clinical expertise to create consistently high outcomes.”

The patient benefit

Surgery is a cornerstone of cancer treatment, but access to skilled surgeons remains unevenly distributed nationwide. Autonomous robotic surgery could address this disparity by increasing access to expert-level care, enhancing the precision and consistency of procedures and unlocking new surgical possibilities beyond human surgeons’ capabilities.

Under the initial concept, the SARRTS system will use a combination of CT imaging and 3D mapping from a robot’s RGB-depth camera. While the robot independently plans and executes the incision and tumor resection, the supervising surgeon retains full control, with the ability to approve, modify or halt the procedure at any time — an interplay between human expertise and robotic precision to help ensure safety.

Testing will be conducted on realistic kidney models, called phantoms, which are designed to train and test surgical outcomes. The project aims to validate the feasibility of supervised autonomous tumor resection while advancing technologies that could pave the way for broader applications.

“Robotics and medicine have finally reached a point where we can consider projects requiring this level of complexity,” said Anthony Sandler, MD, senior vice president and surgeon-in-chief at Children’s National and executive director of SZI. By combining autonomous robotics, artificial intelligence and surgical expertise, we can profoundly impact the lives of patients facing life-altering cancer diagnoses.”

Children’s National leads the way

In addition to the kidney surgery initiative, the Children’s National team is pursuing other groundbreaking projects. These include a second ARPA-H contract focused on robotic gallbladder removal and a National Institutes of Health grant to explore robotic hip-pinning, a procedure used to repair fractured hips with pins, screws and plates.

Axel Krieger, PhD, an associate professor of mechanical engineering at Johns Hopkins University, is collaborating closely on the kidney resection and gallbladder projects. The interdisciplinary team believes this state-of-the-art care could be tested and developed within the next decade.

“This particular surgery is complex, and a robot may offer advantages to address difficulties created by patient anatomy and visibility within the surgical field,” said Dr. Sandler. “We can imagine a day – in the not too distant future – when a human and a robotic arm could team up to successfully advance this care.”

This project has been funded in whole with federal funds from ARPA-H under cooperative agreement AY1AX000023.