Cooperative robot assistant for vitreoretinal microsurgery: development of the RVRMS and feasibility studies in an animal model
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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.
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.
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.
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.
KeywordsVitreoretinal microsurgery Robotic aided surgical system Robot-assisted surgery Pars plana vitrectomy Retinal vascular cannulation
Compliance with ethical standards
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.
Robot-assisted photocoagulation (MP4 1904 kb)
Robot-assisted PPV (MP4 1571 kb)
Robot-assisted removal of retinal foreign body (MP4 2684 kb)
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