FEASIBILITY STUDY OF INTRAOCULAR ROBOTIC SURGERY WITH THE da VINCI SURGICAL SYSTEM

Bourla, Dan; Hubschman, Jean‐Pierre; Culjat, Martin O.; Tsirbas, Angelo; Gupta, Arobinda; Schwartz, Steven D.

doi:10.1097/iae.0b013e318068de46

Cited by 89 publications

(63 citation statements)

References 16 publications

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“…Furthermore, in contrast with previous attempts on the da Vinci surgical system, 15 the IRISS is the first robotic system to not only successfully create a round, curvilinear capsulorhexis essential for cataract surgery, but also the first to carry out an entire cataract extraction from start to finish. As this study demonstrated, the IRISS displayed the needed range of motion, dexterity, and accuracy for delicate intraocular surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Although the field of ophthalmic robotic surgery is still in its infancy, successful demonstrations of extraocular (corneal and scleral wounds), 13,14 anterior segment (foreign body removal and capsulorhexis), and posterior segment (25-gauge PPV) surgical tasks 15 in animal models validate ongoing research efforts towards making it a clinical reality. While most surgical subspecialties have incorporated robotic platforms into routine use, ophthalmic surgery poses a number of unique engineering challenges that have thus far limited this technology's applicability.…”

Section: Discussionmentioning

confidence: 99%

“…15 Two design limitations, however, restrict its practical use in ophthalmic surgery. First, having a high RCM, both located above the wrist and at a long distance from the tip of the instrument, renders intraocular maneuvers less controllable and induces undue tension on the external eye surface next to the entry site.…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, creation of a perfectly round, curvilinear capsulorhexis optimal for cataract surgery has proven to Robot-assisted intraocular surgery E Rahimy et al be quite difficult. 15 Second, intraoperative visualization as ophthalmologists are accustomed to is challenging with the da Vinci surgical system as its video capture system is designed for endoscopic use and does not yield the detail of a sophisticated optical microscope. These shortcomings of the da Vinci surgical system have spurred efforts by several teams towards customizing platforms solely dedicated for intraocular surgery.…”

Section: Discussionmentioning

confidence: 99%

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

Rahimy

Wilson

Tsao

et al. 2013

Eye

100

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Purpose The aim of this study is to develop a novel robotic surgical platform, the IRISS (Intraocular Robotic Interventional and Surgical System), capable of performing both anterior and posterior segment intraocular surgery, and assess its performance in terms of range of motion, speed of motion, accuracy, and overall capacities. Patients and methods To test the feasibility of performing 'bimanual' intraocular surgical tasks using the IRISS, we defined four steps out of typical anterior (phacoemulsification) and posterior (pars plana vitrectomy (PPV)) segment surgery. Selected phacoemulsification steps included construction of a continuous curvilinear capsulorhexis and cortex removal in infusion-aspiration (I/A) mode. Vitrectomy steps consisted of performing a core PPV, followed by aspiration of the posterior hyaloid with the vitreous cutter to induce a posterior vitreous detachment (PVD) assisted with triamcinolone, and simulation of the microcannulation of a temporal retinal vein. For each evaluation, the duration and the successful completion of the task with or without complications or involuntary events was assessed. Results Intraocular procedures were successfully performed on 16 porcine eyes. Four eyes underwent creation of a round, curvilinear anterior capsulorhexis without radialization. Four eyes had I/A of lens cortical material completed without posterior capsular tear. Four eyes completed 23-gauge PPV followed by successful PVD induction without any complications. Finally, simulation of microcannulation of a temporal retinal vein was successfully achieved in four eyes without any retinal tears/perforations noted. Conclusion Robotic-assisted intraocular surgery with the IRISS may be technically feasible in humans. Further studies are pending to improve this particular surgical platform.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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

Rahimy

Wilson

Tsao

et al. 2013

Eye

100

View full text Add to dashboard Cite

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“…Originally designed for laparoscopic surgery, this system has been tested in ophthalmology for extraocular and intraocular procedures. [1][2][3][4][5] Ocular surgery could benefit from robotic systems, which, among other advantages, reduce tremor, enhance precision, and may integrate pre-operative imagery during surgery in real time. However, despite very promising potential, some limitations have hampered further use of surgical robots, mainly because the design of the remote center of motion is not suited for intraocular surgery.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the motion of surgical instruments during intraocular surgery

Hubschman

J²,

Allen³

et al. 2011

Eye

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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.

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Robotically Assisted Amniotic Membrane Transplant Surgery

2015

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Amniotic membrane transplant (AMT) is a surgical technique for ocular surface reconstruction that should be considered for acute chemical or thermal burns, painful bullous keratopathy, shield ulcers, severe bacterial keratitis, necrotizing herpetic keratitis, corneal thinning, refractory neurotrophic keratitis, and other persistent epithelial defects (PED). 1 The literature describes several techniques to place and fix the amniotic membrane (AM). 2 The amniotic membrane may be used as a graft (inlay technique), patch (overlay technique), or combination of both (filling-in or multilayer technique). When used as a patch, the AM covers the epithelial defect without stromal loss and is temporarily sutured to the episclera near the limbus. The patch technique is safe, easy to perform, and effective in promoting corneal epithelial healing and reducing ocular surface inflammation underneath the AM. Robotic surgery has expanded during the last 20 years in abdominal and endoscopic procedures and macrosurgery in general. 3 Microsurgical specialties, including ophthalmology, have progressed neither to the same extent nor at the same pace. 4 To our knowledge, no human clinical procedures have been reported. Potential reasons for this discrepancy include the following: (1) ocular surgery is minimally invasive microsurgery yielding excellent results; (2) a true microsurgical robot does not currently exist; and (3) the cost of robotic systems. We used the high-definition robotic da Vinci Si Surgical System (Intuitive Surgical Inc) to perform robotically assisted AMT, penetrating keratoplasties, and pterygium surgeries on porcine eyes. This version provided greater magnification and better resolution of the operative field than the previous high-definition model. Our conclusions were that robotically assisted ocular surface surgeries such as AMT might be technically feasible for humans. This study aims to investigate the feasibility and safety of robotically assisted AMT and report the first human cases of robotic ocular surgery, to our knowledge.

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FEASIBILITY STUDY OF INTRAOCULAR ROBOTIC SURGERY WITH THE da VINCI SURGICAL SYSTEM

Cited by 89 publications

References 16 publications

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

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

Evaluation of the motion of surgical instruments during intraocular surgery

Robotically Assisted Amniotic Membrane Transplant Surgery

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