Physiological tremor amplitude during retinal microsurgery

Singh, Surya P. N.; Riviere, Cameron N.

doi:10.1109/nebc.2002.999520

Cited by 112 publications

(81 citation statements)

References 4 publications

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“…Previous reports state that the maximum hand tremor of vitreoretinal surgeons during intraocular procedures exceeds 100 mm. 21,[25][26][27] However, microcannulation into retinal vessels with a diameter of B200 mm would require an accuracy of nearly 10 mm. Successful completion of such a task may be indicative of the robot's potential to perform other high-dexterity functions, such as an epiretinal membrane peel.…”

Section: Discussionmentioning

confidence: 99%

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

Rahimy

Wilson

Tsao

et al. 2013

Eye

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Purpose The aim of this study is to develop a novel robotic surgical platform, the IRISS (Intraocular Robotic Interventional and Surgical System), capable of performing both anterior and posterior segment intraocular surgery, and assess its performance in terms of range of motion, speed of motion, accuracy, and overall capacities. Patients and methods To test the feasibility of performing 'bimanual' intraocular surgical tasks using the IRISS, we defined four steps out of typical anterior (phacoemulsification) and posterior (pars plana vitrectomy (PPV)) segment surgery. Selected phacoemulsification steps included construction of a continuous curvilinear capsulorhexis and cortex removal in infusion-aspiration (I/A) mode. Vitrectomy steps consisted of performing a core PPV, followed by aspiration of the posterior hyaloid with the vitreous cutter to induce a posterior vitreous detachment (PVD) assisted with triamcinolone, and simulation of the microcannulation of a temporal retinal vein. For each evaluation, the duration and the successful completion of the task with or without complications or involuntary events was assessed. Results Intraocular procedures were successfully performed on 16 porcine eyes. Four eyes underwent creation of a round, curvilinear anterior capsulorhexis without radialization. Four eyes had I/A of lens cortical material completed without posterior capsular tear. Four eyes completed 23-gauge PPV followed by successful PVD induction without any complications. Finally, simulation of microcannulation of a temporal retinal vein was successfully achieved in four eyes without any retinal tears/perforations noted. Conclusion Robotic-assisted intraocular surgery with the IRISS may be technically feasible in humans. Further studies are pending to improve this particular surgical platform.

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Section: Discussionmentioning

confidence: 99%

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

Rahimy

Wilson

Tsao

et al. 2013

Eye

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“…Manual dexterity, precision, and perception are particularly important during tasks where the ability to position instruments with great accuracy often correlates directly with the results of the procedure [14], [20]. In a recent study, the root mean square (RMS) amplitude of the tremor of an ophthalmic surgeon under surgical conditions was measured to be 182 µm [16]. While it may be possible to briefly position an instrument at a specified target with great accuracy, maintaining the position for extended periods of time becomes increasingly difficult due to physical, visual and mental fatigue [3].…”

Section: -25 Gauge In Diameter)mentioning

confidence: 99%

Development and Application of a New Steady-Hand Manipulator for Retinal Surgery

Mitchell¹,

Koo²,

Iordachita³

et al. 2007

Proceedings 2007 IEEE International Conference on Robotics and Automation

138

107

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Abstract-This paper describes the development and initial testing of a new and optimized version of a steady-hand manipulator for retinal microsurgery. In the steady-hand paradigm, the surgeon and the robot share control of a tool attached to the robot through a force sensor. The robot controller senses forces exerted by the operator on the tool and uses this information in various control modes to provide smooth, tremor-free, precise positional control and force scaling. The steady-hand manipulator reported here has been specifically designed with the unique constraints of retinal microsurgery in mind. In particular, the system makes use of a compact wrist design that places the bulk of the robot away from the operating field. The resulting system has high efficacy, flexibility and ergonomics while meeting the accuracy and safety requirements of microsurgery. We have now tested this robot on a biological model system and we report a protocol for reliably cannulating ∼80 µm OD veins (the size of veins in the human retina) using the system.

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“…A well-known barrier to precision in microsurgery is, physiological hand tremor, occurring predominating in the 6-12 Hz frequency domain with several hundred-micron-order amplitude [1,2]. Retinal microsurgery is performed by passing microsurgical tools through trocars that provide access through the eye wall (sclera).…”

Section: Introductionmentioning

confidence: 99%

Accurate real-time depth control for CP-SSOCT distal sensor based handheld microsurgery tools

Cheon

Huang

Cha

et al. 2015

Biomed. Opt. Express

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This paper presents a novel intuitive targeting and tracking scheme that utilizes a common-path swept source optical coherence tomography (CP-SSOCT) distal sensor integrated handheld microsurgical tool. To achieve micron-order precision control, a reliable and accurate OCT distal sensing method is required; simultaneously, a prediction algorithm is necessary to compensate for the system delay associated with the computational, mechanical and electronic latencies. Due to the multilayered structure of retina, it is necessary to develop effective surface detection methods rather than simple peak detection. To achieve this, a shifted cross-correlation method is applied for surface detection in order to increase robustness and accuracy in distal sensing. A predictor based on Kalman filter was implemented for more precise motion compensation. The performance was first evaluated using an established dry phantom consisting of stacked cellophane tape. This was followed by evaluation in an ex-vivo bovine retina model to assess system accuracy and precision. The results demonstrate highly accurate depth targeting with less than 5 μm RMSE depth locking.

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Physiological tremor amplitude during retinal microsurgery

Cited by 112 publications

References 4 publications

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

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

Development and Application of a New Steady-Hand Manipulator for Retinal Surgery

Accurate real-time depth control for CP-SSOCT distal sensor based handheld microsurgery tools

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