Robotic surgery, vitreoretinal surgery

PURPOSE OF REVIEW: Artificial intelligence and deep learning have become important tools in extracting data from ophthalmic surgery to evaluate, teach, and aid the surgeon in all phases of surgical management. The purpose of this review is to highlight the ever-increasing intersection of computer vision, machine learning, and ophthalmic microsurgery. RECENT FINDINGS: Deep learning algorithms are being applied to help evaluate and teach surgical trainees. Artificial intelligence tools are improving real-time surgical instrument tracking, phase segmentation, as well as enhancing the safety of robotic-assisted vitreoretinal surgery...

Robot-assisted retinal surgery has become increasingly prevalent in recent years in part due to the potential for robots to help surgeons improve the safety of an immensely delicate and difficult set of tasks. The integration of robots into retinal surgery has resulted in diminished surgeon perception of tool-to-tissue interaction forces due to robot's stiffness. The tactile perception of these interaction forces (sclera force) has long been a crucial source of feedback for surgeons who rely on them to guide surgical maneuvers and to prevent damaging forces from being applied to the eye...

Vitreoretinal surgery is among the most delicate surgical tasks during which surgeon hand tremor may severely attenuate surgeon performance. Robotic assistance has been demonstrated to be beneficial in diminishing hand tremor. Among the requirements for reliable assistance from the robot is to provide precise measurements of system states e.g. sclera forces, tool tip position and tool insertion depth. Providing this and other sensing information using existing technology would contribute towards development and implementation of autonomous robot-assisted tasks in retinal surgery such as laser ablation, guided suture placement/assisted needle vessel cannulation, among other applications...

Robot-assisted vitreoretinal surgery can filter surgeons' hand tremors and provide safe, accurate tool manipulation. In this paper, we report the design, optimization, and evaluation of a novel tilt mechanism for a new Steady-Hand Eye Robot (SHER). The new tilt mechanism features a four-bar linkage design and has a compact structure. Its kinematic configuration is optimized to minimize the required linear range of motion (LRM) for implementing a virtual remote center-of-motion (V-RCM) while tilting a surgical tool...

Heads-up three-dimensional (3D) surgical visualization systems allow ophthalmic surgeons to replace surgical microscope eyepieces with high-resolution stereoscopic cameras transmitting an image to a screen. We investigated the effectiveness and safety of the heads-up NGENUITY 3D Visualization System in a retrospective evaluation of 241 consecutive vitreoretinal surgeries performed by the same surgeon using conventional microscopy (CM group) over a 1-year period versus the NGENUITY System (3D group) over a consecutive 1-year period...

The introduction of the intraocular vitrectomy instrument by Machemer et al. has led to remarkable advancements in vitreoretinal surgery enabling the limitations of human physiologic capabilities to be reached. To overcome the barriers of perception, tremor, and dexterity, robotic technologies have been investigated with current advancements nearing the feasibility for clinical use. There are four categories of robotic systems that have emerged through the research: (1) handheld instruments with intrinsic robotic assistance, (2) hand-on-hand robotic systems, (3) teleoperated robotic systems, and (4) magnetic guidance robots...

PURPOSE: To investigate the learning curve of robot-assisted vitreoretinal surgery compared to manual surgery in a simulated setting. METHODS: The study was designed as a randomized controlled longitudinal study. Eight ophthalmic trainees in the 1st or 2nd year of their specialization were included. The participants were randomized to either manual or robot-assisted surgery. Participants completed repetitions of a test consisting of three vitreoretinal modules on the Eyesi virtual reality simulator...

During vitreoretinal surgery, the surgeon is required to precisely manipulate multiple tools in a confined intraocular environment, while the tool tip to retina contact forces are at the limit of human sensation limits. During typical vitrectomy procedures, the surgeon inserts various tools through small incisions performed on the sclera of the eye (sclerotomies), and manipulates them to perform surgical tasks. During intraocular procedures, tool-tissue interactions occur at the sclerotomy ports and at the tool-tip when it contacts retina...

When robotic assistance is present into vitreoretinal surgery, the surgeon will experience reduced sensory input that is otherwise derived from the tool's interaction with the eye wall (sclera). We speculate that disconnecting the surgeon from this sensory input may increase the risk of injury to the eye and affect the surgeon's usual technique. On the other hand, robot autonomous motion to enhance patient safety might inhibit the surgeons tool manipulation and diminish surgeon comfort with the procedure. In this study, to investigate the parameters of patient safety and surgeon comfort in a robot-assisted eye surgery, we implemented three different approaches designed to keep the scleral force in a safe range during a synergic eye manipulation task...

Vitreoretinal surgery is among the most challenging microsurgical procedures as it requires precise tool manipulation in a constrained environment, while the tool-tissue interaction forces are at the human perception limits. While tool tip forces are certainly important, the scleral forces at the tool insertion ports are also important. Clinicians often rely on these forces to manipulate the eyeball position during surgery. Measuring sclera forces could enable valuable sensory input to avoid tissue damage, especially for a cooperatively controlled robotic assistant that otherwise removes the sensation of these familiar intraoperative forces...

PURPOSE: Sustained delivery of regenerative retinal therapies by robotic systems requires intra-operative tracking of the retinal fundus. We propose a supervised deep convolutional neural network to densely predict semantic segmentation and optical flow of the retina as mutually supportive tasks, implicitly inpainting retinal flow information missing due to occlusion by surgical tools. METHODS: As manual annotation of optical flow is infeasible, we propose a flexible algorithm for generation of large synthetic training datasets on the basis of given intra-operative retinal images...

PURPOSE: To compare the Preceyes Surgical Robotic System (Eindhoven, Netherlands) to manual internal limiting membrane (ILM) peeling using the Eyesi surgical simulator (VRmagic, Mannheim, Germany) as the operative platform. METHODS: A comparative study was carried out with surgeons initially performing ILM peeling manually and then with the robot. Twenty-three vitreoretinal surgeons agreed to participate and all consented to the use of their surgical data from the Eyesi surgical simulator...

This paper introduces an optimized input device workflow to control an eye surgical robot in a simulated vitreoretinal environment. The input device is a joystick with four Degrees of Freedom (DOF) that controls a six DOFs robot. This aim is achieved through a segmentation plan for an eye surgeon. In this study, the different surgical phases are defined while each phase includes their specific number of DOFs. The segmentation plan is divided into four surgical phases: Phase I: Approach with three DOFs; Phase II: Introduction with three DOFs; Phase III: Aim with 3+1 DOFs; and Phase IV: Injection with one DOF...

PURPOSE: To compare manual and robot-assisted vitreoretinal surgery using a virtual-reality surgical simulator. METHODS: Randomized controlled crossover study. Ten experienced vitreoretinal surgeons and 10 novice ophthalmic surgeons were included. The participants were randomized to start with either manual or robot-assisted surgery. Participants completed a test session consisting of three vitreoretinal modules on the Eyesi virtual-reality simulator. The automated metrics of performance supplied by the Eyesi simulator were used as outcome measures...

BACKGROUND: Vitreoretinal surgeries require precise, dexterous, and steady instruments for operation in delicate parts of the eye. Robotics has presented solutions for many vitreoretinal surgical problems, but, in a few operations, the available tools are still not dexterous enough to carry out procedures with minimum trauma to patients. Vitrectomy is one of those procedures and requires some dexterous instruments to replace straight ones for better navigation to affected sides inside the eyeball...

PURPOSE: Robot-assisted intraocular microsurgery can improve performance by aiding the surgeon in operating on delicate micron-scale anatomical structures of the eye. In order to account for the eyeball motion that is typical in intraocular surgery, there is a need for fast and accurate algorithms that map the retinal vasculature and localize the retina with respect to the microscope. METHODS: This work extends our previous work by a graph-based SLAM formulation using a sparse incremental smoothing and mapping (iSAM) algorithm...

BACKGROUND: Many surgical specialties are increasingly looking towards robot-assisted surgeries to improve patient outcome. Surgeons conducting robot-assisted operations require real-time surgical view. Ophthalmic robots can lead to novel vitreoretinal treatments, such as cannulating retinal vessels or even gene delivery to targeted retinal cells. This study investigates the feasibility of smartphone-delivered stereoscopic vision for microsurgical use. METHODS: A stereo-camera, connected to a laptop, was used to capture the 3D view from a binocular surgical microscope...

PURPOSE: Compare accuracy and precision in XYZ of stationary and dynamic tasks performed by surgeons with and without the use of a tele-operated robotic micromanipulator in a simulated vitreoretinal environment. The tasks were performed using a surgical microscope or while observing a video monitor. METHOD: Two experienced and two novice surgeons performed tracking and static tasks at a fixed depth with hand-held instruments on a Preceyes Surgical System R0.4. Visualization was through a standard microscope or a video display...

One of the major yet little recognized challenges in robotic vitreoretinal surgery is the matter of tool forces applied to the sclera. Tissue safety, coordinated tool use and interactions between tool tip and shaft forces are little studied. The introduction of robotic assist has further diminished the surgeon's ability to perceive scleral forces. Microsurgical tools capable of measuring such small forces integrated with robotmanipulators may therefore improve functionality and safety by providing sclera force feedback to the surgeon...

Vitreoretinal surgery is one of the most difficult surgical operations, even for experienced surgeons. Thus, a master-slave eye surgical robot has been developed to assist the surgeon in safely performing vitreoretinal surgeries; however, in the master-slave control, the robotic positioning accuracy depends on the surgeon's coordination skills. This paper proposes a new method of autonomous robotic positioning using the shadow of the surgical instrument. First, the microscope image is segmented into three regions-namely, a micropipette, its shadow, and the eye ground-using a Gaussian mixture model (GMM)...