A comparison of robotic and manual surgery for internal limiting membrane peeling

Maberley, David; Beelen, Maarten; Smit, Jorrit; Meenink, Thijs; Naus, Gerrit; Wagner, Clemens; Smet, Marc D. de

doi:10.1007/s00417-020-04613-y

Cited by 28 publications

(27 citation statements)

References 14 publications

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“…Furthermore, it gives us an indication of how increased experience and training affects these parameters over time. Finally, the results of this study verify those of a previous study (Forslund Jacobsen et al 2019) and supports a recently published study (Maberley et al 2020) by confirming that robotassisted vitreoretinal surgery reduces instrument movements and tissue damage, while being significantly slower compared to manual surgery.…”

Section: Discussionsupporting

confidence: 89%

The learning curve of robot‐assisted vitreoretinal surgery – A randomized trial in a simulated setting

Jacobsen

Konge

Cour

et al. 2021

Acta Ophthalmologica

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Purpose: To investigate the learning curve of robot-assisted vitreoretinal surgery compared to manual surgery in a simulated setting. Methods: The study was designed as a randomized controlled longitudinal study. Eight ophthalmic trainees in the 1st or 2nd year of their specialization were included. The participants were randomized to either manual or robot-assisted surgery. Participants completed repetitions of a test consisting of three vitreoretinal modules on the Eyesi virtual reality simulator. The primary outcome measure was time to learning curve plateau (minutes) for total test score. The secondary outcome measures were instrument movement (mm), tissue treatment (mm 2 ) and time with instruments inserted (seconds). Results: There was no significant difference in time to learning curve plateau for robot-assisted vitreoretinal surgery compared to manual. Robot-assisted vitreoretinal surgery was associated with less instrument movements (i.e. improved precision), À0.91 standard deviation (SD) units (p < 0.001). Furthermore, robotassisted vitreoretinal surgery was associated with less tissue damage when compared to manual surgery, À0.94 SD units (p = 0.002). Lastly, robot-assisted vitreoretinal surgery was slower than manual surgery, 0.93 SD units (p < 0.001). Conclusions: There was no significant difference between the lengths of the learning curves for robot-assisted vitreoretinal surgery compared to manual surgery. Robot-assisted vitreoretinal surgery was more precise, associated with less tissue damage, and slower.

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Section: Discussionsupporting

confidence: 89%

The learning curve of robot‐assisted vitreoretinal surgery – A randomized trial in a simulated setting

Jacobsen

Konge

Cour

et al. 2021

Acta Ophthalmologica

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“…For example, the use of virtual reality does not allow practicing the insertion of trocars, but it does allow critical steps such as posterior vitrectomy and ILM peeling. 12 The use of arti cial eyes has been gaining popularity over time and likewise they have been perfected to give greater realism and versatility to practice not only the classic scenarios of retinal surgery but also complex scenarios such as intraocular foreign body removal. Studies are required to perform a comparative analysis between the different models available to date.…”

Section: Reasons Why This Type Of Training Is Implemented or Notmentioning

confidence: 99%

Simulation as a Training Tool in Retina Training in Latin America (SIMRET Project): Survey (Report Nº 1)

Luciano¹,

Montero²,

Calisse³

et al. 2021

Preprint

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Purpose: To evaluate the situation in Latin America regarding the use of simulation as surgical training in the retina.Methods: An online survey was carried out to determine the resources available in simulated retinal training in Latin America. The survey was shared via email to retina fellows and subspecialists in Latin America between November 2020 and March 2021. The relevant resources for retinal subspecialty surgical training were: biological material (pig / goat eyes); artificial eyes, and virtual reality devices. The survey was divided into five sections: (1) Identification of participants (2) Availability of resources in retinal simulation (3) Types of available resources and types of practice techniques (4) Reliability of resources according to their personal experience (5) Reasons why this type of training is implemented or not. Results: 190 participants were surveyed. The overall response rate was 61.05 %. 96 (82.8%) of the 116 responding did not have access to a retinal simulation training program. Of the 20/116 that did have access (17.2%), the most frequent resource available was biological eyes 32/116 (27.6%), followed by artificial eyes 16/116 (14.0%), and virtual reality devices 15/116 (13.0%). The reasons for lack of simulation resources was economic (77.1%), followed by the lack of a physical space (17.1 %), and interestingly some participants (5.2%) reported that it did not seem necessary to use simulation to develop new surgical skills.Conclusions: Our work highlights the lack of resources for surgical training in the retina using simulation in Latin America.

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“…Employing electromagnetic navigation can assist in positioning the isotropic detector probes and light source to the pre-determined optimal locations and allows direct visual feedback of the actual positions during the light exposure [37]. Besides, a fixation tool will be developed to enable a stable fluence rate delivery, whereas several studies showed a reduction of instrument movements by using a surgical robot device compared to manual surgery [38,39]. In addition, the in vivo optical properties of the paranasal sinus will be determined by means of multidiameter single-fiber reflectance (MDSFR) spectroscopy; these properties will be incorporated in this developed 3D light distribution model.…”

Section: Conclusion and Future Perspectivesmentioning

confidence: 99%

Intra-cavity Photodynamic Therapy for malignant tumors of the paranasal sinuses: An in vivo light dosimetry study

Doeveren

Veen

Boom

et al. 2020

Photodiagnosis and Photodynamic Therapy

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Background: Photodynamic therapy (PDT) is a promising treatment option for recurrent sinonasal malignancies. However, light administration in this area is challenging given the complex geometry, varying tissue optical properties and difficult accessibility. The goal of this study was to estimate the temporal and spatial variation in fluence and fluence rate during sinonasal mTHPC-mediated PDT. It was investigated whether the predetermined aim to illuminate with a fluence of 20 J⋅cm − 2 and fluence rate of 100 mW⋅cm − 2 was achieved. Methods: In eleven patients the fluence and fluence rates were measured using in vivo light dosimetry at the target location during real-time sinonasal PDT. There was a variance in sinonasal target location and type of light diffuser used. In four patients two isotropic detectors were used within the same cavity. Results: All measurements showed major fluence rate fluctuations within each single isotropic detector probe over time, as well as between probes within the same cavity. The largest fluence rate range measured was 328 mW⋅cm − 2 . Only one probe showed a mean fluence rate of ~100 mW⋅cm − 2 . Taken all probes together, a fluence rate above 80 mW⋅cm − 2 was measured in 31 % of the total light exposure; in 22 % it was less than 20 mW⋅cm − 2 . Thirty-three percent showed a fluence of at least 20 J⋅cm − 2 . Conclusions: The current dosimetry approach for sinonasal intra-cavity PDT shows major temporal and spatial variations in fluence rate and a large variance in light exposure time. The results emphasize the need for improvement of in vivo light dosimetry and dosimetry planning.

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A comparison of robotic and manual surgery for internal limiting membrane peeling

Cited by 28 publications

References 14 publications

The learning curve of robot‐assisted vitreoretinal surgery – A randomized trial in a simulated setting

The learning curve of robot‐assisted vitreoretinal surgery – A randomized trial in a simulated setting

Simulation as a Training Tool in Retina Training in Latin America (SIMRET Project): Survey (Report Nº 1)

Intra-cavity Photodynamic Therapy for malignant tumors of the paranasal sinuses: An in vivo light dosimetry study

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