Evaluation of the motion of surgical instruments during intraocular surgery

Abstract

Purpose Robot assistance in ocular microsurgery could improve precision, dexterity, save time or prevent complications by task automation, and provide access to ocular surgery in undeserved countries by teleoperation. However, to design robotic devices, the range of motion of surgical instruments needs to be precisely quantified. Methods An electromagnetic tracking system was developed for intraocular surgery in order to quantify the movements of ophthalmic surgeons. Kinematics of surgical steps during phacoemulsification and pars plana vitrectomy procedures were determined by measuring the maximum translation and angular range of motion of intraocular surgical tools in the three planes. Conclusion Important variations in amplitudes of rotation and translation were measured between both hands and between surgical tasks. These parameters may be used to develop a robotic intraocular surgical system or to improve training.

Robot-assisted intraocular surgery: development of the IRISS and feasibility studies in an animal model

“…We previously determined the range of motion required to carry out common intraocular surgical tasks by attaching electromagnetic sensors (MicroBird; Ascension Technology, Burlington, VT, USA) to instruments used in cataract surgery (ie, phacoemulsification handpiece and cataract chopper) and vitrectomy surgery (ie, vitreous cutter and intraocular light pipe), which then quantified microscopic translational and angulational movements. 24 That study's results showed that robotic ocular surgery devices holding instruments should be designed to allow a minimum translation of 3.65, 3.14, and 2.06 cm in the x, y and z-planes, respectively, whereas a minimum angulation of 116 and 1061 were needed intraocularly in the x-and y-planes. 24 Although three of the employed tasks (anterior lens capsulorhexis, I/A of the lens material, and 23-gauge core PPV with PVD induction) were clinically relevant proceedings, the fourth (retinal vein microcannulation) was evaluated because it is a technically difficult and delicate maneuver to assess our prototype with.…”

“…24 That study's results showed that robotic ocular surgery devices holding instruments should be designed to allow a minimum translation of 3.65, 3.14, and 2.06 cm in the x, y and z-planes, respectively, whereas a minimum angulation of 116 and 1061 were needed intraocularly in the x-and y-planes. 24 Although three of the employed tasks (anterior lens capsulorhexis, I/A of the lens material, and 23-gauge core PPV with PVD induction) were clinically relevant proceedings, the fourth (retinal vein microcannulation) was evaluated because it is a technically difficult and delicate maneuver to assess our prototype with. Previous reports state that the maximum hand tremor of vitreoretinal surgeons during intraocular procedures exceeds 100 mm.…”

Robotic Vitreoretinal Surgery

“…Similarly, in ophthalmology, electromagnetic tracking systems and force-sensing tools can quantify surgical movements by providing the amplitude and rate of forces being generated during tissue manipulation, the distance of the instrument tip and shaft from ocular structures, or the velocity movement of instruments by the surgeon (44, 45). This information can be used to develop a library of quantified movements for any surgical procedure, thus creating a “language of surgery”.…”

Intraocular robotic interventional surgical system (IRISS): Mechanical design, evaluation, and master–slave manipulation

“…While effective in performing such procedures, laser‐based technologies are unable to perform surgical steps that require physical manipulation, such as removal of an emulsified lens or insertion of an intraocular lens implant. In addition to intricate physical manipulation, a complete cataract surgery can require simultaneous manipulation of two surgical instruments, a range of motion up to 180° about each major rotational axis, two remote centres of motion (RCMs) in close proximity, and an array of surgical instruments— at least one of which is uniquely associated with each surgical step …”