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Wang T, Li H, Pu T, Yang L. Microsurgery Robots: Applications, Design, and Development. SENSORS (BASEL, SWITZERLAND) 2023; 23:8503. [PMID: 37896597 PMCID: PMC10611418 DOI: 10.3390/s23208503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023]
Abstract
Microsurgical techniques have been widely utilized in various surgical specialties, such as ophthalmology, neurosurgery, and otolaryngology, which require intricate and precise surgical tool manipulation on a small scale. In microsurgery, operations on delicate vessels or tissues require high standards in surgeons' skills. This exceptionally high requirement in skills leads to a steep learning curve and lengthy training before the surgeons can perform microsurgical procedures with quality outcomes. The microsurgery robot (MSR), which can improve surgeons' operation skills through various functions, has received extensive research attention in the past three decades. There have been many review papers summarizing the research on MSR for specific surgical specialties. However, an in-depth review of the relevant technologies used in MSR systems is limited in the literature. This review details the technical challenges in microsurgery, and systematically summarizes the key technologies in MSR with a developmental perspective from the basic structural mechanism design, to the perception and human-machine interaction methods, and further to the ability in achieving a certain level of autonomy. By presenting and comparing the methods and technologies in this cutting-edge research, this paper aims to provide readers with a comprehensive understanding of the current state of MSR research and identify potential directions for future development in MSR.
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Affiliation(s)
- Tiexin Wang
- ZJU-UIUC Institute, International Campus, Zhejiang University, Haining 314400, China; (T.W.); (H.L.); (T.P.)
- School of Mechanical Engineering, Zhejiang University, Hangzhou 310058, China
| | - Haoyu Li
- ZJU-UIUC Institute, International Campus, Zhejiang University, Haining 314400, China; (T.W.); (H.L.); (T.P.)
| | - Tanhong Pu
- ZJU-UIUC Institute, International Campus, Zhejiang University, Haining 314400, China; (T.W.); (H.L.); (T.P.)
| | - Liangjing Yang
- ZJU-UIUC Institute, International Campus, Zhejiang University, Haining 314400, China; (T.W.); (H.L.); (T.P.)
- School of Mechanical Engineering, Zhejiang University, Hangzhou 310058, China
- Department of Mechanical Engineering, University of Illinois Urbana-Champaign, Urbana, IL 61801, USA
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Iordachita II, de Smet MD, Naus G, Mitsuishi M, Riviere CN. Robotic Assistance for Intraocular Microsurgery: Challenges and Perspectives. PROCEEDINGS OF THE IEEE. INSTITUTE OF ELECTRICAL AND ELECTRONICS ENGINEERS 2022; 110:893-908. [PMID: 36588782 PMCID: PMC9799958 DOI: 10.1109/jproc.2022.3169466] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Intraocular surgery, one of the most challenging discipline of microsurgery, requires sensory and motor skills at the limits of human physiological capabilities combined with tremendously difficult requirements for accuracy and steadiness. Nowadays, robotics combined with advanced imaging has opened conspicuous and significant directions in advancing the field of intraocular microsurgery. Having patient treatment with greater safety and efficiency as the final goal, similar to other medical applications, robotics has a real potential to fundamentally change microsurgery by combining human strengths with computer and sensor-based technology in an information-driven environment. Still in its early stages, robotic assistance for intraocular microsurgery has been accepted with precaution in the operating room and successfully tested in a limited number of clinical trials. However, owing to its demonstrated capabilities including hand tremor reduction, haptic feedback, steadiness, enhanced dexterity, micrometer-scale accuracy, and others, microsurgery robotics has evolved as a very promising trend in advancing retinal surgery. This paper will analyze the advances in retinal robotic microsurgery, its current drawbacks and limitations, as well as the possible new directions to expand retinal microsurgery to techniques currently beyond human boundaries or infeasible without robotics.
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Affiliation(s)
- Iulian I Iordachita
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Marc D de Smet
- Microinvasive Ocular Surgery Center (MIOS), Lausanne, Switzerland
| | | | - Mamoru Mitsuishi
- Department of Mechanical Engineering, The University of Tokyo, Japan
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Zanaty M, Fussinger T, Rogg A, Lovera A, Lambelet D, Vardi I, Wolfensberger TJ, Baur C, Henein S. Programmable Multistable Mechanisms for Safe Surgical Puncturing. J Med Device 2019. [DOI: 10.1115/1.4043016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
We present novel medical devices for safe surgical puncturing, in particular a cannula for the treatment of retinal vein occlusion (RVO). This passive mechanical device has an adjustable stroke and exerts a puncturing force independent of operator applied displacement. The innovative feature of this tool is that puncturing stroke is decoupled from operator input thereby minimizing the possibility of overpuncturing. This is achieved using our concept of stability programming, where the user modifies the mechanism strain energy as opposed to imposing direct displacement which is the case for standard bistable mechanisms. Ultra-fast laser three-dimensional (3D) printing is used to manufacture the needle in glass. A microfluidic channel is integrated into the needle tip for drug injection. Numerical simulations and experimental measurements validate the mechanical stability behavior of the puncture mechanism and characterize its puncturing stroke and force.
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Affiliation(s)
- Mohamed Zanaty
- Instant-Lab, École Polytechnique Fédérale de Lausanne, Neuchâtel 2000, Switzerland e-mail:
| | - Thomas Fussinger
- Instant-Lab, École Polytechnique Fédérale de Lausanne, Neuchâtel 2000, Switzerland e-mail:
| | - Arno Rogg
- Instant-Lab, École Polytechnique Fédérale de Lausanne, Neuchâtel 2000, Switzerland e-mail:
| | | | - David Lambelet
- Galatea-Lab, École Polytechnique Fédérale de Lausanne, Neuchâtel 2000, Switzerland e-mail:
| | - Ilan Vardi
- Instant-Lab, École Polytechnique Fédérale de Lausanne, Neuchâtel 2000, Switzerland e-mail:
| | - Thomas J. Wolfensberger
- Department of Ophthalmology, University of Lausanne, Hôpital Ophtalmique Jules-Gonin, Lausanne 1004, Switzerland e-mail:
| | - Charles Baur
- Instant-Lab, École Polytechnique Fédérale de Lausanne, Neuchâtel 2000, Switzerland e-mail:
| | - Simon Henein
- Instant-Lab, École Polytechnique Fédérale de Lausanne, Neuchâtel 2000, Switzerland e-mail:
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Roizenblatt M, Edwards TL, Gehlbach PL. Robot-assisted vitreoretinal surgery: current perspectives. ROBOTIC SURGERY (AUCKLAND) 2018; 5:1-11. [PMID: 29527537 PMCID: PMC5842029 DOI: 10.2147/rsrr.s122301] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Vitreoretinal microsurgery is among the most technically challenging of the minimally invasive surgical techniques. Exceptional precision is required to operate on micron scale targets presented by the retina while also maneuvering in a tightly constrained and fragile workspace. These challenges are compounded by inherent limitations of the unassisted human hand with regard to dexterity, tremor and precision in positioning instruments. The limited human ability to visually resolve targets on the single-digit micron scale is a further limitation. The inherent attributes of robotic approaches therefore, provide logical, strategic and promising solutions to the numerous challenges associated with retinal microsurgery. Robotic retinal surgery is a rapidly emerging technology that has witnessed an exponential growth in capabilities and applications over the last decade. There is now a worldwide movement toward evaluating robotic systems in an expanding number of clinical applications. Coincident with this expanding application is growth in the number of laboratories committed to "robotic medicine". Recent technological advances in conventional retina surgery have also led to tremendous progress in the surgeon's capabilities, enhanced outcomes, a reduction of patient discomfort, limited hospitalization and improved safety. The emergence of robotic technology into this rapidly advancing domain is expected to further enhance important aspects of the retinal surgery experience for the patients, surgeons and society.
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Affiliation(s)
- Marina Roizenblatt
- Department of Ophthalmology, Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil,
| | - Thomas L Edwards
- Department of Clinical Neurosciences, University of Oxford, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia
| | - Peter L Gehlbach
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil,
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Molaei A, Abedloo E, de Smet MD, Safi S, Khorshidifar M, Ahmadieh H, Khosravi MA, Daftarian N. Toward the Art of Robotic-assisted Vitreoretinal Surgery. J Ophthalmic Vis Res 2017; 12:212-218. [PMID: 28540014 PMCID: PMC5423376 DOI: 10.4103/jovr.jovr_63_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
New technological progress in robotics has brought many beneficial clinical applications. Currently, computer integrated robotic surgery has gained clinical acceptance for several surgical procedures. Robotically assisted eye surgery is envisaged as a promising solution to overcome the shortcomings inherent to conventional surgical procedures as in vitreoretinal surgeries. Robotics by its high precision and fine mechanical control can improve dexterity, cancel tremor, and allow highly precise remote surgical capability, delicate vitreoretinal manipulation capabilities. Combined with magnified three-dimensional imaging of the surgical site, it can enhance surgical precision. Tele-manipulation can provide the ability for tele-surgery or haptic feedback of forces generated by the manipulation of intraocular tissues. It presents new solutions for some sight-threatening conditions such as retinal vein cannulation where, due to physiological limitations of the surgeon's hand, the procedure cannot be adequately performed. In this paper, we provide an overview of the research and advances in robotically assisted vitreoretinal eye surgery. Additionally the barriers to the integration of this method in the field of ocular surgery are summarized. Finally, we discuss the possible applications of the method in the area of vitreoretinal surgery.
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Affiliation(s)
- Amir Molaei
- Department of Electrical Engineering, K.N Toosi University of Technology, Tehran, Iran.,Department of Mechanical Engineering, Concordia University, Montreal, Canada
| | - Ebrahim Abedloo
- Department of Electrical Engineering, K.N Toosi University of Technology, Tehran, Iran
| | - Marc D de Smet
- MicroInvasive Ocular Surgery Center (MIOS sa), Lausanne, Switzerland.,Preceyes bv, Eindhoven, the Netherlands
| | - Sare Safi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Milad Khorshidifar
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Ahmadieh
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Narsis Daftarian
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Ocular Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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