Active tremor cancellation by a “Smart” handheld vitreoretinal microsurgical tool using swept source optical coherence tomography

Abstract

Microsurgeons require dexterity to make precise and stable maneuvers to achieve surgical objectives and to minimize surgical risks during freehand procedures. This work presents a novel, common path, swept source optical coherence tomography-based "smart" micromanipulation aided robotic-surgical tool (SMART) that actively suppresses surgeon hand tremor. The tool allows enhanced tool tip stabilization, more accurate targeting and the potential to lower surgical risk. Freehand performance is compared to smart tool-assisted performance and includes assessment of the one-dimensional motion tremor in an active microsurgeon's hand. Surgeon hand tremor-the ability to accurately locate a surgical target and maintain tool tip offset distances-were all improved by smart tool assistance.

Review of intraoperative optical coherence tomography: technology and applications [Invited]

“…The Kang group at Johns Hopkins University demonstrated that Ascans could be acquired adjacent to the tooltip by mounting a fiber-optic common-path (CP) OCT probe along [107,108] or within [109][110][111] the shafts of forceps and needles for vitreoretinal surgery (Fig. 3(a)).…”

“…In its most recent iteration [108], the probe used a 100 kHz swept-source with a 1060 nm central wavelength, and M-scan images could be acquired and processed with GPU-accelerated software. The OCT probe was primarily used as a single-point axial ranger with micrometer-scale resolution to quantify hand tremor [111] and drive active motion cancellation systems [107,108,110], and to provide ranging feedback for a cooperative robotic surgery platform [109] (discussed in detail in Section 5.2). The Joos group at Vanderbilt University incorporated a needle-based OCT probe [105] capable of Bscan imaging into the shaft of 23-gauge surgical forceps [112] (Fig.…”

“…10). In contrast to the master-slave system, other studies explored the utility of OCT-guided cooperative robots, in which the surgeon controlled the robot with their hand instead of a haptic device [107][108][109][110][111]. These robots utilized OCT integrated into the surgical instruments to provide closed loop feedback for applications such as tremor reduction or tool depth locking.…”

Optical coherence tomography for precision brain imaging, neurosurgical guidance and minimally invasive theranostics

“…For giving an intuitive view of brain tissue, some researchers have designed and manufactured a neurosurgical probe of OCT, including endoscopic, needle-type, hand-held probe, and other kinds of neurosurgical OCT robotic arms (68,(72)(73)(74)(75)(76)(77)(78)(79) intrinsic brain tumors (68). In microsurgery, Kang et al proposed a common-path OCT system with an applicable fiber-optic endoscopic probe (74,76).…”

“…In microsurgery, Kang et al proposed a common-path OCT system with an applicable fiber-optic endoscopic probe (74,76). Furthermore, a hand-held forward-viewing probe is useful for neurosurgical imaging and residual tumor detection due to the irregular and limited resection cavity.…”