Final Report, Center for Computer-Integrated Computer-Integrated Surgical Systems and Technology, NSF ERC Cooperative Agreement EEC9731748, Volume 1

Medical agents increasingly combine general reasoning models with specialized clinical tools, yet their capabilities remain largely fixed by what clinicians and engineers design before deployment. Recursive self-improvement (RSI) offers a different paradigm in which agents learn from their own failures and autonomously expand their capabilities, but directly applying RSI to medicine introduces fundamental safety challenges. We introduce MedRSI, the first recursive self-improvement framework for medicine, which continuously transforms diagnostic failures into new clinical capabilities through tool composition and task-specific model training. Inspired by clinical practice, MedRSI introduces two mechanisms for clinically aligned self-evolution. Clinical-cost-aware failure prioritization directs improvement toward errors according to their potential clinical consequences rather than frequency alone. Fast discovery with slow registration separates rapid capability invention from conservative adoption, allowing new tools to enter the persistent agent only after demonstrating sustained benefit across subsequent patient cohorts. Across public glaucoma and heart disease benchmarks and two private clinical tasks, MedRSI progressively develops segmentation, measurement, prediction, multimodal reasoning, and generative capabilities, surpasses manually engineered medical agents, and autonomously discovers solutions to clinical problems not anticipated by its original designers. Our results show that medical agents need not remain constrained by capabilities specified before deployment: with clinically grounded mechanisms governing what to improve and what to retain, they can continuously construct, validate, and accumulate new capabilities from diagnostic experience. Code is available at https://github.com/ImprintLab/MedRSI.

Autonomous robot-assisted surgery demands reliable, high-precision platforms that strictly adhere to the safety and kinematic constraints of minimally invasive procedures. Existing research platforms, primarily based on the da Vinci Research Kit, suffer from cable-driven mechanical limitations that degrade state-space consistency and hinder the downstream training of reliable autonomous policies. We present an open-source, robot-agnostic Remote Center of Motion (RCM) controller based on a closed-form analytical velocity solver that enforces the trocar constraint deterministically without iterative optimization. The controller operates in Cartesian space, enabling any industrial manipulator to function as a surgical robot. We provide implementations for the UR5e and Franka Emika Panda manipulators, and integrate stereoscopic 3D perception. We integrate the robot control into a full-stack ROS-based surgical robotics platform supporting teleoperation, demonstration recording, and deployment of learned policies via a decoupled server-client architecture. We validate the system on a bowel grasping and retraction task across phantom, ex vivo, and in vivo porcine laparoscopic procedures. RCM deviations remain sub-millimeter across all conditions, and trajectory smoothness metrics (SPARC, LDLJ) are comparable to expert demonstrations from the JIGSAWS benchmark recorded on the da Vinci system. These results demonstrate that the platform provides the precision and robustness required for teleoperation, data collection and autonomous policy deployment in realistic surgical scenarios.

Input devices for robotic microsurgery are frequently described as preserving the surgeon's trained technique, but the claim is rarely measured. We compared manual and teleoperated intraocular instrument motion with the trocar constraint, the instrument, the eye model and the tracking source common to both conditions, so that the control interface was the only factor varied. Prior comparisons cannot hold the instrument fixed, because a robotic instrument is not the tool used manually. Sixteen participants performed a navigation task on a commercial ophthalmic simulator by hand and through a three-degree-of-freedom input device commanding a five-joint robot. Task outcome was equal but at ceiling: every participant acquired all five targets under both interfaces with no retinal or lens injury. Execution differed on every measure. Teleoperated trials took three times as long at a quarter of the median speed, covered less than half the angular working range, and were broken into 3.5 times as many separate movements. Completion time and movement fragmentation improved substantially across four trials of practice and had not plateaued; the measures set by the configured rate ceiling and joint limit changed the least. Finger activity doubled and pinch variability tripled, so reducing instrument degrees of freedom redistributed manual effort rather than reducing it. The interface preserves the outcome and reshapes the execution.