Robotic posterior capsule polishing by optical coherence tomography image guidance

Gerber, Matthew J.; Hubschman, Jean‐Pierre; Tsao, Tsu‐Chin

doi:10.1002/rcs.2248

Cited by 6 publications

(5 citation statements)

References 25 publications

(50 reference statements)

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“…Shorter pulse durations could enable higher peak power with less energy per pulse, and a multispot laser treatment could shorten the treatment time. Robotization of the steps of lens aspiration is in its infancy in cataract surgery (98,99), but this technology could be integrated with FLACS to create fully automated cataract extraction platforms in the future.…”

Section: Discussion and Perspectivesmentioning

confidence: 99%

Femtosecond laser-assisted cataract surgery: Update and perspectives

Kecik

Schweitzer

2023

Front. Med.

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Cataract surgery is among the most frequently performed surgical procedures worldwide and has a tremendous impact on patients' quality of life. Phacoemulsification (PCS) is accepted as a standard of care; its technique has continuously evolved and already achieved good anatomical, visual, and refractive outcomes. Lasers in ophthalmology are widely used in clinical practice, femtosecond lasers (FSLs) for corneal surgery in particular. It was natural to assess the usefulness of FSL in cataract surgery as this technology was within reach. Indeed, precise and reproducible cuttings provided by FSL platforms could improve standardization of care and limit the risk associated with the human element in surgery and provide a step toward robot-assisted surgery. After docking and planning the procedure, femtosecond lasers are used to perform corneal incisions, capsulorhexis, lens fragmentation, and arcuate incisions in an automated manner. A well-constructed corneal incision is primordial as it offers safety during the procedure, self-seals afterward, and influences the refractive outcome. Capsulorhexis size, centration, and resistance to shearing influence the surgery, intraocular lens (IOL) centration and stability, and posterior capsular opacification formation. Lens fragmentation is where most of the energy is delivered into the eye, and its amount influences endothelial cell damage and potential damage to other ocular structures. The arcuate incisions offer an additional opportunity to influence postoperative astigmatism. Femtosecond laser-assisted cataract surgery (FLACS) has been a topic of research in many studies and clinical trials that attempted to assess its potential benefits and cost-effectiveness over PCS and is the subject of this mini-review.

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Section: Discussion and Perspectivesmentioning

confidence: 99%

Femtosecond laser-assisted cataract surgery: Update and perspectives

Kecik

Schweitzer

2023

Front. Med.

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“…In recent research, investigators have applied OCT imaging technology to the IRISS system and developed a series of OCT and camera image-guided semi-automation/automation schemes for intraocular surgery. These include semi-automated lens removal [55,258], posterior capsular polishing [85], identification and removal of residual lens fragments [228], and automated retinal vein cannulation [22]; these schemes have been validated using ex vivo porcine eyes or silicone phantoms.…”

Section: Irissmentioning

confidence: 99%

“…For example, incorporating machine learning techniques, MSR systems can identify and analyze patient status preoperatively, thus enabling automatic intraoperative targeting or providing patient-specific surgical recommendations to the surgeon [55]. In the intraoperative phase, the application of automation technology allows the MSR to automatically perform some of the surgical tasks based on a predefined surgical path or adjust the path in real-time based on sensor feedback, leading to improved surgical efficiency [85].…”

Section: Higher Level Of Autonomymentioning

confidence: 99%

“…Yu et al designed the OCT-forceps, a surgical forceps with OCT B-Scan functionality, which was installed on a teleoperate MSR to enable OCT-guided epiretinal membrane peeling [84]. Gerber et al combined the MSR with a commercially available OCT scanning device (Telesto II-1060LR, Thorlabs, NJ, USA), enabling the intraoperative ocular tissue identification and tool tip visual servoing, and completed several OCT-guided robotic surgical tasks, including semi-automated cataract removal [55], automated posterior capsule polishing [85], and automated retinal vein cannulation [22].…”

mentioning

confidence: 99%

“…In addition, polishing of the posterior capsule (PC, approximately 4-9 µm thick) reduces complications but is considered a high-risk procedure [229]. To address this, Gerber et al developed the posterior capsule polishing function for IRISS, incorporating the guidance provided by OCT volume scan and B-scan [85].…”

mentioning

confidence: 99%

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Microsurgery Robots: Applications, Design, and Development

Wang,

Li,

et al. 2023

Sensors

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Microsurgical techniques have been widely utilized in various surgical specialties, such as ophthalmology, neurosurgery, and otolaryngology, which require intricate and precise surgical tool manipulation on a small scale. In microsurgery, operations on delicate vessels or tissues require high standards in surgeons’ skills. This exceptionally high requirement in skills leads to a steep learning curve and lengthy training before the surgeons can perform microsurgical procedures with quality outcomes. The microsurgery robot (MSR), which can improve surgeons’ operation skills through various functions, has received extensive research attention in the past three decades. There have been many review papers summarizing the research on MSR for specific surgical specialties. However, an in-depth review of the relevant technologies used in MSR systems is limited in the literature. This review details the technical challenges in microsurgery, and systematically summarizes the key technologies in MSR with a developmental perspective from the basic structural mechanism design, to the perception and human–machine interaction methods, and further to the ability in achieving a certain level of autonomy. By presenting and comparing the methods and technologies in this cutting-edge research, this paper aims to provide readers with a comprehensive understanding of the current state of MSR research and identify potential directions for future development in MSR.

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Preparing porcine lens to mimic human lens capsule

Pei,

Han,

et al. 2024

J Cataract Refract Surg

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Purpose: To develop a chemical method that makes porcine lens anterior capsule resemble human lens anterior capsule in tear force and perforating force. Setting: Beijing Tongren Hospital, Beijing, China Design: Experimental study. Methods: Porcine eyes were divided into groups, and reagents (0.9% physiological saline, 0.1% sodium hypochlorite, 0.3% sodium hypochlorite and 0.5% sodium hypochlorite) were injected into the anterior chamber respectively, recorded as groups A, B, C and D, respectively. A senior physician collected each group of anterior capsules after performing continuous circular capsulorhexis and assessing the anterior capsule's tearing and perforation forces.an additional group, which consisted of human lens anterior capsules taken in the operating room from cataract patients, recorded as group E. A tensile system was used to measure each sample's tensile force. Results: A significant difference was found between group A and any other group in maximum tensile force and average tensile force both in transverse and longitudinal directions. No significant difference was found between any two groups from group B to group E. According to the surgeon's assessment, the tear force characteristic of the porcine lens anterior capsule treated with 0.1%, 0.3%, and 0.5% sodium hypochlorite solution was similar to that of the human lens anterior capsule. Conclusions: Porcine lens capsule treated using this method can be used for training of new surgeons. The porcine lens anterior capsule treated with 0.5% sodium hypochlorite, which results showed most resembled human lens anterior capsule, can be used for robotic training.

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Robotic posterior capsule polishing by optical coherence tomography image guidance

Cited by 6 publications

References 25 publications

Femtosecond laser-assisted cataract surgery: Update and perspectives

Femtosecond laser-assisted cataract surgery: Update and perspectives

Microsurgery Robots: Applications, Design, and Development

Preparing porcine lens to mimic human lens capsule

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