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Wang T, Li H, Pu T, Yang L. Microsurgery Robots: Applications, Design, and Development. SENSORS (BASEL, SWITZERLAND) 2023; 23:8503. [PMID: 37896597 PMCID: PMC10611418 DOI: 10.3390/s23208503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023]
Abstract
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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Affiliation(s)
- Tiexin Wang
- ZJU-UIUC Institute, International Campus, Zhejiang University, Haining 314400, China; (T.W.); (H.L.); (T.P.)
- School of Mechanical Engineering, Zhejiang University, Hangzhou 310058, China
| | - Haoyu Li
- ZJU-UIUC Institute, International Campus, Zhejiang University, Haining 314400, China; (T.W.); (H.L.); (T.P.)
| | - Tanhong Pu
- ZJU-UIUC Institute, International Campus, Zhejiang University, Haining 314400, China; (T.W.); (H.L.); (T.P.)
| | - Liangjing Yang
- ZJU-UIUC Institute, International Campus, Zhejiang University, Haining 314400, China; (T.W.); (H.L.); (T.P.)
- School of Mechanical Engineering, Zhejiang University, Hangzhou 310058, China
- Department of Mechanical Engineering, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA
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Yang C, Zhao Q, Li S, Pu L, Yu L, Liu Y, Lai X. Effects of Lycium barbarum L. Polysaccharides on Vascular Retinopathy: An Insight Review. Molecules 2022; 27:5628. [PMID: 36080395 PMCID: PMC9457721 DOI: 10.3390/molecules27175628] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 11/18/2022] Open
Abstract
Vascular retinopathy is a pathological change in the retina caused by ocular or systemic vascular diseases that can lead to blurred vision and the risk of blindness. Lycium barbarum polysaccharides (LBPs) are extracted from the fruit of traditional Chinese medicine, L. barbarum. They have strong biological activities, including immune regulation, antioxidation, and neuroprotection, and have been shown to improve vision in numerous studies. At present, there is no systematic literature review of LBPs on vascular retinal prevention and treatment. We review the structural characterization and extraction methods of LBPs, focus on the mechanism and pharmacokinetics of LBPs in improving vascular retinopathy, and discuss the future clinical application and lack of work. LBPs are involved in the regulation of VEGF, Rho/ROCK, PI3K/Akt/mTOR, Nrf2/HO-1, AGEs/RAGE signaling pathways, which can alleviate the occurrence and development of vascular retinal diseases in an inflammatory response, oxidative stress, apoptosis, autophagy, and neuroprotection. LBPs are mainly absorbed by the small intestine and stomach and excreted through urine and feces. Their low bioavailability in vivo has led to the development of novel dosage forms, including multicompartment delivery systems and scaffolds. Data from the literature confirm the medicinal potential of LBPs as a new direction for the prevention and complementary treatment of vascular retinopathy.
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Affiliation(s)
- Chunhong Yang
- Department of Chinese Medicine and Pharmacy, College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Qi Zhao
- Department of Chinese Medicine and Pharmacy, College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Shiling Li
- Department of Chinese Medicine and Pharmacy, College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Lili Pu
- Department of Chinese Medicine and Pharmacy, College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Liqiong Yu
- Department of Chinese Medicine and Pharmacy, College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Yaqin Liu
- Department of Chinese Medicine and Pharmacy, College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Xianrong Lai
- Department of Ethnic Medicine, College of Ethnomedicine, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
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Singh G, Jie WWJ, Sun MT, Casson R, Selva D, Chan W. Overcoming the impact of physiologic tremors in ophthalmology. Graefes Arch Clin Exp Ophthalmol 2022; 260:3723-3736. [PMID: 35788893 DOI: 10.1007/s00417-022-05718-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/26/2022] [Accepted: 05/27/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Ophthalmic surgery involves the manipulation of micron-level sized structures such as the internal limiting membrane where tactile sensation is practically absent. All humans have physiologic tremors that are of low amplitude and not discernible to the naked eye; they do not adversely affect the majority of the population's daily functioning. However, during microsurgery, such tremors can be problematic. In this review, we focus on the impact of physiological tremors on ophthalmic microsurgery and offer a comparative discussion on the impact of such tremors on other surgical specialties. METHODS A single investigator used the MEDLINE database (via PubMed) to search for and identify articles for inclusion in this systematic review. Ten key factors were identified as potentially having an impact on tremor amplitude: beta-blockers, muscle fatigue, robotic systems, handheld tools/micromanipulators, armrests/wrist supports, caffeine, diet, sleep deprivation, consuming alcohol, and workouts (exercise). These key terms were then searched using the advanced Boolean search tool and operators (i.e., AND, OR) available on PubMed: (*keyword*) AND (surgeon tremor OR microsurgery tremor OR hand steadiness OR simulator score). RESULTS Ten studies attempted to quantify the baseline severity of operator physiologic tremor. Approximately 89% of studies accessing the impact of tremors on performance in regards to surgical metrics reported an improvement in performance compared to 57% of studies concluding that tremor elimination was of benefit when considering procedural outcomes. CONCLUSIONS Robotic technology, new instruments, exoskeletons, technique modifications, and lifestyle factors have all demonstrated the potential to assist in overcoming tremors in ophthalmology.
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Affiliation(s)
- Gurfarmaan Singh
- School of Medicine, University of Adelaide, Health & Medical Sciences Building, 4 North Terrace, Adelaide, SA, 5000, Australia.
- Royal Adelaide Hospital, Adelaide, SA, Australia.
| | | | - Michelle Tian Sun
- School of Medicine, University of Adelaide, Health & Medical Sciences Building, 4 North Terrace, Adelaide, SA, 5000, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Robert Casson
- School of Medicine, University of Adelaide, Health & Medical Sciences Building, 4 North Terrace, Adelaide, SA, 5000, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Dinesh Selva
- School of Medicine, University of Adelaide, Health & Medical Sciences Building, 4 North Terrace, Adelaide, SA, 5000, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - WengOnn Chan
- School of Medicine, University of Adelaide, Health & Medical Sciences Building, 4 North Terrace, Adelaide, SA, 5000, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
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He C, Patel N, Shahbazi M, Yang Y, Gehlbach P, Kobilarov M, Iordachita I. Toward Safe Retinal Microsurgery: Development and Evaluation of an RNN-Based Active Interventional Control Framework. IEEE Trans Biomed Eng 2019; 67:966-977. [PMID: 31265381 DOI: 10.1109/tbme.2019.2926060] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Robotics-assisted retinal microsurgery provides several benefits including improvement of manipulation precision. The assistance provided to the surgeons by current robotic frameworks is, however, a "passive" support, e.g., by damping hand tremor. Intelligent assistance and active guidance are, however, lacking in the existing robotic frameworks. In this paper, an active interventional control framework (AICF) has been presented to increase operation safety by actively intervening the operation to avoid exertion of excessive forces to the sclera. METHODS AICF consists of the following four components: first, the steady-hand eye robot as the robotic module; second, a sensorized tool to measure tool-to-sclera forces; third, a recurrent neural network to predict occurrence of undesired events based on a short history of time series of sensor measurements; and finally, a variable admittance controller to command the robot away from the undesired instances. RESULTS A set of user studies were conducted involving 14 participants (with four surgeons). The users were asked to perform a vessel-following task on an eyeball phantom with the assistance of AICF as well as other two benchmark approaches, i.e., auditory feedback (AF) and real-time force feedback (RF). Statistical analysis shows that AICF results in a significant reduction of proportion of undesired instances to about 2.5%, compared with 38.4% and 26.2% using AF and RF, respectively. CONCLUSION AICF can effectively predict excessive-force instances and augment performance of the user to avoid undesired events during robot-assisted microsurgical tasks. SIGNIFICANCE The proposed system may be extended to other fields of microsurgery and may potentially reduce tissue injury.
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