A Novel Wax Based Piezo Actuator for Autonomous Deep Anterior Lamellar Keratoplasty (Piezo-DALK)

Opfermann, Justin D.; Barbic, Mladen; Khrenov, Mikhail; Guo, Shoujing; Sarfaraz, Nicolas; Kang, Jun; Krieger, Axel

doi:10.1109/iros51168.2021.9636153

Cited by 4 publications

(1 citation statement)

References 32 publications

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“…While the tool proved to be more consistent and accurate at placing a needle within 100 µm of the DM, the robot was based on a linear DC motor, which was heavy, cumbersome, and required the operator to manually balance during use. To overcome the weight limitations of this first design, the robot was miniaturized with a novel wax-based piezo stack that was light enough to mount to the eye [ 29 ]. We demonstrated that the actuator could repeatably reach 90% of the stromal thickness while under OCT guidance; however, the needle’s wax mechanism required more than 3 h for tissue penetration, making it impractical for ex vivo or in vivo studies.…”

Section: Previous Workmentioning

confidence: 99%

Design and Evaluation of an Eye Mountable AutoDALK Robot for Deep Anterior Lamellar Keratoplasty

Opfermann,

Wang,

Kaluna

et al. 2024

Micromachines

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Partial-thickness corneal transplants using a deep anterior lamellar keratoplasty (DALK) approach has demonstrated better patient outcomes than a full-thickness cornea transplant. However, despite better clinical outcomes from the DALK procedure, adoption of the technique has been limited because the accurate insertion of the needle into the deep stroma remains technically challenging. In this work, we present a novel hands-free eye mountable robot for automatic needle placement in the cornea, AutoDALK, that has the potential to simplify this critical step in the DALK procedure. The system integrates dual light-weight linear piezo motors, an OCT A-scan distance sensor, and a vacuum trephine-inspired design to enable the safe, consistent, and controllable insertion of a needle into the cornea for the pneumodissection of the anterior cornea from the deep posterior cornea and Descemet’s membrane. AutoDALK was designed with feedback from expert corneal surgeons and performance was evaluated by finite element analysis simulation, benchtop testing, and ex vivo experiments to demonstrate the feasibility of the system for clinical applications. The mean open-loop positional deviation was 9.39 µm, while the system repeatability and accuracy were 39.48 µm and 43.18 µm, respectively. The maximum combined thrust of the system was found to be 1.72 N, which exceeds the clinical penetration force of the cornea. In a head-to-head ex vivo comparison against an expert surgeon using a freehand approach, AutoDALK achieved more consistent needle depth, which resulted in fewer perforations of Descemet’s membrane and significantly deeper pneumodissection of the stromal tissue. The results of this study indicate that robotic needle insertion has the potential to simplify the most challenging task of the DALK procedure, enable more consistent surgical outcomes for patients, and standardize partial-thickness corneal transplants as the gold standard of care if demonstrated to be more safe and more effective than penetrating keratoplasty.

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Section: Previous Workmentioning

confidence: 99%

Design and Evaluation of an Eye Mountable AutoDALK Robot for Deep Anterior Lamellar Keratoplasty

Opfermann,

Wang,

Kaluna

et al. 2024

Micromachines

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Overcoming the Force Limitations of Magnetic Robotic Surgery: Magnetic Pulse Actuated Collisions for Tissue‐Penetrating‐Needle for Tetherless Interventions

Erin

Liu

et al. 2022

Advanced Intelligent Systems

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The field of magnetic robotics aims to obviate physical connections between the actuators and end‐effectors. Such tetherless control may enable new ultraminimally invasive surgical manipulations in clinical settings. While wireless actuation offers advantages in medical applications, the challenge of providing sufficient force to magnetic needles for tissue penetration remains a barrier to practical application. Applying sufficient force for tissue penetration is required for tasks such as biopsy, suturing, cutting, drug delivery, and accessing deep‐seated regions of complex structures in organs such as the eye. To expand the force landscape for such magnetic surgical tools, an impact force‐based suture needle capable of penetrating in vitro and ex vivo samples with 3‐degrees‐of‐freedom (DOF) planar motion is proposed. Using custom‐built 14 and 25 G needles, generation of 410 mN penetration force is demonstrated, a 22.7‐fold force increase with more than 20 times smaller volume compared with similar magnetically guided needles. With the Magnetic Pulse Actuated Collisions for Tissue‐penetrating (MPACT)‐Needle, gauze mesh suturing onto an agar gel is demonstrated. In addition, the tip size is reduced to 25 G, a typical needle size for eye interventions, to demonstrate ex vivo penetration in a rabbit eye towards corneal injections and transscleral drug delivery.

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A Robotic Injection System for Consistent Pneumo-dissection of the Deep Stroma in Big Bubble DALK Surgery

Kaluna,

Opfermann,

Wang

et al. 2024

2024 46th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC)

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A Novel Wax Based Piezo Actuator for Autonomous Deep Anterior Lamellar Keratoplasty (Piezo-DALK)

Cited by 4 publications

References 32 publications

Design and Evaluation of an Eye Mountable AutoDALK Robot for Deep Anterior Lamellar Keratoplasty

Design and Evaluation of an Eye Mountable AutoDALK Robot for Deep Anterior Lamellar Keratoplasty

Overcoming the Force Limitations of Magnetic Robotic Surgery: Magnetic Pulse Actuated Collisions for Tissue‐Penetrating‐Needle for Tetherless Interventions

A Robotic Injection System for Consistent Pneumo-dissection of the Deep Stroma in Big Bubble DALK Surgery

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