A Review of Robotic and OCT-Aided Systems for Vitreoretinal Surgery

Abstract

The introduction of the intraocular vitrectomy instrument by Machemer et al. has led to remarkable advancements in vitreoretinal surgery enabling the limitations of human physiologic capabilities to be reached. To overcome the barriers of perception, tremor, and dexterity, robotic technologies have been investigated with current advancements nearing the feasibility for clinical use. There are four categories of robotic systems that have emerged through the research: (1) handheld instruments with intrinsic robotic assistance, (2) hand-on-hand robotic systems, (3) teleoperated robotic systems, and (4) magnetic guidance robots. This review covers the improvements and the remaining needs for safe, cost-effective clinical deployment of robotic systems in vitreoretinal surgery.

Keywords: Image-guided surgery; Medical robotics; Micromanipulator; Ophthalmic surgery; Ophthalmology; Optical coherence tomography; Telemanipulation; Vitreoretinal surgery.

Fig. 1

i An active surgical tool, Micron, that senses a user’s tremor during manual microsurgeries and cancels the effects of tremor on tool tip trajectory using piezoelectric actuators for procedures such as retinal vein cannulation. ii The improvement of tool tip trajectory during manual manipulation with the inclusion of visual feedback to Micron (Figures reproduced with permission from Becker et al. [76])

Fig. 2

A two-arm parallel robot used for vitreoretinal operations that allow eye maneuvering and intraocular dexterity (Figure courtesy of Nabil Simaan)

Fig. 3

A nine-DOF robot with parallel actuation platform carrying a stenting robot capable of maneuvering with precision better than 5 µm (Photo courtesy of Nabil Simaan)

Fig. 4

OCT-forceps with OCT fiber embedded in the 25-gauge stainless steel tube (SST). External actuation causes the 23-gauge SST to slide axially on the 25-gauge SST causing opening–closing of the forceps (Photo courtesy of Karen Joos)

Fig. 5

A hybrid parallel-serial surgical cooperative robot capable of microscale motion using piezo actuators (Figure reproduced with permission from Nasseri et al. [81])

Fig. 6

i An early iteration of a cooperative surgical robot, the Steady-Hand Robot with robotic platform and surgical tool attached to a six-DOF force sensor for robot control (Photo courtesy of Russell H. Taylor and Iulian I. Iordachita). ii An iteration of the Steady-Hand Robot, the Steady-Hand Robot 2, or Eye Robot 2 (ER2). (Figure reproduced with permission from Üneri et al. [10])

Fig. 7

The extraocular magnetic field generating system, OctoMag, capable of guiding magnetic drug-eluting microcapsules and magnetic tip microcannula in five DOFs, i.e., three degrees of positional control and two orientational degrees (Figure courtesy of Bradley Nelson and MagnebotiX AG, Zurich, Switzerland)