Robot-assisted vitreoretinal surgery: current perspectives

Abstract

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.

In Situ Tremor in Vitreoretinal Surgery

“…Evidence that surgeon tremor is a significant problem is a common justification for robot-assisted surgery ( Channa et al, 2017 ; Gudeloglu et al, 2014 ; Nuzzi & Brusasco, 2018 ; Riviere et al, 2006 ; Roizenblatt et al, 2018 ). Specifically, for one of the most technically demanding microsurgical fields, vitreoretinal surgery, a main technical limitation is imprecise maneuver during micromanipulation of tissues due to natural hand tremor ( Nuzzi & Brusasco, 2018 ).…”

“…Specifically, for one of the most technically demanding microsurgical fields, vitreoretinal surgery, a main technical limitation is imprecise maneuver during micromanipulation of tissues due to natural hand tremor ( Nuzzi & Brusasco, 2018 ). In a recent review of robot-assisted vitreoretinal surgery, chief among the challenges faced by ultra-microsurgeons is physiologic hand tremor ( Roizenblatt et al, 2018 ). A high number of surgical procedures have been performed with robot assistance without enough evidence to support full implementation.…”

Treatment-Emergent Adverse Events in Gene Therapy Trials for Inherited Retinal Diseases: A Narrative Review

“…Microscope-integrated OCT (MIOCT) may help prevent complications of inaccurate needle tip placement and repeat subretinal bleb formations such as hemorrhage, cannula tip obstruction, macular hole formation, retinoschisis, and RPE damage [ 43 ]. Robotic augmented vitreoretinal surgery has emerged in an effort to improve dexterity and control [ 44 ]. The first trial to use robotic-assisted surgery in human patients, the Robotic Retinal Dissection Device trial, demonstrated promising early safety results [ 45 ].…”

Robotics and ophthalmology: Are we there yet?

“…The robotic systems are effective for the purposes that require repetitive tasks, making the work easier for the ophthalmologist. [25]…”