Surgical Robot Autonomously Performs First Appendectomy: Da Vinci Xi System Enters Fully Autonomous Mode

Surgeons at Johns Hopkins Hospital watched from behind a glass partition last Tuesday as a da Vinci Xi robotic system independently removed a patient's inflamed appendix. The 47-minute procedure marks the first fully autonomous soft-tissue surgery performed on a human being.

The patient, a 34-year-old man diagnosed with acute appendicitis, had consented to the autonomous protocol after being briefed on its experimental status. A human surgical team stood by in the same operating room, ready to intervene within seconds.

"This was not remote-controlled surgery," said Dr. Axel Krieger, who leads the university's computational interaction and robotics lab. "The robot made every decision — where to cut, how much force to apply, when to cauterize. We supervised, but we did not touch the controls."

The system relied on a combination of preoperative CT imaging and real-time intraoperative vision. A custom segmentation model identified the appendix, mesoappendix, and surrounding blood vessels, while a force-feedback controller modulated instrument pressure to avoid tearing delicate tissue. Intraoperative bleeding was minimal, and the robot correctly identified and clipped the appendicular artery on its first attempt.

The achievement builds on years of research into autonomous suturing and tissue manipulation. In 2024, Krieger's team demonstrated that their Smart Tissue Autonomous Robot, or STAR, could suture intestinal tissue more consistently than human surgeons in controlled trials. The leap to a complete procedure required solving problems of real-time adaptation: unexpected anatomical variation, bleeding, and tool occlusion.

Not everyone in the surgical community is celebrating. Dr. Catherine Wu, president of the American College of Surgeons, cautioned that "autonomy in the lab does not equal autonomy in the chaos of a real operating room." She called for randomized controlled trials involving thousands of patients before any clinical adoption.

Regulatory pathways remain unclear. The FDA has no specific framework for autonomous surgical devices, though Intuitive Surgical is reportedly preparing a De Novo classification request. European regulators are said to be developing draft guidance.

The patient was discharged 36 hours after surgery with no complications. He told reporters he felt "perfectly fine" and would recommend the procedure to others.