3.2 Robotics for Eye Surgery: Improving Surgical Dexterity and Speed – Dr Christos Bergeles

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Robotics for Eye Surgery: Improving Surgical Dexterity and Speed
Dr Christos Bergeles
Lecturer, Department of Medical Physics and Biomedical Engineering of University College London.
Translational Imaging Group
Centre for Medical Image Computing
The benefits that Robotics are bringing to Healthcare are self-evident. From efficient and rapid delivery of food and medicine from one hospital wing to another, to supporting the work of nurses and physicians in patient rehabilitation, and assisting in surgery by providing increased dexterity, robotics are becoming a key pillar of efficient and effective healthcare services.
Following their increased uptake in the domains of rehabilitation, laparoscopic or keyhole surgery (which ensures less time in hospital and faster recovery times) and orthopaedics (prevention/treatment of skeletal and associated muscle/bone disorders), , robotics is starting to find applications in eye surgery, fulfilling the unique needs of this niche area of healthcare.
Two main research branches can be identified in robotics for eye surgery. For example:
Firstly, robotics aim to speed up and simplify existing operations of high volume such as cataract surgery, corneal sculpting and transplantation where various procedures can be supported by snake like robotic instrumentation in the front (anterior) of the eye. Also, in the back (posterior) of the eye, robots aim to improve the precision of epiretinal membrane peeling and increase the safety of the procedure by providing auditory, visual, and haptic (touch) feedback to the surgeon when risks are identified.
Secondly, research is being conducted to create systems that surpass the surgeon’s capabilities towards enabling currently impossible interventions. Most notably, researchers are investigating the delivery of stem cells, genes, and small drug molecules to specific retinal layers. Therefore, with those new systems, it will be possible to reach and affect every part of the retinal surface, from the photoreceptors to the retinal pigment epithelium and choroid.
However, despite the increasing success of robots in improving speed, safety and the minimally invasive nature of existing surgical procedures, they all need to achieve very high levels of precision, meeting the minimum requirement of suppressing/removing the natural hand tremor, especially if subretinal interventions are to be considered. Also, As the forces applied in eye surgery are sometimes below the threshold of human perception, the recording and amplification of haptic information is vitally important, thereby keeping the clinician in the loop and in control of the robot.
Close collaboration between engineers and clinicians is ensuring that robots continue to be developed which are clinically relevant and allow for co-manipulation and full hands on control by the clinician. In time, robotic tools and systems will become an integral and indispensable part of the operating theatre.

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