Development of cooperative robot-assistant surgery system for vitreoretinal microsurgery and its feasibility test in an animal model

Background Robotic systems are increasingly utilized in numerous disciplines including ophthalmology.Several reports showed potential benefits of robotic-assisted surgery, such as increased precision and dexterity, elimination of tremor, task automation and shortening of learning curve.However, there is still no relative report in China. Objective The present study was to develop a novel robotic-assisted vitreoretinal microsurgery system and assess its overall capacities. Methods A robotic-assisted vitreous and retinal microsurgery system was cooperatively built by Eye Hospital of Wenzhou Medical University and Beijing University of Aeronautics.This platform has two mechanical arms, end-effector of each can grip common instruments such as vitrectomy cutter, illumination probe, laser probe, 23-gauge intraocular forceps.The intraocular surgical tasks were performed assisted by surgical robot on 15 fresh in vitro porcine eyes by three interns to test the feasibility of performing pars plana vitrectomy (PPV) and posterior vitreous detachment (PVD). Vitrectomy steps consisted of preparing three 23-gauge scleral incisions, inserting vitreous cutter towards vitreous and retina via the incisions, and using vitreous cutter to induce and remove a PVD assisted with triamcinolone.The duration and the successful completion of the task with or without complications or involuntary events was assessed. Results PPV and PVD procedures were successfully finished on 15 porcine eyes, and no noted deformation of eyeballs during surgery and no iatrogenic complication such as retinal tear or retinal detachment occurred after operations, with the successful rate 100%.The mean duration of surgery was (12.76±3.44) minutes among the 15 eyeballs and the mean duration for each operator was (13.67±4.23), (10.83±2.30) and (13.77±1.91) minutes, respectively. Conclusions Robotic-assisted vitreoretinal microsurgery system is varified to have good stability and accuracy in intraocular surgery, and the robotic surgical system may be technically feasible to preform human manual PPV and PVD procedures. Key words: Robotic surgical procedures; Robotics/instrumentation; Surgery, computer-assisted/methods; Vitrectomy/methods; Feasibility studies; Swine