Robot-assisted tremor control for performance enhancement of retinal microsurgeons

Abstract

Pars plana vitrectomy is a challenging, minimally invasive microsurgical procedure due to its intrinsic manoeuvres and physiological limits that constrain human capability. An important human limitation is physiological hand tremor, which can significantly increase the risk of iatrogenic retinal damage resulting from unintentional manoeuvres that affect anatomical and functional surgical outcomes. The limitations imposed by normal physiological tremor are more evident and challenging during ‘micron-scale’ manoeuvres such as epiretinal membrane and internal limiting membrane peeling, and delicate procedures requiring coordinated bimanual surgery such as tractional retinal detachment repair. Therefore, over the previous three decades, attention has turned to robot-assisted surgical devices to overcome these challenges. Several systems have been developed to improve microsurgical accuracy by cancelling hand tremor and facilitating faster, safer and more effective microsurgeries. By markedly reducing tremor, microsurgical precision is improved to a level beyond present human capabilities. In conclusion, robotics offers potential advantages over free-hand microsurgery as it is currently performed during ophthalmic surgery and opens the door to a new class of revolutionary microsurgical modalities. The skills transfer that is beyond human capabilities to robotic technology is a logical next step in microsurgical evolution.

Epiretinal membrane: A review

“…Vitrectomy may become a robotic operator‐dependent field of surgery. Tremor‐cancelling and force‐sensing micro‐forceps are robotic features which are anticipated to improve microsurgery in the future for better surgical outcomes 161 . Hands‐free microsurgery may overcome the limitations of human physical skill, adequate visualisation and mental fatigue 161 …”

Existe espaço para a microcirurgia na cirurgia robótica?

“…Além disso, o uso do robô associado com métodos de imagem conferiu ainda mais precisão cirúrgica. Os autores 22 sugerem que a tecnologia tende a se desenvolver cada vez mais, o que permitirá a execução de procedimentos inviáveis por cirurgia convencional, assim como sugeriram Roizenblatt et al 23 Kavoussi 24 comparou reversão de vasectomia realizada por cirurgia robótica e por microcirurgia. Seu estudo não demonstrou diferença estatisticamente significativa entre os dois métodos em termos da eficácia do procedimento.…”

Effects of microsurgical repair treatment on the clinical efficacy, complications, and flap follow-up scores of patients with exposed steel plates after surgery for foot and ankle fractures

“…Ankle-hindfoot function recovery and ankle joint recovery were assessed before treatment and at 3 and 6 months after treatment using the American Orthopedic Foot and Ankle Society (AOFAS) score and the Baird ankle score, respectively (7). The Ankle-hindfoot score ranges from 0 to 100 points, with higher scores indicating better the recovery of the ankle-hindfoot function.…”