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Robotic surgery, vitreoretinal surgery

Marina Roizenblatt, Thomas L Edwards, Peter L Gehlbach
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...
2018: Robotic Surgery: Research and Reviews
Berk Gonenc, Alireza Chamani, James Handa, Peter Gehlbach, Russell H Taylor, Iulian Iordachita
In vitreoretinal surgery, membrane peeling is a prototypical task where a layer of fibrous tissue is delaminated off the retina with a micro-forceps by applying very fine forces that are mostly imperceptible to the surgeon. Previously we developed sensitized ophthalmic surgery tools based on fiber Bragg grating (FBG) strain sensors, which were shown to precisely detect forces at the instrument's tip in two degrees of freedom perpendicular to the tool axis. This paper presents a new design that employs an additional sensor to capture also the tensile force along the tool axis...
June 1, 2017: IEEE Sensors Journal
Amir Molaei, Ebrahim Abedloo, Marc D de Smet, Sare Safi, Milad Khorshidifar, Hamid Ahmadieh, Mohammad Azam Khosravi, Narsis Daftarian
New technological progress in robotics has brought many beneficial clinical applications. Currently, computer integrated robotic surgery has gained clinical acceptance for several surgical procedures. Robotically assisted eye surgery is envisaged as a promising solution to overcome the shortcomings inherent to conventional surgical procedures as in vitreoretinal surgeries. Robotics by its high precision and fine mechanical control can improve dexterity, cancel tremor, and allow highly precise remote surgical capability, delicate vitreoretinal manipulation capabilities...
April 2017: Journal of Ophthalmic & Vision Research
Yi-Qi Chen, Ji-Wei Tao, Ling-Ya Su, Liang Li, Shi-Xin Zhao, Yang Yang, Li-Jun Shen
PURPOSE: The purpose of the study was to describe the development of a robotic aided surgical system named RVRMS (robotic vitreous retinal microsurgery system) and to evaluate the capability for using it to perform vitreoretinal surgery. METHODS: The RVRMS was designed and built to include the key components of two independent arms. End-effectors of each arm fix various surgical instruments and perform intraocular manipulation. To evaluate properly the RVRMS, robot-assisted 23-gauge surgical tasks including endolaser for retinal photocoagulation, pars plana vitrectomy (PPV), retinal foreign body removal and retinal vascular cannulation were performed in two different sizes of an animal model...
June 2017: Graefe's Archive for Clinical and Experimental Ophthalmology
Roomasa Channa, Iulian Iordachita, James T Handa
PURPOSE: To review the current literature on robotic assistance for ophthalmic surgery, especially vitreoretinal procedures. METHODS: MEDLINE, Embase, and Web of Science databases were searched from inception to August, 2016, for articles relevant to the review topic. Queries included combinations of the terms: robotic eye surgery, ophthalmology, and vitreoretinal. RESULTS: In ophthalmology, proof-of-concept papers have shown the feasibility of performing many delicate anterior segment and vitreoretinal surgical procedures accurately with robotic assistance...
July 2017: Retina
Fang-Yu Lin, Christos Bergeles, Guang-Zhong Yang
Vitreoretinal surgery requires dexterous manoeuvres of tiny surgical tools in the confined cavity of the human eye through incisions made on the sclera. The fulcrum effect stemming from these incisions limits the safely reachable intraocular workspace and may result in scleral stress and collision with the intraocular lens. This paper proposes a concentric tube robot for panretinal interventions without risking scleral or lens damage. The robot is designed based on biometric measurements of the human eye, the required workspace, and the ease of incorporation in the clinical workflow...
2015: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
Ajay Vikram Singh, Metin Sitti
Miniature untethered medical robots have been receiving growing attention due to technological advances in microactuation, microsensors, and microfabrication and have significant potential to reduce the invasiveness and improve the accessibility of medical devices into unprecedented small spaces inside the human body. In this review, we discuss therapeutic and diagnostic applications of untethered medical microrobots. Wirelessly controlled milli/microrobots with integrated sensors are revolutionizing micromanipulation based medical interventions and are enabling doctors to perform minimally invasive procedures not possible before...
2016: Current Pharmaceutical Design
Tomoya Sakai, Kanako Harada, Shinichi Tanaka, Takashi Ueta, Yasuo Noda, Naohiko Sugita, Mamoru Mitsuishi
A five degree-of-freedom (DOF) miniature parallel robot has been developed to precisely and safely remove the thin internal limiting membrane in the eye ground during vitreoretinal surgery. A simulator has been developed to determine the design parameters of this robot. The developed robot's size is 85 mm × 100 mm × 240 mm, and its weight is 770 g. This robot incorporates an emergency instrument retraction function to quickly remove the instrument from the eye in case of sudden intraoperative complications such as bleeding...
2014: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
Berk Gonenc, Ellen Feldman, Peter Gehlbach, James Handa, Russell H Taylor, Iulian Iordachita
In vitreoretinal practice, controlled tremor-free motion and limitation of applied forces to the retina are two highly desired features. This study addresses both requirements with a new integrated system: a force-sensing motorized micro-forceps combined with an active tremor-canceling handheld micromanipulator, known as Micron. The micro-forceps is a 20 Ga instrument that is mechanically decoupled from its handle and senses the transverse forces at its tip with an accuracy of 0.3 mN. Membrane peeling trials on a bandage phantom revealed a 60-95% reduction in the 2-20 Hz band in both the tip force and position spectra, while peeling forces remained below the set safety threshold...
May 2014: IEEE International Conference on Robotics and Automation: ICRA: [proceedings]
Peter Kazanzides, Min Yang Jung, Anton Deguet, Balazs Vagvolgyi, Marcin Balicki, Russell H Taylor
This paper presents the rationale for the use of a component-based architecture for computer-assisted intervention (CAI) systems, including the ability to reuse components and to easily develop distributed systems. We introduce three additional capabilities, however, that we believe are especially important for research and development of CAI systems. The first is the ability to deploy components among different processes (as conventionally done) or within the same process (for optimal real-time performance), without requiring source-level modifications to the component...
October 1, 2011: MIDAS Journal
Xingchi He, Marcin Balicki, Peter Gehlbach, James Handa, Russell Taylor, Iulian Iordachita
Robotic assistants and smart surgical instruments have been developed to overcome many significant physiological limitations faced by vitreoretinal surgeons, one of which is lack of force perception below 7.5 mN. This paper reports the development of a new force sensor based on fiber Bragg grating (FBG) with the ability to sense forces at the tip of the surgical instrument located inside the eye and also provide information about instrument interaction with the sclera. The sclera section provides vital feedback for cooperative robot control to minimize potentially dangerous forces on the eye...
December 31, 2013: IEEE International Conference on Robotics and Automation: ICRA: [proceedings]
Berk Gonenc, James Handa, Peter Gehlbach, Russell H Taylor, Iulian Iordachita
In vitreoretinal surgery, application of excessive forces and unintentional motion due to hand-tremor can easily result in serious complications. Robotic assistance when combined with tool-to-tissue force sensing capabilities has significant potential to improve such practice. In this paper, we evaluate the membrane peeling performance of a single user for two distinct robotic systems with integrated force sensing capabilities: Micron and the Steady-Hand Robot. We show that these systems provide promising performance improvement with similar impact on peeling forces and comparable tremor cancellation trends...
2013: IEEE International Conference on Robotics and Automation: ICRA: [proceedings]
Brian C Becker, Robert A Maclachlan, Louis A Lobes, Gregory D Hager, Cameron N Riviere
Performing micromanipulation and delicate operations in submillimeter workspaces is difficult because of destabilizing tremor and imprecise targeting. Accurate micromanipulation is especially important for microsurgical procedures, such as vitreoretinal surgery, to maximize successful outcomes and minimize collateral damage. Robotic aid combined with filtering techniques that suppress tremor frequency bands increases performance; however, if knowledge of the operator's goals is available, virtual fixtures have been shown to further improve performance...
February 19, 2013: IEEE Transactions on Robotics: a Publication of the IEEE Robotics and Automation Society
Berk Gonenc, James Handa, Peter Gehlbach, Russell H Taylor, Iulian Iordachita
Vitreoretinal surgery is associated with serious complications that can easily stem from excessive tissue manipulation forces while the forces required for such surgery are routinely well below human tactile sensation. Despite the critical need in this area, there is still no practical vitreoretinal instrument that can sense both the axial and transverse tool-to-tissue interaction forces with sub-mN accuracy. In this study, we present the conceptual design and optimization of a 3 degrees-of-freedom (DOF) force sensing micro-forceps as the next generation of our force sensing instruments...
2013: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
Berk Gonenc, Marcin A Balicki, James Handa, Peter Gehlbach, Cameron N Riviere, Russell H Taylor, Iulian Iordachita
Highly accurate positioning is fundamental to the performance of vitreoretinal microsurgery. Of vitreoretinal procedures, membrane peeling is among the most prone to complications since extremely delicate manipulation of retinal tissue is required. Associated tool-to-tissue interaction forces are usually below the threshold of human perception, and the surgical tools are moved very slowly, within the 0.1-0.5 mm/s range. During the procedure, unintentional tool motion and excessive forces can easily give rise to vision loss or irreversible damage to the retina...
December 20, 2012: Proceedings of the ... IEEE/RSJ International Conference on Intelligent Robots and Systems
Ismail Kuru, Berk Gonenc, Marcin Balicki, James Handa, Peter Gehlbach, Russell H Taylor, Iulian Iordachita
Membrane peeling is a standard vitreoretinal procedure, where the surgeon delaminates a very thin membrane from retina surface using surgical picks and forceps. This requires extremely delicate manipulation of the retinal tissue. Applying excessive forces during the surgery can cause serious complications leading to vision loss. For successful membrane peeling, most of the applied forces need to be very small, well below the human tactile sensation threshold. In this paper, we present a robotic system that combines a force sensing forceps tool and a cooperatively-controlled surgical robot...
2012: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
Yasuo Noda, Yoshiki Ida, Shinichi Tanaka, Taku Toyama, Murilo Felix Roggia, Yasuhiro Tamaki, Naohiko Sugita, Mamoru Mitsuishi, Takashi Ueta
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...
2013: PloS One
Cheol Song, Peter L Gehlbach, Jin U Kang
Microsurgeons require dexterity to make precise and stable maneuvers to achieve surgical objectives and to minimize surgical risks during freehand procedures. This work presents a novel, common path, swept source optical coherence tomography-based "smart" micromanipulation aided robotic-surgical tool (SMART) that actively suppresses surgeon hand tremor. The tool allows enhanced tool tip stabilization, more accurate targeting and the potential to lower surgical risk. Freehand performance is compared to smart tool-assisted performance and includes assessment of the one-dimensional motion tremor in an active microsurgeon's hand...
October 8, 2012: Optics Express
Yoshiki Ida, Naohiko Sugita, Takashi Ueta, Yasuhiro Tamaki, Keiji Tanimoto, Mamoru Mitsuishi
PURPOSE: Robotics may improve vitreoretinal surgery by steadying hand motion, thereby reducing negative outcomes. This study aimed to develop a microsurgical robot for vitreoretinal surgery and to perform clinical procedures using robot-assisted interventions. METHODS: A microsurgical system for vitreoretinal surgery was designed to meet specific requirements for the degree of freedom, accuracy, and workspace. The system was intended to provide micrometer accurate manipulation within the eye...
January 2012: International Journal of Computer Assisted Radiology and Surgery
Ali Uneri, Marcin A Balicki, James Handa, Peter Gehlbach, Russell H Taylor, Iulian Iordachita
In retinal microsurgery, surgeons are required to perform micron scale maneuvers while safely applying forces to the retinal tissue that are below sensory perception. Real-time characterization and precise manipulation of this delicate tissue has thus far been hindered by human limits on tool control and the lack of a surgically compatible endpoint sensing instrument. Here we present the design of a new generation, cooperatively controlled microsurgery robot with a remote center-of-motion (RCM) mechanism and an integrated custom micro-force sensing surgical hook...
September 1, 2010: Proceedings of the ... IEEE/RAS-EMBS International Conference on Biomedical Robotics and Biomechatronics
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