Da Vinci Xi Robot–Assisted Penetrating Keratoplasty

Abstract

PurposeThis study aims (1) to investigate the feasibility of robot-assisted penetrating keratoplasty (PK) using the new Da Vinci Xi Surgical System and (2) to report what we believe to be the first use of this system in experimental eye surgery.MethodsRobot-assisted PK procedures were performed on human corneal transplants using the Da Vinci Xi Surgical System. After an 8-mm corneal trephination, four interrupted sutures and one 10.0 monofilament running suture were made. For each procedure, duration and successful completion of the surgery as well as any unexpected events were assessed. The depth of the corneal sutures was checked postoperatively using spectral-domain optical coherence tomography (SD-OCT).ResultsRobot-assisted PK was successfully performed on 12 corneas. The Da Vinci Xi Surgical System provided the necessary dexterity to perform the different steps of surgery. The mean duration of the procedures was 43.4 ± 8.9 minutes (range: 28.5–61.1 minutes). There were no unexpected intraoperative events. SD-OCT confirmed that the sutures were placed at the appropriate depth.ConclusionsWe confirm the feasibility of robot-assisted PK with the new Da Vinci Surgical System and report the first use of the Xi model in experimental eye surgery. Operative time of robot-assisted PK surgery is now close to that of conventional manual surgery due to both improvement of the optical system and the presence of microsurgical instruments.Translational RelevanceExperimentations will allow the advantages of robot-assisted microsurgery to be identified while underlining the improvements and innovations necessary for clinical use.

Robot-Assisted Simulated Strabismus Surgery

“…Communication between members of the surgical team (step 17) was carried out using the microphone on the surgeon console. We did not observe the needle or thread breakage frequently seen with da Vinci–assisted procedures using 9/0 or 10/0 nylon 9. Manipulation of the instruments around the eyeball was easy in comparison to previously experimented intraocular procedures 9,12.…”

“…We did not observe the needle or thread breakage frequently seen with da Vinci–assisted procedures using 9/0 or 10/0 nylon 9. Manipulation of the instruments around the eyeball was easy in comparison to previously experimented intraocular procedures 9,12. Access to the orbit proved very easy without helper-induced potential awkwardness, although the absence of muscle tension in our model did not require the use of a hook on the muscle.…”

“…The system can filter tremors and provides 3D visualization of the operative field. We first used the Si HD to perform robot-assisted ocular surface surgery in experimental8,9 and clinical settings 10,11. We recently demonstrated the feasibility of all of the main steps of simulated cataract surgery using the new robotic da Vinci Xi Surgical System in combination with a phacoemulsification system 12.…”

Robotic (super) microsurgery: Feasibility of a new master‐slave platform in an in vivo animal model and future directions

“…The application of robotic surgery in ophthalmology has not advanced at the same pace compared to other specialties. The latter is probably due to the relatively bulky instruments of the da Vinci system, which lack the finesse and specific design required in the field of ocular microsurgery . Robotic assistance has been evaluated in vivo in amniotic membrane transplant and pterygium surgery .…”

“…Robotic assistance has been evaluated in vivo in amniotic membrane transplant and pterygium surgery . Robotics for penetrating keratoplasty has also shown to be feasible using the new Xi da Vinci system …”