Design and evaluation of a new bioelectrical impedance sensor for micro-surgery: application to retinal vein cannulation

Abstract

Purpose

Nowadays, millions of people suffer from retinal vein occlusion, a blind-making eye disease. No curative treatment currently exists for this vascular disorder. However, a promising treatment consists in injecting a thrombolytic drug directly inside the affected retinal vessel. Successfully puncturing miniature vessels with diameters between 50 and 400 \(\upmu \hbox {m}\) remains a real challenge, amongst others due to human hand tremor, poor visualisation and depth perception. As a consequence, there is a significant risk of double-puncturing the targeted vessel. Sub-surfacic injection of thrombolytic agent could potentially lead to severe retinal damage.

Methods

A new bio-impedance sensor has been developed to visually display the instant of vessel puncture. The physical working principle of the sensor has been analysed, and a representative electrical model has been derived. Based on this model, the main design parameters were derived to maximise the sensor sensitivity. A detailed characterisation and experimental validation of this concept were conducted.

Results

Stable, repeatable and robust impedance measurements were obtained. In an experimental campaign, 35 puncture attempts on ex vivo pig eyes vessels were conducted. A confusion matrix shows a detection accuracy of 80% if there is a puncture, a double puncture or no puncture. The 20% of inaccuracy most probably comes from the limitations of the employed eye model and the experimental conditions.

Conclusions

The developed bio-impedance sensor has shown great promise to help in avoiding double punctures when cannulating retinal veins. Compared to other puncture detection methods, the proposed sensor is simple and therefore potentially more affordable. Future research will include validation in an in vivo situation involving vitreoretinal surgeons.

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Funding

This study was funded by a C3-fund (3E160419) from KU Leuven.

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Correspondence to Laurent Schoevaerdts.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or living animals performed by any of the authors. All applicable national and/or institutional guidelines for the care and use of ex vivo animal material were followed.

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Schoevaerdts, L., Esteveny, L., Gijbels, A. et al. Design and evaluation of a new bioelectrical impedance sensor for micro-surgery: application to retinal vein cannulation. Int J CARS 14, 311–320 (2019). https://doi.org/10.1007/s11548-018-1850-3

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Keywords

  • Vitreoretinal surgery
  • Sensorised instruments
  • Bio-impedance sensor
  • Robot-assisted surgery