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Mi H, MacLaren RE, Cehajic-Kapetanovic J. Robotising vitreoretinal surgeries. Eye (Lond) 2024:10.1038/s41433-024-03149-3. [PMID: 38965320 DOI: 10.1038/s41433-024-03149-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/04/2024] [Accepted: 05/17/2024] [Indexed: 07/06/2024] Open
Abstract
The use of robotic surgery in ophthalmology has been shown to offer many potential advantages to current surgical techniques. Vitreoretinal surgery requires complex manoeuvres and high precision, and this is an area that exceeds manual human dexterity in certain surgical situations. With the advent of advanced therapeutics such as subretinal gene therapy, precise delivery and minimising trauma is imperative to optimize outcomes. There are multiple robotic systems in place for ophthalmology in pre-clinical and clinical use, and the Preceyes Robotic Surgical System (Preceyes BV) has also gained the CE mark and is commercially available for use. Recent in-vivo and in-human surgeries have been performed successfully with robotics systems. This includes membrane peeling, subretinal injections of therapeutics, and retinal vein cannulation. There is huge potential to integrate robotic surgery into mainstream clinical practice. In this review, we summarize the existing systems, and clinical implementation so far, and highlight the future clinical applications for robotic surgery in vitreo-retina.
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Affiliation(s)
- Helen Mi
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Robert E MacLaren
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Jasmina Cehajic-Kapetanovic
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
- NIHR Oxford Biomedical Research Centre, Oxford, UK.
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Wang Y, Sun J, Liu X, Li Y, Fan X, Zhou H. Robot-Assisted Orbital Fat Decompression Surgery: First in Human. Transl Vis Sci Technol 2022; 11:8. [PMID: 35536720 PMCID: PMC9100477 DOI: 10.1167/tvst.11.5.8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To explore the safety and feasibility of robot-assisted orbital fat decompression surgery. Methods Ten prospectively enrolled patients (18 eyes) with Graves’ ophthalmopathy underwent robot-assisted orbital fat decompression surgery with the da Vinci Xi surgical system. Intraoperative blood loss, operative time, and complications were recorded. For every patient, the exophthalmos of the operated eyes and Graves’ orbitopathy quality of life (GO-QoL) were measured both preoperatively and 3 months postoperatively to assess the surgical effect. Results All surgical procedures were successfully performed. The mean duration to complete the whole procedure was 124.3 ± 33.2 minutes (range, 60–188). The mean intraoperative blood loss was 17.8 ± 6.2 mL (range, 7.5–28). There were neither complications nor unexpected events in terms of either orbital decompression surgery or robot-assisted procedures. The mean exophthalmos was 20.2 ± 1.8 mm before surgery and 17.9 ± 1.4 mm postoperatively (P < 0.0001). The preoperative and postoperative GO-QoL on the visual function arm was 84.38 ± 20.04 and 93.75 ± 9.32, respectively. The preoperative and postoperative GO-QoL on the appearance arm was 42.50 ± 14.97 and 64.38 ± 21.46, respectively (P = 0.027). Conclusions The da Vinci Xi surgical system provided the stability, dexterity, and good visualization necessary for orbital fat decompression surgery, indicating the safety and feasibility of robot-assisted orbital fat decompression surgery. Translational Relevance Based on a literature search using EMBASE and MEDLINE databases, we believe that this study reports the first in-human results of the safety and effectiveness of da Vinci robot-assisted orbital fat decompression surgery.
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Affiliation(s)
- Yi Wang
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Jing Sun
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xingtong Liu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yinwei Li
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xianqun Fan
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Huifang Zhou
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
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He B, de Smet MD, Sodhi M, Etminan M, Maberley D. A review of robotic surgical training: establishing a curriculum and credentialing process in ophthalmology. Eye (Lond) 2021; 35:3192-3201. [PMID: 34117390 PMCID: PMC8602368 DOI: 10.1038/s41433-021-01599-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 05/04/2021] [Accepted: 05/07/2021] [Indexed: 12/21/2022] Open
Abstract
Ophthalmic surgery requires a highly dexterous and precise surgical approach to work within the small confines of the eye, and the use of robotics offers numerous potential advantages to current surgical techniques. However, there is a lag in the development of a comprehensive training and credentialing system for robotic eye surgery, and certification of robotic skills proficiency relies heavily on industry leadership. We conducted a literature review on the curricular elements of established robotics training programs as well as privileging guidelines from various institutions to outline key components in training and credentialing robotic surgeons for ophthalmic surgeries. Based on our literature review and informal discussions between the authors and other robotic ophthalmic experts, we recommend that the overall training framework for robotic ophthalmic trainees proceeds in a stepwise, competency-based manner from didactic learning, to simulation exercises, to finally operative experiences. Nontechnical skills such as device troubleshooting and interprofessional teamwork should also be formally taught and evaluated. In addition, we have developed an assessment tool based on validated global rating scales for surgical skills that may be used to monitor the progress of trainees. Finally, we propose a graduating model for granting privileges to robotic surgeons. Further work will need to be undertaken to assess the feasibility, efficacy and integrity of the training curriculum and credentialing practices for robotic ophthalmic surgery.
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Affiliation(s)
- Bonnie He
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Marc D de Smet
- Department of Ophthalmology, University of Leiden, Leiden, Netherlands
| | - Mohit Sodhi
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Mahyar Etminan
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - David Maberley
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
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Chammas J, Sauer A, Pizzuto J, Pouthier F, Gaucher D, Marescaux J, Mutter D, Bourcier T. Da Vinci Xi Robot-Assisted Penetrating Keratoplasty. Transl Vis Sci Technol 2017; 6:21. [PMID: 28660096 PMCID: PMC5482186 DOI: 10.1167/tvst.6.3.21] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 04/30/2017] [Indexed: 12/19/2022] Open
Abstract
PURPOSE This study aims (1) to investigate the feasibility of robot-assisted penetrating keratoplasty (PK) using the new Da Vinci Xi Surgical System and (2) to report what we believe to be the first use of this system in experimental eye surgery. METHODS Robot-assisted PK procedures were performed on human corneal transplants using the Da Vinci Xi Surgical System. After an 8-mm corneal trephination, four interrupted sutures and one 10.0 monofilament running suture were made. For each procedure, duration and successful completion of the surgery as well as any unexpected events were assessed. The depth of the corneal sutures was checked postoperatively using spectral-domain optical coherence tomography (SD-OCT). RESULTS Robot-assisted PK was successfully performed on 12 corneas. The Da Vinci Xi Surgical System provided the necessary dexterity to perform the different steps of surgery. The mean duration of the procedures was 43.4 ± 8.9 minutes (range: 28.5-61.1 minutes). There were no unexpected intraoperative events. SD-OCT confirmed that the sutures were placed at the appropriate depth. CONCLUSIONS We confirm the feasibility of robot-assisted PK with the new Da Vinci Surgical System and report the first use of the Xi model in experimental eye surgery. Operative time of robot-assisted PK surgery is now close to that of conventional manual surgery due to both improvement of the optical system and the presence of microsurgical instruments. TRANSLATIONAL RELEVANCE Experimentations will allow the advantages of robot-assisted microsurgery to be identified while underlining the improvements and innovations necessary for clinical use.
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Affiliation(s)
- Jimmy Chammas
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France.,EA7290, FMTS, University of Strasbourg, Strasbourg, France
| | - Arnaud Sauer
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Joëlle Pizzuto
- Cornea Bank, EFS Bourgogne Franche-Comté, Besancon, France
| | | | - David Gaucher
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France.,EA7290, FMTS, University of Strasbourg, Strasbourg, France
| | - Jacques Marescaux
- IHU, Institute of Image-Guided Surgery, FMTS, University of Strasbourg, Strasbourg, France.,IRCAD, European Institute of Telesurgery, Strasbourg, France.,Department of Digestive and Robotic Surgery, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Didier Mutter
- IHU, Institute of Image-Guided Surgery, FMTS, University of Strasbourg, Strasbourg, France.,IRCAD, European Institute of Telesurgery, Strasbourg, France.,Department of Digestive and Robotic Surgery, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Tristan Bourcier
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France.,EA7290, FMTS, University of Strasbourg, Strasbourg, France.,IHU, Institute of Image-Guided Surgery, FMTS, University of Strasbourg, Strasbourg, France
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Bourcier T, Nardin M, Sauer A, Gaucher D, Speeg C, Mutter D, Marescaux J, Liverneaux P. Robot-Assisted Pterygium Surgery: Feasibility Study in a Nonliving Porcine Model. Transl Vis Sci Technol 2015; 4:9. [PMID: 25722953 DOI: 10.1167/tvst.4.1.9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 01/11/2015] [Indexed: 11/24/2022] Open
Abstract
PURPOSE This study aims to investigate the feasibility of pterygium surgery using the DaVinci Si HD robotic surgical system, and to describe a porcine model for pterygium surgery and evaluate its usefulness. METHODS The pterygium models were constructed using enucleated pig eyes and cold cuts. Robotically-assisted pterygium surgeries in nonliving biological pterygium models were performed using the DaVinci Si HD robotic surgical system. Twelve models were prepared, and 12 pterygium excision and conjunctival autografts were performed. RESULTS The DaVinci system provided the necessary dexterity to perform delicate ocular surface surgery and robotic tools were safe for the tissues. The mean duration of the surgical procedures was 36 minutes. There were no intraoperative complications and no unexpected events. CONCLUSIONS Robotic-assisted pterygium surgery is technically feasible for porcine eyes using the DaVinci Si HD robotic surgical system. The pterygium model that we describe could be of interest for surgical training. TRANSLATIONAL RELEVANCE Little research has been done in robotic microsurgery. Animal experimentation will allow the advantages of robotic-assisted microsurgery to be identified, while underlining the improvements and innovations necessary for clinical use.
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Affiliation(s)
- Tristan Bourcier
- Department of Ophthalmology, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France. ; IRCAD-EITS, Strasbourg, France
| | - Mathieu Nardin
- Department of Ophthalmology, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Arnaud Sauer
- Department of Ophthalmology, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - David Gaucher
- Department of Ophthalmology, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Claude Speeg
- Department of Ophthalmology, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | | | | | - Philippe Liverneaux
- IRCAD-EITS, Strasbourg, France. ; Department of Hand Surgery, Strasbourg University Hospital, FMTS, University of Strasbourg, llkirch, France
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Juanes JA, Ruisoto P, Prats-Galino A, Framiñán A, Riesco JM. Computed anatomical modelling of the optic pathway and oculomotor system using magnetic resonance imaging. J Neuroradiol 2013; 41:168-76. [PMID: 24095291 DOI: 10.1016/j.neurad.2013.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 05/10/2013] [Accepted: 06/13/2013] [Indexed: 11/19/2022]
Abstract
This study presents a computer-based tool for three-dimensional (3D) visualization of the optic pathway and oculomotor system using 3D high-resolution magnetic resonance imaging (MRI) datasets from a healthy subject. The 3D models were built as wireframe grids co-registered with MRI sections. First, 3D anatomical models were generated of the visual pathway from the eyeball to the primary visual cortex and of the cranial oculomotor nerves from the brain stem to the extrinsic eye muscles. Second, a graphical user interface allowed individual and group visualization, translation, rotation and zooming of the 3D models in different spatial positions simultaneously with MRI orthogonal cut planes. Educational and clinical applications are also discussed.
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Affiliation(s)
- J A Juanes
- Department of Human Anatomy and Histology, Faculty of Medicine, University of Salamanca, C/Alfonso X El Sabio, s/n 37007 Salamanca, Spain.
| | - P Ruisoto
- Department of Human Anatomy and Histology, Faculty of Medicine, University of Salamanca, C/Alfonso X El Sabio, s/n 37007 Salamanca, Spain
| | - A Prats-Galino
- Laboratory of Surgical NeuroAnatomy, Human Anatomy and Embryology Unit, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - A Framiñán
- Department of Human Anatomy and Histology, Faculty of Medicine, University of Salamanca, C/Alfonso X El Sabio, s/n 37007 Salamanca, Spain
| | - J M Riesco
- Department of Human Anatomy and Histology, Faculty of Medicine, University of Salamanca, C/Alfonso X El Sabio, s/n 37007 Salamanca, Spain
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Noda Y, Ida Y, Tanaka S, Toyama T, Roggia MF, Tamaki Y, Sugita N, Mitsuishi M, Ueta T. Impact of robotic assistance on precision of vitreoretinal surgical procedures. PLoS One 2013; 8:e54116. [PMID: 23335991 PMCID: PMC3545993 DOI: 10.1371/journal.pone.0054116] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 12/06/2012] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To elucidate the merits of robotic application for vitreoretinal maneuver in comparison to conventional manual performance using an in-vitro eye model constructed for the present study. METHODS Capability to accurately approach the target on the fundus, to stabilize the manipulator tip just above the fundus, and to perceive the contact of the manipulator tip with the fundus were tested. The accuracies were compared between the robotic and manual control, as well as between ophthalmologists and engineering students. RESULTS In case of manual control, ophthalmologists were superior to engineering students in all the 3 test procedures. Robotic assistance significantly improved accuracy of all the test procedures performed by engineering students. For the ophthalmologists including a specialist of vitreoretinal surgery, robotic assistance enhanced the accuracy in the stabilization of manipulator tip (from 90.9 µm to 14.9 µm, P = 0.0006) and the perception of contact with the fundus (from 20.0 mN to 7.84 mN, P = 0.046), while robotic assistance did not improve pointing accuracy. CONCLUSIONS It was confirmed that telerobotic assistance has a potential to significantly improve precision in vitreoretinal procedures in both experienced and inexperienced hands.
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Affiliation(s)
- Yasuo Noda
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yoshiki Ida
- School of Engineering, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Shinichi Tanaka
- School of Engineering, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Taku Toyama
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Murilo Felix Roggia
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yasuhiro Tamaki
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Naohiko Sugita
- School of Engineering, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Mamoru Mitsuishi
- School of Engineering, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Takashi Ueta
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- * E-mail:
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Santoro E, Pansadoro V. Robotic surgery in Italy national survey (2011). Updates Surg 2012; 65:1-9. [DOI: 10.1007/s13304-012-0190-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 11/23/2012] [Indexed: 02/02/2023]
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Friedman DI, Frishberg B. Neuro-ophthalmology and its contribution to headaches: a case-based approach. Expert Rev Neurother 2010; 10:1467-78. [DOI: 10.1586/ern.10.113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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