Robot-assisted retinal surgery: overcoming human limitations
Open accessAbstract
Robotics offer the potential to improve the precision and safety of retinal surgery. The starting point of advanced mechanical assistance in vitreoretinal surgery may be traced back to the invention of the motorized vitreous cutter by Machemer in the 1970s [1]. This revolutionized vitreoretinal surgical techniques and made it possible to treat complex retinal detachments, vitreous haemorrhage, epiretinal membranes and macular holes. Over the last decade, the use of vital dyes to stain retinal membranes has further improved the safety of some of the most intricate surgical steps such as peeling internal limiting membrane (ILM), stripping epiretinal membrane (ERM) and removing proliferative vitreoretinopathy (PVR), but minor retinal trauma remains inevitable even in experienced hands. Further improvements in the precision of retinal surgery are limited by human physiology, not only in terms of hand tremor and stability but also the resolving power of human vision even with the aid of the operating microscope. Modern laser-based in vivo imaging techniques such as intraoperative OCT can provide histological levels of detail, yet the limitations of human depth perception and hand-eye coordination mean that it remains a challenge for a surgeon to translate detailed imaging information into enhanced surgical performance. Various types of robotic assistance could help propel intraocular surgery beyond these human physiological limitations.
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All physiological constraints-tremor, jerks and low drifts-are accentuated when attempting to remain stationary or when actuating an instrument.
“All of these physiological constraints: tremor, jerks and low drifts are accentuated when attempting to remain stationary or when actuating an instrument (13).”
From Subretinal therapy: technological solutions to surgical and immunological challenges (2022) · cites this paper as [13]
Holding static causes the appearance of micro jerks of 250 μm or more.
“holding static causes the appearance of micro jerks of 250 μm or more (13).”
From Subretinal therapy: technological solutions to surgical and immunological challenges (2022) · cites this paper as [13]
Cites
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Edwards, T. L., Xue, K., Meenink, H. C. M., Beelen, M. J., Naus, G. J. L., Simunovic, M. P., Latasiewicz, M., Farmery, A. D., de Smet, M. D., & MacLaren, R. E. (2018) · Nature Biomedical Engineering · doi:10.1038/s41551-018-0248-4 · Cited by 231 · see citing works
Self-citationA New Concept for Vitreous Surgery
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Robotic Assisted Cannulation of Occluded Retinal Veins
de Smet, M. D., Meenink, T. C. M., Janssens, T., Valerie, V., Naus, G. J. L., Beelen, M. J., Meers, C., Jonckx, B., & Stassen, J.-M. (2016) · PLoS ONE · doi:10.1371/journal.pone.0162037 · Cited by 94 · see citing works
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Subretinal therapy: technological solutions to surgical and immunological challenges
Ladha, R., Caspers, L. E., Willermain, F., & de Smet, M. D. (2022) · Frontiers in Medicine · doi:10.3389/fmed.2022.846782 · Cited by 54 · see citing works
Ladha, R., Meenink, T., Smit, J., & de Smet, M. D. (2023) · Gene Therapy · doi:10.1038/s41434-021-00262-w · Cited by 42 · see citing works
- Authors
- Xue, K., Edwards, T. L., Meenink, H. C. M., Beelen, M. J., Naus, G. J. L., Simunovic, M. P., de Smet, M. D., & MacLaren, R. E.
- Affiliations
- University of Oxford (GB)
- Corresponding author
- MacLaren, R. E.
- Venue
- Retina Atlas
- Publisher
- Springer Singapore
- Published
- 2019
- Pages
- 109-114
- ISSN
- 2662-5741 (ISSN-L)
- 2662-575X
- OpenAlex
- W2945237863
- Cited by
- 18
- References
- 9
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 3 · 2023: 3 · 2022: 3 · 2021: 2 · 2020: 2
- FWCI
- 5.05
- Type
- book chapter
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Retina atlas (publishedVersion)
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal and Macular Surgery
- Health Sciences › Medicine › Ophthalmology › Intraocular Surgery and Lenses
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal Imaging and Analysis
- Keywords
- robotic surgery, vitrectomy, retinal detachment, epiretinal membrane, macular hole, proliferative vitreoretinopathy, internal limiting membrane peeling, surgical precision, hand tremor, depth perception
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