Optical Coherence Tomography Guided Robotic Device for Autonomous Needle Insertion in Cornea Transplant Surgery

Guo, Shoujing; Sarfaraz, Nicolas; Gensheimer, William G.; Krieger, Axel; Kang, Jin U.

doi:10.1109/iros40897.2019.8968193

Cited by 6 publications

(4 citation statements)

References 23 publications

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“…To overcome the above limitations, our team previously described a robotic DALK system using OCT-A scan to generate one-dimensional depth measurements of the cornea and enable precise needle insertion with DM pneumodissection [ 28 ]. 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.…”

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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“…It has been applied in vitreoretinal surgery, [9] bladder cancer diagnosis, [10] and neurointerventional surgery. [11] OCT also can be used to guide the movement of surgical devices such as detecting the depth of needle insertions [12] and guiding surgical instruments to complete optical biopsy. [13] However, due to its narrow field of view (FOV, approximately 200-600 μm), [14] it is necessary to collect large area microscopic images for image stitching.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Novel Flexible Endomicroscopic Scanning Instrument with Visual Servoing Control

Xu,

Zhang,

Zhang

et al. 2024

Advanced Intelligent Systems

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Optical biopsy using probe‐based confocal laser endomicroscopy (pCLE) and optical coherence tomography (OCT) technologies performs in vivo tissue scanning of organ surfaces and plays a crucial role in early cancer diagnosis. Herein, a flexible endomicroscopic scanning instrument based on a 3‐degree‐of‐freedom flexible hinge structure and visual servoing control is presented. The instrument integrates OCT and pCLE. OCT information compensates for the imaging distance of pCLE, which can combine the advantages of the two technologies. The mechanism allows for tissue surface scanning with a wire‐driven active bending part and dynamic adjustment of the probe‐tissue distance using a combination of wire and spring‐driven, which satisfy large‐area scanning while maintaining consistence tissue contacts. Local optimization‐based visual servoing control is proposed to optimize the tissue scanning. Through the scanning experiments, high‐quality mosaics of uneven surfaces are obtained with an effective area that is larger than 4 mm2. In vivo animal trial further verifies the feasibility and clinical potential of the instrument.

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“…This device allows for the autonomous insertion of a needle for pneumo-dissection based on the depth-sensing results from the OCT system. An earlier prototype of AUTO-DALK was introduced by the authors in [33]. In contrast, this work adds a detailed description of the OCT sensor design and integration, includes successful big bubble results, and contains a comparison to manual needle insertion under OCT guidance.…”

Section: Introductionmentioning

confidence: 99%

Demonstration of Optical Coherence Tomography Guided Big Bubble Technique for Deep Anterior Lamellar Keratoplasty (DALK)

Guo

Sarfaraz

Gensheimer

et al. 2020

Sensors

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Deep anterior lamellar keratoplasty (DALK) is a highly challenging procedure for cornea transplant that involves removing the corneal layers above Descemet’s membrane (DM). This is achieved by a “big bubble” technique where a needle is inserted into the stroma of the cornea down to DM and the injection of either air or liquid. DALK has important advantages over penetrating keratoplasty (PK) including lower rejection rate, less endothelial cell loss, and increased graft survival. In this paper, we successfully designed and evaluated the optical coherence tomography (OCT) distal sensor integrated needle for a precise big bubble technique. We successfully used this sensor for micro-control of a robotic DALK device termed AUTO-DALK for autonomous big bubble needle insertion. The OCT distal sensor was integrated inside a 25-gauge needle, which was used for pneumo-dissection. The AUTO-DALK device is built on a manual trephine platform which includes a vacuum ring to fix the device on the eye and add a needle driver at an angle of 60 degrees from vertical. During the test on five porcine eyes with a target depth of 90%, the measured insertion depth as a percentage of cornea thickness for the AUTO-DALK device was 90.05 % ± 2.33 % without any perforation compared to 79.16 % ± 5.68 % for unassisted free-hand insertion and 86.20 % ± 5.31 % for assisted free-hand insertion. The result showed a higher precision and consistency of the needle placement with AUTO-DALK, which could lead to better visual outcomes and fewer complications.

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Optical Coherence Tomography Guided Robotic Device for Autonomous Needle Insertion in Cornea Transplant Surgery

Cited by 6 publications

References 23 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

A Novel Flexible Endomicroscopic Scanning Instrument with Visual Servoing Control

Demonstration of Optical Coherence Tomography Guided Big Bubble Technique for Deep Anterior Lamellar Keratoplasty (DALK)

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