Robotic ocular surgery

Abstract

Background: Bimanual, three-dimensional robotic surgery has proved valuable for a variety of surgical procedures. Aims: To examine the use of a commercially available surgical robot for ocular microsurgery. Methods: Using a da Vinci surgical robot, ocular microsurgery was performed with repair of a corneal laceration in a porcine model. The experiments were performed on harvested porcine eyes placed in an anatomical position using a foam head on a standard operating room table. A video scope and two, 360˚-rotating, 8-mm, wrested-end effector instruments were placed over the eye with three robotic arms. The surgeon performed the actual procedures while positioned at a robotic system console that was located across the operating room suite. Each surgeon placed three 10-0 sutures, and this was documented with still and video photography. Results: Ocular microsurgery was successfully performed using the da Vinci surgical robot. The robotic system provided excellent visualisation, as well as controlled and delicate placement of the sutures at the corneal level. Conclusions: Robotic ocular microsurgery is technically feasible in the porcine model and warrants consideration for evaluation in controlled human trials to deploy functioning remote surgical centres in areas without access to state-of-the-art surgical skill and technology.

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

“…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.…”

Robotic Eye Surgery: Past, Present, and Future

“…In ophthalmic surgery, this system has been used to perform suture repair of a corneal laceration [14], complete a continuous capsulorhexis on the anterior lens capsule in cataract surgery, and perform a 3-port 25-gauge pars plan a vitrectomy (Figure 2c) in porcine eyes [15]. Several limitations of the Da Vinci Surgical System were noted.…”

‘The Microhand’: a new concept of micro-forceps for ocular robotic surgery

“…2,4 Encouraging developments have stemmed from recent studies on ocular robotic surgery. 9,10 For ocular microsurgery, dedicated surgical instruments have to be specifically adapted for ocular robotic tasks, and the force applied by the robot on ocular tissues should be well quantified and controlled to avoid unexpected ocular damage. Although forces applied during retinal microsurgery have already been estimated, 11,12 no dedicated microsurgical forceps have been designed so far allowing calibrated forces to be reliably applied to tissues during ocular surgery.…”