Robot-Assisted Simulated Strabismus Surgery

Abstract

Purpose: This study aims to investigate the feasibility of robot-assisted simulated strabismus surgery using the new da Vinci Xi Surgical System and to report what we believe is the first use of a surgical robot in experimental eye muscle surgery.

Methods: Robot-assisted strabismus surgeries were performed on a strabismus eye model using the robotic da Vinci Xi Surgical System. On the lateral rectus of each eye, we performed a procedure including, successively, a 4-mm plication followed by a 4-mm recession of the muscle to end with a 4-mm resection. Operative time from conjunctival opening to closing and successful completion of the different steps with or without complications or unexpected events were assessed.

Results: Robot-assisted strabismus procedures were successfully performed on six eyes. The feasibility of robot-assisted simulated strabismus surgery is confirmed. The da Vinci Xi system provided the appropriate dexterity and operative field visualization necessary to perform conjunctival and Tenon's capsule opening and closing, muscle identification, suturing, desinsertion, sectioning, and resuturing. The mean duration to complete the whole procedure was 27 minutes (range, 22-35). There were no complications or unexpected intraoperative events.

Conclusions: Experimental robot-assisted strabismus surgery is technically feasible using the new robotic da Vinci Xi Surgical System. This is, to our knowledge, the first use of a surgical robot in ocular muscle surgery.

Translational relevance: Further experimentation will allow the advantages of robot-assisted microsurgery to be identified while underlining the improvements and innovations necessary for clinical use.

Keywords: da Vinci; muscle; robot; strabismus; surgery.

Figure 1

Installation. On the left side are the surgical tables with the strabismus dry-lab training system installed under the robotic da Vinci Xi Surgical System above it. On the right side and in the background are the surgeon's remote consoles. The video screen (top) shows the operative field with the three robotic arms above the eye model.

Figure 2

Surgical sequences. (A) The conjunctival opening was made with the Potts scissors (arm number 4) and the micro bipolar forceps (arm number 1). (B) The rectus muscle was identified and sutured with 5/0 polyglactin. (C) Desinsertion of the muscle from the sclera was made with Potts scissors (arm number 4). (D) Resuturing of the muscle to the globe was made using the Black Diamond micro forceps (arm number 3) and the micro bipolar forceps (arm number 1) with 5/0 polyglactin. The muscle insertion was secured with two partial-thickness scleral passes.