Robotic surgery getting closer

A fully automated robotic cataract surgery platform that extracts the nucleus and cortical materials has been successfully tested in pig eyes and could enter human trials in three-to-four years, Jean-Pierre Hubschman MD told a session of the American Academy of Ophthalmology Annual Meeting in San Francisco. Known as IRISS, the automated cataract platform uses a complete preoperative OCT scan to construct a 3D model of the eye and plan surgery. Planning includes determining the precise trajectory of instrument tips to be used throughout the procedure, explained Dr Hubschman, of the University of California-Los Angeles, USA. Precise guidance During surgery, real-time OCT data acquisition and processing provide precise guidance to the instrument inside the eye, allowing automated cleaning of the lens and cortical material located in capsular bag. A surgeon monitors the operation and can override the device if necessary, said Dr Hubschman, of the Stein Eye Institute and Director of the Advanced Robotic Eye Surgery 
Lab at UCLA. In a study involving fully automated surgery on 30 harvested pig eyes, all lens material was successfully removed from 25 eyes, with minute particles left behind or attached to the iris or capsule in five eyes, Dr Hubschman reported. No posterior capsule ruptures occurred and completion time averaged less than five minutes. Potential advantages of automated surgery include more complete nucleus and cortex removal and reduced risk of capsule rupture, Dr Hubschman said. This is done by providing better visualisation of the anatomical structures during the procedure, for example providing complete visualisation of the capsule periphery, which is normally hidden by the iris in manual surgery. He hopes to automate capsule polishing and IOL alignment soon. “It takes the guesswork out of surgery,” he noted. Limits hand tremor Semi-automated systems envisioned for vitreoretinal surgery eliminate physiological tremor in surgeons’ hands and provides augmented visual and tactile feedback, enhancing precision and control, Dr Hubschman added. These include a semi-automated robot-assisted retinal vein cannulation device that limits hand tremor and maintains a stable position with a surgeon operating the device, Dr Hubschman said. A robotic device known as Preceyes for retinal membrane peeling and subretinal injections operated by a surgeon from a console also has been tested in humans. Dr Hubschman and colleagues are developing the IRISS platform for fully automated cataract surgery and semi-automated retinal surgery, enhancing visualisation and increasing feedback. He expects a prototype ready for human trials around 2024. Jean-Pierre Hubschman: hubschman@jsei.ucla.edu

Tags: ophtalmology robotic surgery