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L'Abbate D, Prescott K, Geraghty B, Kearns VR, Steel DHW. BIOMECHANICAL CONSIDERATIONS FOR OPTIMISING SUBRETINAL INJECTIONS. Surv Ophthalmol 2024:S0039-6257(24)00053-5. [PMID: 38797394 DOI: 10.1016/j.survophthal.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 05/16/2024] [Accepted: 05/20/2024] [Indexed: 05/29/2024]
Abstract
Subretinal injection is the preferred delivery technique for various novel ocular therapies and is widely used because of its precision and efficient delivery of gene and cell therapies; however, choosing an injection point and defining delivery parameters to target a specified retinal location and area is an inexact science. We provide an overview of the key factors that play important roles during subretinal injections to refine the technique, enhance patient outcomes, and minimise risks. We describe the role of anatomical and physical variables that affect subretinal bleb propagation and shape and their impact on retinal integrity. We highlight the risks associated with subretinal injections and consider strategies to mitigate reflux and retinal trauma. Finally, we explore the emerging field of robotic assistance in improving intraocular manouvrability and precision to facilitate the injection procedure.
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Affiliation(s)
- Dario L'Abbate
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Kia Prescott
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Brendan Geraghty
- Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Victoria R Kearns
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
| | - David H W Steel
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Sunderland Eye Infirmary, Sunderland, UK; Bioscience Institute, Newcastle University, Newcastle Upon Tyne, UK
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Guo X, McFall F, Jiang P, Liu J, Lepora N, Zhang D. A Lightweight and Affordable Wearable Haptic Controller for Robot-Assisted Microsurgery. SENSORS (BASEL, SWITZERLAND) 2024; 24:2676. [PMID: 38732782 PMCID: PMC11085189 DOI: 10.3390/s24092676] [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: 12/31/2023] [Revised: 04/06/2024] [Accepted: 04/17/2024] [Indexed: 05/13/2024]
Abstract
In robot-assisted microsurgery (RAMS), surgeons often face the challenge of operating with minimal feedback, particularly lacking in haptic feedback. However, most traditional desktop haptic devices have restricted operational areas and limited dexterity. This report describes a novel, lightweight, and low-budget wearable haptic controller for teleoperated microsurgical robotic systems. We designed a wearable haptic interface entirely made using off-the-shelf material-PolyJet Photopolymer, fabricated using liquid and solid hybrid 3D co-printing technology. This interface was designed to resemble human soft tissues and can be wrapped around the fingertips, offering direct contact feedback to the operator. We also demonstrated that the device can be easily integrated with our motion tracking system for remote microsurgery. Two motion tracking methods, marker-based and marker-less, were compared in trajectory-tracking experiments at different depths to find the most effective motion tracking method for our RAMS system. The results indicate that within the 4 to 8 cm tracking range, the marker-based method achieved exceptional detection rates. Furthermore, the performance of three fusion algorithms was compared to establish the unscented Kalman filter as the most accurate and reliable. The effectiveness of the wearable haptic controller was evaluated through user studies focusing on the usefulness of haptic feedback. The results revealed that haptic feedback significantly enhances depth perception for operators during teleoperated RAMS.
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Affiliation(s)
- Xiaoqing Guo
- Department of Engineering Mathematics, University of Bristol, Bristol BS8 1QU, UK
| | - Finn McFall
- Department of Engineering Mathematics, University of Bristol, Bristol BS8 1QU, UK
| | - Peiyang Jiang
- Department of Engineering Mathematics, University of Bristol, Bristol BS8 1QU, UK
| | - Jindong Liu
- Hamlyn Centre for Robotic Surgery, Imperial College London, London SW7 2AZ, UK
| | - Nathan Lepora
- Department of Engineering Mathematics, University of Bristol, Bristol BS8 1QU, UK
| | - Dandan Zhang
- Department of Bioengineering, Imperial College London, London SW7 2AZ, UK
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Liu Y, Song D, Zhang G, Bu Q, Dong Y, Hu C, Shi C. A Novel Electromagnetic Driving System for 5-DOF Manipulation in Intraocular Microsurgery. CYBORG AND BIONIC SYSTEMS 2024; 5:0083. [PMID: 38533379 PMCID: PMC10964225 DOI: 10.34133/cbsystems.0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/29/2023] [Indexed: 03/28/2024] Open
Abstract
This work presents a novel electromagnetic driving system that consists of eight optimized electromagnets arranged in an optimal configuration and employs a control framework based on an active disturbance rejection controller (ADRC) and virtual boundary. The optimal system configuration enhances the system's compatibility with other ophthalmic surgical instruments, while also improving its capacity to generate magnetic force in the vertical direction. Besides, the optimal electromagnet parameters provide a superior comprehensive performance on magnetic field generation capacity and thermal power. Hence, the presented design achieves a stronger capacity for sustained work. Furthermore, the ADRC controller effectively monitors and further compensates the total disturbance as well as gravity to enhance the system's robustness. Meanwhile, the implementation of virtual boundaries substantially enhances interactive security via collision avoidance. The magnetic and thermal performance tests have been performed on the electromagnet to verify the design optimization. The proposed electromagnet can generate a superior magnetic field of 2.071 mT at a distance of 65 mm with an applied current of 1 A. Moreover, it demonstrates minimal temperature elevation from room temperature (25 °C) to 46 °C through natural heat dissipation in 3 h, thereby effectively supporting prolonged magnetic manipulation of intraocular microsurgery. Furthermore, trajectory tracking experiments with disturbances have been performed in a liquid environment similar to the practical ophthalmic surgery scenarios, to verify the robustness and security of the presented control framework. The maximum root mean square (RMS) error of performance tests in different operation modes remains 35.8 μm, providing stable support for intraocular microsurgery.
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Affiliation(s)
- Yangyu Liu
- Key Laboratory of Mechanism Theory and Equipment Design of Ministry of Education, School of Mechanical Engineering,
Tianjin University, Tianjin 300072, China
| | - Dezhi Song
- Key Laboratory of Mechanism Theory and Equipment Design of Ministry of Education, School of Mechanical Engineering,
Tianjin University, Tianjin 300072, China
| | - Guanghao Zhang
- Key Laboratory of Mechanism Theory and Equipment Design of Ministry of Education, School of Mechanical Engineering,
Tianjin University, Tianjin 300072, China
| | - Qingyu Bu
- Key Laboratory of Mechanism Theory and Equipment Design of Ministry of Education, School of Mechanical Engineering,
Tianjin University, Tianjin 300072, China
| | - Yuanqing Dong
- Key Laboratory of Mechanism Theory and Equipment Design of Ministry of Education, School of Mechanical Engineering,
Tianjin University, Tianjin 300072, China
| | - Chengzhi Hu
- Guangdong Provincial Key Laboratory of Human-Augmentation and Rehabilitation Robotics in Universities, Department of Mechanical and Energy Engineering,
Southern University of Science and Technology, Shenzhen 518055, China
| | - Chaoyang Shi
- Key Laboratory of Mechanism Theory and Equipment Design of Ministry of Education, School of Mechanical Engineering,
Tianjin University, Tianjin 300072, China
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Faulkner J, Malik M, Daniel C, Uddin J, Arora A, Stein H, Jeannon JP. Soft Tissue Robotic Assisted Orbital Surgery Using da Vinci SP: A Cadaveric Experience. Ophthalmic Plast Reconstr Surg 2024:00002341-990000000-00323. [PMID: 38231616 DOI: 10.1097/iop.0000000000002597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
PURPOSE Robotic surgical techniques have transformed many surgical specialties however robotic techniques and applications have been much more limited in ophthalmology. This study aims to evaluate the feasibility of robotic assisted orbital surgery using a single-port novel robotic platform, the da Vinci SP. METHODS A series of orbital procedures were performed in cadaveric specimens utilizing the da Vinci SP robotic system. The procedures performed included lacrimal gland dissection and biopsy, medial and lateral orbital wall dissections, enucleation, and lid-sparing orbital exenteration. Successful completion of each procedure was defined by the operating surgeon and was considered the primary outcome and marker of feasibility. RESULTS Seven cadaveric procedures were performed in 3 cadaveric specimens. All 7 procedures were completed successfully without complication. Setup optimization occurred throughout the study and setup and operative times were acceptable. Three instrument arms and 1 endoscope were utilized throughout the study allowing 3 arm operating and dynamic retraction. Instrument size was found to limit surgical access and precision particular at the orbital apex. CONCLUSIONS This preclinical study demonstrates that the da Vinci SP can be utilized within the orbit and is feasible for several applications. Robotic surgical systems offer significant advantages over conventional techniques and should be embraced. However, current commercially available robotic platforms are not optimized for the orbit and have their limitations although they may be suitable for some clinical applications.
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Affiliation(s)
- Jack Faulkner
- Department of Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Mohsan Malik
- Adnexal Service, Moorfields Eye Hospital, London, United Kingdom
| | - Claire Daniel
- Adnexal Service, Moorfields Eye Hospital, London, United Kingdom
| | - Jimmy Uddin
- Adnexal Service, Moorfields Eye Hospital, London, United Kingdom
| | - Asit Arora
- Department of Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Hubert Stein
- Department of Surgical Applications Engineering, Intuitive Surgical Inc., Sunnyvale, California, U.S.A
| | - Jean-Pierre Jeannon
- Department of Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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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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Posselli NR, Bernstein PS, Abbott JJ. Eye-mounting goggles to bridge the gap between benchtop experiments and in vivo robotic eye surgery. Sci Rep 2023; 13:15503. [PMID: 37726336 PMCID: PMC10509142 DOI: 10.1038/s41598-023-42561-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/12/2023] [Indexed: 09/21/2023] Open
Abstract
A variety of robot-assisted surgical systems have been proposed to improve the precision of eye surgery. Evaluation of these systems has typically relied on benchtop experiments with artificial or enucleated eyes. However, this does not properly account for the types of head motion that are common among patients undergoing eye surgery, which a clinical robotic system will encounter. In vivo experiments are clinically realistic, but they are risky and thus require the robotic system to be at a sufficiently mature state of development. In this paper, we describe a low-cost device that enables an artificial or enucleated eye to be mounted to standard swim goggles worn by a human volunteer to enable more realistic evaluation of eye-surgery robots after benchtop studies and prior to in vivo studies. The mounted eye can rotate about its center, with a rotational stiffness matching that of an anesthetized patient's eye. We describe surgeon feedback and technical analyses to verify that various aspects of the design are sufficient for simulating a patient's eye during surgery.
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Affiliation(s)
- Nicholas R Posselli
- Robotics Center and Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA.
| | - Paul S Bernstein
- Department of Ophthalmology and Visual Sciences, Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Jake J Abbott
- Robotics Center and Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA
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