Varun Ranganathan, MCOptom

Clinical Optometrist

An OCULAR Interface Exclusive

Synopsis

Robotic-assisted eye surgery is revolutionising the field of ophthalmology, offering unmatched precision, safety, and improved outcomes for patients. This blog explores how robotic systems are enhancing procedures like retinal detachment repairs, cataract surgeries, and glaucoma treatments by minimising risks and maximising accuracy. Learn about the cutting-edge technology driving these advancements, the benefits for both patients and surgeons, and what the future holds for robotics in vision care.

Keywords: Robotics, Robotic surgery, Advance engineering, Artificial Intelligence, Eye care.

Introduction

Robotic surgery is a complex but minimally invasive procedure which involves the use of Artificial Intelligence (AI), robotics and advanced engineering. Specialised robotic platforms improve precision of the surgeon in performing complex movements in small anatomical spaces. By eliminating hand tremors, involuntary surgical inaccuracies can be prevented, improving the outcome of the surgery, and promoting faster wound healing.  It also results in less pain, less blood loss and shorter hospital stays, ¹ which can reduce healthcare costs for the patient and makes their journey more comfortable.

In any healthcare field, the robotic surgical system consists of two main components; the master console which surgeons use, and the robotic arms controlled through the console by the surgeon. ² The master console has a camera which provides an endoscopic view of the surgical field within the anatomical space. The robotic arms are controlled by a joystick for the surgeon to manipulate. The specialty of these robotic arms is that even if the surgeon has physiological tremor, it is filtered by the processor. The robotic arms move in real-time and there is no significant delay between the surgeon’s movement and that of the robotic arms. ³

Principle of the Robotic Surgery

The robotic systems are already in use and are approved by the Food and Drug Administration (FDA). These systems are the da Vinci Surgical System (Intuitive Surgical, Mountain View, California) and the ZEUS system (Computer Motion, Goleta, California). ⁴

The da Vinci System offers tremendous potential for ocular surgical procedures due to its optical magnification. The stereoscopic camera offers optical and digital magnification enabling minute incisions with precision. ⁵ The joints in the robotic arms enable a 360° movement called EndoWrist technology. ⁶ The use of the da Vinci System is the only telemanipulator in the market and has been introduced for both anterior and posterior surgeries such as pterygium, anterior capsulorhexis, pars plana vitrectomy and intraocular foreign body removal. ⁷

Despite the advantages of the da Vinci System, it has its limitations. Remote centre of motion (RCM) is a mechanism that allows the surgeon to the arm around a fixed point, from a distance. ⁸ This location of the RCM makes the intraocular movements less controllable and promotes unnecessary tension on the external surface of the eye. To overcome this the surgeon has to utilise another RCM in the procedure during the incision. ⁹  To ensure the right positioning and movement of the RCM, the surgeon needs to maintain the correct position constantly during the surgery. These motions cannot mirror the exact movements of the surgeon’s arms, limiting the range of motion. It can be particularly challenging when creating a round, such as the curvilinear capsulorhexis which is indispensable in cataract surgeries.

The endoscopic camera which visualises the operating site cannot offer an optimal and detailed image like that of an operating microscope which can significantly limit its uses in the current scenario.

The ZEUS System, which came into use in 1995 was approved by the FDA in 2001. It offers a 2D image initially but through an active polarising matrix, the resultant image is 3D. The Zeus system was discontinued in 2003 after the discovery of the more advanced da Vinci System, but it offered a less expensive setup than da Vinci which is to be noted. ¹⁰

Conclusion

Despite the limitations of the da Vinci System, with subsequent research and advancement, it can significantly improve the surgical landscape in eye care. It has tremendous capability of improving surgical outcomes, particularly in complex cases so that intraocular inflammation can be reduced drastically.

References

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