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Al-Khulaidi R, Akmeliawati R, Grainger S, Lu TF. Structural Optimisation and Design of a Cable-Driven Hyper-Redundant Manipulator for Confined Semi-Structured Environments. SENSORS (BASEL, SWITZERLAND) 2022; 22:8632. [PMID: 36433229 PMCID: PMC9694924 DOI: 10.3390/s22228632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/22/2022] [Accepted: 11/07/2022] [Indexed: 06/16/2023]
Abstract
Structural optimisation of robotic manipulators is critical for any manipulator used in confined semi-structured environments, such as in agriculture. Many robotic manipulators utilised in semi-structured environments retain the same characteristics and dimensions as those used in fully-structured industrial environments, which have been proven to experience low dexterity and singularity issues in challenging environments due to their structural limitations. When implemented in environments other than fully-structured industrial environments, conventional manipulators are liable to singularity, joint limits and workspace obstacles. This makes them inapplicable in confined semi-structured environments, as they lack the flexibility to operate dexterously in such challenging environments. In this paper, structural optimisation of a hyper-redundant cable-driven manipulator is proposed to improve its performance in semi-structured and challenging confined spaces, such as in agricultural settings. The optimisation of the manipulator design is performed in terms of its manipulability and kinematics. The lengths of the links and the joint angles are optimised to minimise any error between the actual and desired position/orientation of the end-effector in a confined semi-structured task space, as well as to provide optimal flexibility for the manipulators to generate different joint configurations for obstacle avoidance in confined environments. The results of the optimisation suggest that the use of a redundant manipulator with rigid short links can result in performance with higher dexterity in confined, semi-structured environments, such as agricultural greenhouses.
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2
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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: 1] [Impact Index Per Article: 0.3] [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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3
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Wendler T, van Leeuwen FWB, Navab N, van Oosterom MN. How molecular imaging will enable robotic precision surgery : The role of artificial intelligence, augmented reality, and navigation. Eur J Nucl Med Mol Imaging 2021; 48:4201-4224. [PMID: 34185136 PMCID: PMC8566413 DOI: 10.1007/s00259-021-05445-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/01/2021] [Indexed: 02/08/2023]
Abstract
Molecular imaging is one of the pillars of precision surgery. Its applications range from early diagnostics to therapy planning, execution, and the accurate assessment of outcomes. In particular, molecular imaging solutions are in high demand in minimally invasive surgical strategies, such as the substantially increasing field of robotic surgery. This review aims at connecting the molecular imaging and nuclear medicine community to the rapidly expanding armory of surgical medical devices. Such devices entail technologies ranging from artificial intelligence and computer-aided visualization technologies (software) to innovative molecular imaging modalities and surgical navigation (hardware). We discuss technologies based on their role at different steps of the surgical workflow, i.e., from surgical decision and planning, over to target localization and excision guidance, all the way to (back table) surgical verification. This provides a glimpse of how innovations from the technology fields can realize an exciting future for the molecular imaging and surgery communities.
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Affiliation(s)
- Thomas Wendler
- Chair for Computer Aided Medical Procedures and Augmented Reality, Technische Universität München, Boltzmannstr. 3, 85748 Garching bei München, Germany
| | - Fijs W. B. van Leeuwen
- Department of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, The Netherlands
- Department of Urology, The Netherlands Cancer Institute - Antonie van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Orsi Academy, Melle, Belgium
| | - Nassir Navab
- Chair for Computer Aided Medical Procedures and Augmented Reality, Technische Universität München, Boltzmannstr. 3, 85748 Garching bei München, Germany
- Chair for Computer Aided Medical Procedures Laboratory for Computational Sensing + Robotics, Johns-Hopkins University, Baltimore, MD USA
| | - Matthias N. van Oosterom
- Department of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, The Netherlands
- Department of Urology, The Netherlands Cancer Institute - Antonie van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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4
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Li Y, Wolf MD, Kulkarni AD, Bell J, Chang JS, Nimunkar A, Radwin RG. In Situ Tremor in Vitreoretinal Surgery. HUMAN FACTORS 2021; 63:1169-1181. [PMID: 32286884 PMCID: PMC8521350 DOI: 10.1177/0018720820916629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/04/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Surgeon tremor was measured during vitreoretinal microscopic surgeries under different hand support conditions. BACKGROUND While the ophthalmic surgeon's forearm is supported using a standard symmetric wrist rest when operating on the patient's same side as the dominant hand (SSD), the surgeon's hand is placed directly on the patient's forehead when operating on the contralateral side of the dominant hand (CSD). It was hypothesized that more tremor is associated with CSD surgeries than SSD surgeries and that, using an experimental asymmetric wrist rest where the contralateral wrist bar gradually rises and curves toward the patient's operative eye, there is no difference in tremor associated with CSD and SSD surgeries. METHODS Seventy-six microscope videos, recorded from three surgeons performing macular membrane peeling operations, were analyzed using marker-less motion tracking, and movement data (instrument path length and acceleration) were recorded. Tremor acceleration frequency and magnitude were measured using spectral analysis. Following 47 surgeries using a conventional symmetric wrist support, surgeons incorporated the experimental asymmetric wrist rest into their surgical routine. RESULTS There was 0.11 mm/s2 (22%) greater (p = .05) average tremor acceleration magnitude for CSD surgeries (0.62 mm/s2, SD = 0.08) than SSD surgeries (0.51 mm/s2, SD = 0.09) for the symmetric wrist rest, while no significant (p > .05) differences were observed (0.57 mm, SD = 0.13 for SSD and 0.58 mm, SD = 0.11 for CSD surgeries) for the experimental asymmetric wrist rest. CONCLUSION The asymmetric wrist support reduced the difference in tremor acceleration between CSD and SSD surgeries.
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Affiliation(s)
- Yifan Li
- University of Wisconsin-Madison, USA
| | | | | | - James Bell
- SSM Health Dean Medical Group, Madison, WI, USA
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Bourcier T, Dormegny L, Sauer A, Nardin M, Becmeur PH, Chammas J, Gaucher D, Ballonzoli L, Speeg C, Liverneaux P, Vix M, Marescaux J, Mutter D. State of the Art in Robot-Assisted Eye Surgery. Klin Monbl Augenheilkd 2021; 238:1290-1293. [PMID: 34571552 DOI: 10.1055/a-1562-2350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Despite the advantages that robot-assisted surgery can offer to patient care, its use in ophthalmic surgery has not yet progressed to the extent seen in other fields. As such, its use remains limited to research environments, both basic and clinical. The technical specifications for such ophthalmic surgical robots are highly challenging, but rapid progress has been made in recent years, and recent developments in this field ensure that the use of this technology in operating theatres will soon be a real possibility. Fully automated ocular microsurgery, carried out by a robot under the supervision of a surgeon, is likely to become our new reality. This review discusses the use of robot-assisted ophthalmic surgery, the recent progress in the field, and the necessary future developments which must occur before its use in operating theatres becomes routine.
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Affiliation(s)
- Tristan Bourcier
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Léa Dormegny
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Arnaud Sauer
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Mathieu Nardin
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Pierre-Henri Becmeur
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Jimmy Chammas
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - David Gaucher
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Laurent Ballonzoli
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Claude Speeg
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Philippe Liverneaux
- Department of Hand Surgery, Hautepierre Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Michel Vix
- IRCAD, European Institute of Telesurgery, Strasbourg, France.,IHU, Institute of Image-Guided Surgery, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France.,Department of Digestive Surgery, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | | | - Didier Mutter
- IRCAD, European Institute of Telesurgery, Strasbourg, France.,IHU, Institute of Image-Guided Surgery, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France.,Department of Digestive Surgery, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
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6
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Thoracic vertebra interbody fusion surgery with robotic assisted system in a swine model. J Clin Neurosci 2021; 92:85-88. [PMID: 34509268 DOI: 10.1016/j.jocn.2021.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/06/2021] [Accepted: 07/24/2021] [Indexed: 11/21/2022]
Abstract
Minimally invasive procedures have been increasing in spine surgery, and interest in robotic systems has inclined. In this study, we aimed to evaluate feasibility of a robotic-assisted thoracic spine interbody fusion in a swine model. Neurosurgeons performed the surgical procedures with robotic surgery certificates on the Da Vinci Xi Surgical System. Surgical approaches were applied using four ports while the swine was in the left lateral position. The surgical procedure was accomplished in 70 min including positioning and preparation of robotic system (20 min), placement of ports and thoracic dissection and confirmation of level with the C-arm system (10 min), discectomy and cage insertion (15 min), control of cage position via the C-arm system and closure (10 min). This study showed the anterior thoracic approach with robotic surgery is safe and feasible with providing a wide working area and high image quality.
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7
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The potential impact of 5G telecommunication technology on ophthalmology. Eye (Lond) 2021; 35:1859-1868. [PMID: 33731893 PMCID: PMC7968572 DOI: 10.1038/s41433-021-01450-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 01/14/2021] [Accepted: 01/29/2021] [Indexed: 01/31/2023] Open
Abstract
Advances in information and communication technology (ICT) are having an increasing impact on the practice of ophthalmology. Successive generations of 4G networks have provided continued improvements in bandwidth and download speeds. Fibre-optic networks were promised as the next step in the development of a faster and more reliable network. However, due to considerable delays in their widespread implementation, original expectations have not been met. Currently, the new 5G network is on the verge of widespread release and aims to offer previously unparalleled bandwidth, speed, reliability and access. This review aims to highlight the potential profound impact near instantaneous communication (the 5G network) may have on ophthalmology and the delivery of eyecare to the global population. Conversely, if the new network fails to deliver as intended, the wireless network itself may become yet another obstacle to adopting next-generation technologies in eyecare.
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D'Souza M, Gendreau J, Feng A, Kim LH, Ho AL, Veeravagu A. Robotic-Assisted Spine Surgery: History, Efficacy, Cost, And Future Trends. ROBOTIC SURGERY : RESEARCH AND REVIEWS 2019; 6:9-23. [PMID: 31807602 PMCID: PMC6844237 DOI: 10.2147/rsrr.s190720] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 10/14/2019] [Indexed: 01/02/2023]
Abstract
Robot-assisted spine surgery has recently emerged as a viable tool to enable less invasive and higher precision surgery. The first-ever spine robot, the SpineAssist (Mazor Robotics Ltd., Caesarea, Israel), gained FDA approval in 2004. With its ability to provide real-time intraoperative navigation and rigid stereotaxy, robotic-assisted surgery has the potential to increase accuracy while decreasing radiation exposure, complication rates, operative time, and recovery time. Currently, robotic assistance is mainly restricted to spinal fusion and instrumentation procedures, but recent studies have demonstrated its use in increasingly complex procedures such as spinal tumor resections and ablations, vertebroplasties, and deformity correction. However, robots do require high initial costs and training, and thus, require justification for their incorporation into common practice. In this review, we discuss the history of spinal robots along as well as currently available systems. We then examine the literature to evaluate accuracy, operative time, complications, radiation exposure, and costs – comparing robotic-assisted to traditional fluoroscopy-assisted freehand approaches. Finally, we consider future applications for robots in spine surgery.
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Affiliation(s)
| | | | - Austin Feng
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Lily H Kim
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Allen L Ho
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Anand Veeravagu
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
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Abstract
Ophthalmology is a field that is now seeing the integration of robotics in its surgical procedures and interventions. Assistance facilitated by robots offers substantial improvements in terms of movement control, tremor cancellation, enhanced visualization, and distance sensing. Robotic technology has only recently been integrated into ophthalmology; hence, the progression is only in its initial stages. Robotic technologies such as da Vinci Surgical System are integrated into the field of ophthalmology and are assisting surgeons in complex eye surgeries. Ophthalmic surgeries require high accuracy and precision to execute tissue manipulation, and some complex ocular surgery may take few hours to complete the procedures that may predispose high-volume ophthalmic surgeons to work-related musculoskeletal disorders. A complete paradigm shift has been achieved in this particular field through the integration of advanced robotic technology, resulting in easier and more efficient procedures. Where robotic technology assists the surgeons and improves the overall quality of care, it also projects several challenges including limited availability, training, and the high cost of the robotic system. Although considerable studies and trials have been conducted for various robotic systems, only a few of them have made it to the commercial stage and ophthalmology, on its own, has a long way to go in robotics technology.
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Affiliation(s)
- Suresh K Pandey
- Department of Ophthalmology, SuVi Eye Institute and Lasik Laser Center, Kota, Rajasthan, India
| | - Vidushi Sharma
- Department of Ophthalmology, SuVi Eye Institute and Lasik Laser Center, Kota, Rajasthan, India
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10
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Bourcier T, Chammas J, Gaucher D, Liverneaux P, Marescaux J, Speeg-Schatz C, Mutter D, Sauer A. Robot-Assisted Simulated Strabismus Surgery. Transl Vis Sci Technol 2019; 8:26. [PMID: 31171993 PMCID: PMC6543922 DOI: 10.1167/tvst.8.3.26] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 03/24/2019] [Indexed: 12/12/2022] Open
Abstract
Purpose This study aims to investigate the feasibility of robot-assisted simulated strabismus surgery using the new da Vinci Xi Surgical System and to report what we believe is the first use of a surgical robot in experimental eye muscle surgery. Methods Robot-assisted strabismus surgeries were performed on a strabismus eye model using the robotic da Vinci Xi Surgical System. On the lateral rectus of each eye, we performed a procedure including, successively, a 4-mm plication followed by a 4-mm recession of the muscle to end with a 4-mm resection. Operative time from conjunctival opening to closing and successful completion of the different steps with or without complications or unexpected events were assessed. Results Robot-assisted strabismus procedures were successfully performed on six eyes. The feasibility of robot-assisted simulated strabismus surgery is confirmed. The da Vinci Xi system provided the appropriate dexterity and operative field visualization necessary to perform conjunctival and Tenon's capsule opening and closing, muscle identification, suturing, desinsertion, sectioning, and resuturing. The mean duration to complete the whole procedure was 27 minutes (range, 22–35). There were no complications or unexpected intraoperative events. Conclusions Experimental robot-assisted strabismus surgery is technically feasible using the new robotic da Vinci Xi Surgical System. This is, to our knowledge, the first use of a surgical robot in ocular muscle surgery. Translational Relevance Further experimentation 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)
- Tristan Bourcier
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France.,EA7290, FMTS, University of Strasbourg, Strasbourg, France
| | - Jimmy Chammas
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, 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
| | - Philippe Liverneaux
- Department of Hand Surgery, PMTL, Hautepierre Hospital, Strasbourg University Hospital, 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
| | - Claude Speeg-Schatz
- Department of Ophthalmology, 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
| | - Arnaud Sauer
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
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11
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The physician of the future and the future of physicians. Am J Surg 2019; 217:811-812. [DOI: 10.1016/j.amjsurg.2018.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 04/20/2018] [Accepted: 04/22/2018] [Indexed: 01/04/2023]
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12
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Ezeanosike E, Azu-Okeke JC, Achigbu EO, Ezisi CN, Aniemeka DI, Ogbonnaya CE, Chuka-Okosa CM. Cost-Effective Ophthalmic Surgical Wetlab Using the Porcine Orbit with a Simple Dissection Protocol. ACTA ACUST UNITED AC 2019. [DOI: 10.4236/ojoph.2019.94020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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13
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Roizenblatt M, Grupenmacher AT, Belfort Junior R, Maia M, Gehlbach PL. Robot-assisted tremor control for performance enhancement of retinal microsurgeons. Br J Ophthalmol 2018; 103:1195-1200. [DOI: 10.1136/bjophthalmol-2018-313318] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/30/2018] [Accepted: 12/05/2018] [Indexed: 12/25/2022]
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.
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14
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Jiang DJ, Xu CL, Tsang SH. Revolution in Gene Medicine Therapy and Genome Surgery. Genes (Basel) 2018; 9:E575. [PMID: 30486314 PMCID: PMC6315778 DOI: 10.3390/genes9120575] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/17/2018] [Accepted: 11/20/2018] [Indexed: 12/11/2022] Open
Abstract
Recently, there have been revolutions in the development of both gene medicine therapy and genome surgical treatments for inherited disorders. Much of this progress has been centered on hereditary retinal dystrophies, because the eye is an immune-privileged and anatomically ideal target. Gene therapy treatments, already demonstrated to be safe and efficacious in numerous clinical trials, are benefitting from the development of new viral vectors, such as dual and triple adeno-associated virus (AAV) vectors. CRISPR/Cas9, which revolutionized the field of gene editing, is being adapted into more precise "high fidelity" and catalytically dead variants. Newer CRISPR endonucleases, such as CjCas9 and Cas12a, are generating excitement in the field as well. Stem cell therapy has emerged as a promising alternative, allowing human embryo-derived stem cells and induced pluripotent stem cells to be edited precisely in vitro and then reintroduced into the body. This article highlights recent progress made in gene therapy and genome surgery for retinal disorders, and it provides an update on precision medicine Food and Drug Administration (FDA) treatment trials.
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Affiliation(s)
- David J Jiang
- Jonas Children's Vision Care and Bernard & Shirlee Brown Glaucoma Laboratory, Columbia University, New York, NY, 10032, USA.
- Edward S. Harkness Eye Institute, New York-Presbyterian Hospital, New York, NY, 10032, USA.
| | - Christine L Xu
- Jonas Children's Vision Care and Bernard & Shirlee Brown Glaucoma Laboratory, Columbia University, New York, NY, 10032, USA.
- Edward S. Harkness Eye Institute, New York-Presbyterian Hospital, New York, NY, 10032, USA.
| | - Stephen H Tsang
- Jonas Children's Vision Care and Bernard & Shirlee Brown Glaucoma Laboratory, Columbia University, New York, NY, 10032, USA.
- Edward S. Harkness Eye Institute, New York-Presbyterian Hospital, New York, NY, 10032, USA.
- Department of Pathology & Cell Biology, Stem Cell Initiative (CSCI), Institute of Human Nutrition, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA.
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15
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Abstract
Recently, there have been revolutions in the development of both gene medicine therapy and genome surgical treatments for inherited disorders. Much of this progress has been centered on hereditary retinal dystrophies, because the eye is an immune-privileged and anatomically ideal target. Gene therapy treatments, already demonstrated to be safe and efficacious in numerous clinical trials, are benefitting from the development of new viral vectors, such as dual and triple adeno-associated virus (AAV) vectors. CRISPR/Cas9, which revolutionized the field of gene editing, is being adapted into more precise "high fidelity" and catalytically dead variants. Newer CRISPR endonucleases, such as CjCas9 and Cas12a, are generating excitement in the field as well. Stem cell therapy has emerged as a promising alternative, allowing human embryo-derived stem cells and induced pluripotent stem cells to be edited precisely in vitro and then reintroduced into the body. This article highlights recent progress made in gene therapy and genome surgery for retinal disorders, and it provides an update on precision medicine Food and Drug Administration (FDA) treatment trials.
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Affiliation(s)
- David J Jiang
- Jonas Children's Vision Care and Bernard & Shirlee Brown Glaucoma Laboratory, Columbia University, New York, NY, 10032, USA. .,Edward S. Harkness Eye Institute, New York-Presbyterian Hospital, New York, NY, 10032, USA.
| | - Christine L Xu
- Jonas Children's Vision Care and Bernard & Shirlee Brown Glaucoma Laboratory, Columbia University, New York, NY, 10032, USA. .,Edward S. Harkness Eye Institute, New York-Presbyterian Hospital, New York, NY, 10032, USA.
| | - Stephen H Tsang
- Jonas Children's Vision Care and Bernard & Shirlee Brown Glaucoma Laboratory, Columbia University, New York, NY, 10032, USA. .,Edward S. Harkness Eye Institute, New York-Presbyterian Hospital, New York, NY, 10032, USA. .,Department of Pathology & Cell Biology, Stem Cell Initiative (CSCI), Institute of Human Nutrition, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA.
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