Abstract
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. Endolaser was performed in the eye of a living Irish rabbit and the other tasks were done in a harvested porcine eye. For each evaluation, the duration and the successful completion of the task was assessed.
Results
Robot-assisted vitreoretinal operations were successfully performed in nine rabbit eyes and 25 porcine eyes without any iatrogenic complication such as retinal tear or retinal detachment. In the task of using an endolaser, three rows of burns around the induced retinal hole were performed in nine rabbit eyes with half size intervals of laser spots. Nine procine eyes underwent PPV followed by successful posterior vitreous detachment (PVD) induction assisted with triamcinolone acetonide (TA). Nine porcine eyes completed removal of a fine stainless steel wire, which was inserted into prepared retinal tissue. Finally, retinal vascular cannulation with a piece of stainless steel wire (6mm length, 45 μm pipe diameter and one end cut to ∼30° slope) was successfully achieved in seven porcine eyes. The average duration of each procedure was 10.91±1.22 min, 11.68±2.11min, 5.90±0.46 min and 13.5±6.2 min, respectively.
Conclusions
Maneuverability, accuracy and stability of robot-assisted vitreoretinal microsurgery using the RVRMS were demonstrated in this study. Wider application research of robotic surgery and improvement of a robotic system should be continued.
Similar content being viewed by others
References
Esposito MP, Ilbeigi P, Ahmed M et al (2005) Use of fourth arm in da Vinci robot-assisted extraperitoneal laparoscopic prostatectomy: novel technique. Urology 66(3):649–652
Falk V, Walther T, Autschbach R et al (1998) Robot-assisted minimally invasive solo mitral valve operation. J Thorac Cardiovasc Surg 115(2):470–471
Fanning J, Fenton B, Purohit M (2008) Robotic radical hysterectomy. Am J Obstet Gynecol 198(6):649 e1-4
Jacob BP, Gagner M (2003) Robotics and general surgery. Surg Clin North Am 83(6):1405–1419
Morita A, Sora S, Mitsuishi M et al (2005) Microsurgical robotic system for the deep surgical field: development of a prototype and feasibility studies in animal and cadaveric models. J Neurosurg 103(2):320–327
Marescaux J, Rubino F (2004) Robot-assisted remote surgery: technological advances, potential complications, and solutions. Surg Technol Int 12:23–26
Marescaux J, Leroy J, Gagner M et al (2001) (2001) transatlantic robot-assisted telesurgery. Nature 413(6854):379–380
Langer D, Pudil J, Ryska M (2006) Robotic laparoscopic cholecystectomy. Rozhl Chir 85(9):450–454
Biardeau X, Rizk J, Marcelli F (2015) Robot-assisted laparoscopic approach for artificial urinary sphincter implantation in 11 women with urinary stress incontinence: surgical technique and initial experience. Eur Urol 67(5):937–942
Nakamura H, Suda T, Ikeda N et al (2014) Initial results of robot-assisted thoracoscopic surgery in Japan. Gen Thorac Cardiovasc Surg 62(12):720–725
Fleming I, Balicki M, Koo J, et al (2008) Cooperative robot assistant for retinal microsurgery. 11th International Conference on Medical Image Computing and Computer Assisted Intervention. Berlin, Germany: Springer, p 543–550
Ueta T, Yamaguchi Y, Shirakawa Y et al (2009) Robot-assisted vitreoretinal surgery: development of a prototype and feasibility studies in an animal model. Ophthalmology 116(8):1538–1543 1543.e1-2
Rahimy E, Wilson J, Tsao TC (2013) Robot-assisted intraocular surgery: development of the IRISS and feasibility studies in an animal model. Eye 27(8):972–978
Riviere CN, Ang WT, Khosla PK (2003) Toward active tremor canceling in handheld microsurgical instruments. IEEE Trans Robot Autom 19(5):793–800
Singhy S P N, Riviere C N (2002) Physiological tremor amplitude during retinal microsurgery. Bioengineering Conference, 2002 Proceedings of the IEEE 28th Annual Northeast
Bourla DH, Hubschman JP, Culjat M et al (2008) Feasibility study of intraocular robotic surgery with the da Vinci surgical system. Retina 28(1):154–158
Koen W, Andy G, Laurent S et al (2017) Robot-assisted retinal vein cannulation in an in vivo porcine retinal vein occlusion model. Acta Ophthalmol. doi:10.1111/aos.13358
Shen LJ, Chen YQ, Wei LL et al (2009) Bypassing occluded retinal main vessel segments in isolated arterially perfused caprine eyes. Curr Eye Res 34(6):415–420
Chen Y, Wu W, Zhang X et al (2011) Feasibility study on retinal vascular bypass surgery in isolated arterially perfused caprine eye model. Eye 25:1499–1503
Shen LJ, Chen YQ, Cheng D et al (2016) In vivo retinal vein bypass surgery in a porcine model. Curr Eye Res 41(1):79–87
Jeganathana VS, Shah S (2010) Robotic technology in ophthalmic surgery. Curr Opin Ophthalmol 21:75–80
Terakawa Y, Ishibashi K, Goto T et al (2011) Three-dimensional video presentation of microsurgery by the cross-eyed viewing method using a high-definition video system. Neurol Med Chir (Tokyo) 51(6):467–471
Nishiyama K, Natori Y, Oka K (2014) A novel three-dimensional and high-definition flexible scope. Acta Neurochir 156(6):1245–1249
Bhadri PR, Rowley AP, Khurana RN et al (2007) Evaluation of a stereoscopic camera-based three-dimensional viewing workstation for ophthalmic surgery. Am J Ophthalmol 143(5):891–892
Kotsougiani D, Hundepool CA, Bulstra LF et al (2016) The learning rate in three dimensional high definition video assisted microvascular anastomosis in a rat model. J Plast Reconstr Aesthet Surg 69(11):1528–1536
Liu J, Chen B, Ni Y et al (2014) Application of a three-dimensional microsurgical video system for a rat femoral vessel anastomosis. Chin Med J 127(2):348–352
Marescaux J, Leroy J, Gagner M et al (2001) Transatlantic robot-assisted telesurgery. Nature 413:379–380
Marescaux J, Leroy J, Rubino F et al (2002) Transcontinental robot-assisted remote telesurgery: feasibility and potential applications. Ann Surg 235:487–492
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
Li-Jun Shen provided financial support in the form of the Ministry of Health Research Foundation (WKJ2010–2-018 and WKJ-ZJ-1726) and the Major Issue Funded Project of Eye the Hospital of Wenzhou Medical College (YNZD201003) funding. Yi-Qi Chen provided financial support in the form of the Educational Commission of Zhejiang Province Research Foundation (Y201431237) funding. Yang Yang provided financial support in the form of National Natural Science Foundation of China (Grant Nos. 50,675,008 and 51,175,013) funding.
Conflict of interest
All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
All procedures performed in studies involving animals were in accordance with the ethical standards of the institution or practice at which the studies were conducted.
Electronic supplementary material
Video 1
External ocular manipulation (MP4 4156 kb)
Robot-assisted photocoagulation (MP4 1904 kb)
Robot-assisted PPV (MP4 1571 kb)
Robot-assisted removal of retinal foreign body (MP4 2684 kb)
Rights and permissions
About this article
Cite this article
Chen, YQ., Tao, JW., Su, LY. et al. Cooperative robot assistant for vitreoretinal microsurgery: development of the RVRMS and feasibility studies in an animal model. Graefes Arch Clin Exp Ophthalmol 255, 1167–1171 (2017). https://doi.org/10.1007/s00417-017-3656-3
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00417-017-3656-3