Robotic Vitreoretinal Surgery

Channa, Roomasa; Iordachita, Iulian; Handa, James T.

doi:10.1097/iae.0000000000001398

Cited by 46 publications

(44 citation statements)

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“…In order to suppress involuntary motion in retinal microsurgery, various robotic systems have been developed [ 27 ]. Among the handheld robotic devices is Micron [ 33 ], which aims to preserve the intuitive feel of standard handheld ophthalmic tools, and actively attenuate the physiological hand tremor of the surgeon.…”

Section: System Componentsmentioning

confidence: 99%

“…Hand tremor limits precise targeting of retinal veins and also limits the ability to maintain the cannula within the lumen for the period of drug delivery [ 11 ]. In order to provide a more precise tool manipulation in vitreoretinal surgery, various robotic systems have been developed during the past 20 years [ 27 ]. These research platforms include teleoperated devices [ 28 , 29 , 30 , 31 , 32 ], cooperatively-controlled systems [ 33 , 34 ], injectable ocular microrobots [ 35 , 36 ], or handheld tools [ 37 , 38 , 39 , 40 , 41 , 42 , 43 ], and mostly shared the common goal of suppressing involuntary components of motion, such as the physiological hand tremor of the operator.…”

Section: Introductionmentioning

confidence: 99%

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Towards Robot-Assisted Retinal Vein Cannulation: A Motorized Force-Sensing Microneedle Integrated with a Handheld Micromanipulator †

Gonenc

Chae

Gehlbach

et al. 2017

Sensors

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Retinal vein cannulation is a technically demanding surgical procedure where therapeutic agents are injected into the retinal veins to treat occlusions. The clinical feasibility of this approach has been largely limited by the technical challenges associated with performing the procedure. Among the challenges to successful vein cannulation are identifying the moment of venous puncture, achieving cannulation of the micro-vessel, and maintaining cannulation throughout drug delivery. Recent advances in medical robotics and sensing of tool-tissue interaction forces have the potential to address each of these challenges as well as to prevent tissue trauma, minimize complications, diminish surgeon effort, and ultimately promote successful retinal vein cannulation. In this paper, we develop an assistive system combining a handheld micromanipulator, called “Micron”, with a force-sensing microneedle. Using this system, we examine two distinct methods of precisely detecting the instant of venous puncture. This is based on measured tool-tissue interaction forces and also the tracked position of the needle tip. In addition to the existing tremor canceling function of Micron, a new control method is implemented to actively compensate unintended movements of the operator, and to keep the cannulation device securely inside the vein following cannulation. To demonstrate the capabilities and performance of our uniquely upgraded system, we present a multi-user artificial phantom study with subjects from three different surgical skill levels. Results show that our puncture detection algorithm, when combined with the active positive holding feature enables sustained cannulation which is most evident in smaller veins. Notable is that the active holding function significantly attenuates tool motion in the vein, thereby reduces the trauma during cannulation.

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Section: System Componentsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Towards Robot-Assisted Retinal Vein Cannulation: A Motorized Force-Sensing Microneedle Integrated with a Handheld Micromanipulator †

Gonenc

Chae

Gehlbach

et al. 2017

Sensors

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“…As technology advances, different surgical specialties are increasingly looking towards robot-assisted surgeries with the aim of increasing precision and dexterity, reducing surgical wound size and operating time, eliminating surgeon-related factors such as tremor and fatigue and ultimately improving patient outcome. In ophthalmology, microsurgical robots can lead to novel vitreoretinal treatments, such as cannulating retinal vessels for targeted drug delivery to occluded vessels (thrombolysis) or intraocular tumour (chemotherapy), or even gene delivery to targeted retinal cells for hereditary diseases, as robots are not confined by the physiological tremor of a human hand [1]. Notable examples include the Da Vinci Robotic Surgical System (Intuitive Surgical), which has been used in simulated intraocular surgery [2] and the first roboticallyassisted anterior segment operation [3], Preceyes Surgical System, which was used in the world's first robot-assisted human intraocular operation in 2016 and the Intraocular Robotic Interventional and Surgical System (IRISS) by UCLA [4].…”

Section: Introductionmentioning

confidence: 99%

Using smartphone-delivered stereoscopic vision in microsurgery: a feasibility study

2019

Eye

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Background Many surgical specialties are increasingly looking towards robot-assisted surgeries to improve patient outcome. Surgeons conducting robot-assisted operations require real-time surgical view. Ophthalmic robots can lead to novel vitreoretinal treatments, such as cannulating retinal vessels or even gene delivery to targeted retinal cells. This study investigates the feasibility of smartphone-delivered stereoscopic vision for microsurgical use. Methods A stereo-camera, connected to a laptop, was used to capture the 3D view from a binocular surgical microscope. Wi-Fi connection was used to live-stream the laptop display onto the smartphone screen wirelessly. Finally, a Virtual Reality (VR) headset, which acts as a stereoscope, was used to house the smartphone. The headset wearer then fused these images to achieve stereoscopic perception. Results Using smartphone-delivered 3D vision, the author performed a simulated cataract extraction operation successfully, despite a time lag of 0.354 s ± 0.038. To the author's knowledge, this is the first simulated ophthalmic operation performed via smartphone-delivered stereoscopic vision. Conclusions Microscopic output in 3D with minimal time lag can be readily achievable with smartphones and VR headsets. Uncoupling the surgeon from the operating microscope is required to achieve tele-presence, an essential step in tele-robotics. Where operating theatre space is a concern, head-mounted displays may be more convenient than 3D televisions. This 3D live-casting technique can be used in teaching and mentoring settings, where microsurgeries can be live-streamed stereoscopically onto smartphones via local Wi-Fi network. When connected to the internet, microsurgeries can be broadcasted live and viewers worldwide can see the surgeon's view wearing their VR headsets.

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“… 10 In response to this trend, hundreds of robotic systems have been sold worldwide with an increasing number of laboratories committing research effort to robotic medicine. 11 , 12 …”

Section: Introduction To Robotics In Surgerymentioning

confidence: 99%

Robot-assisted vitreoretinal surgery: current perspectives

Roizenblatt¹,

Edwards²,

Gehlbach³

2018

RSRR

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Vitreoretinal microsurgery is among the most technically challenging of the minimally invasive surgical techniques. Exceptional precision is required to operate on micron scale targets presented by the retina while also maneuvering in a tightly constrained and fragile workspace. These challenges are compounded by inherent limitations of the unassisted human hand with regard to dexterity, tremor and precision in positioning instruments. The limited human ability to visually resolve targets on the single-digit micron scale is a further limitation. The inherent attributes of robotic approaches therefore, provide logical, strategic and promising solutions to the numerous challenges associated with retinal microsurgery. Robotic retinal surgery is a rapidly emerging technology that has witnessed an exponential growth in capabilities and applications over the last decade. There is now a worldwide movement toward evaluating robotic systems in an expanding number of clinical applications. Coincident with this expanding application is growth in the number of laboratories committed to “robotic medicine”. Recent technological advances in conventional retina surgery have also led to tremendous progress in the surgeon’s capabilities, enhanced outcomes, a reduction of patient discomfort, limited hospitalization and improved safety. The emergence of robotic technology into this rapidly advancing domain is expected to further enhance important aspects of the retinal surgery experience for the patients, surgeons and society.

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Robotic Vitreoretinal Surgery

Cited by 46 publications

References 47 publications

Towards Robot-Assisted Retinal Vein Cannulation: A Motorized Force-Sensing Microneedle Integrated with a Handheld Micromanipulator †

Towards Robot-Assisted Retinal Vein Cannulation: A Motorized Force-Sensing Microneedle Integrated with a Handheld Micromanipulator †

Using smartphone-delivered stereoscopic vision in microsurgery: a feasibility study

Robot-assisted vitreoretinal surgery: current perspectives

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