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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; 40:403-407. [PMID: 38231616 DOI: 10.1097/iop.0000000000002597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [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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Thirunavukarasu AJ, Hu ML, Foster WP, Xue K, Cehajic-Kapetanovic J, MacLaren RE. Robot-Assisted Eye Surgery: A Systematic Review of Effectiveness, Safety, and Practicality in Clinical Settings. Transl Vis Sci Technol 2024; 13:20. [PMID: 38916880 PMCID: PMC11210629 DOI: 10.1167/tvst.13.6.20] [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: 03/21/2024] [Accepted: 05/15/2024] [Indexed: 06/26/2024] Open
Abstract
Purpose Surgical innovation in ophthalmology is impeded by the physiological limits of human motion, and robotic assistance may facilitate an expansion of the surgical repertoire. We conducted a systematic review to identify ophthalmic procedures in which robotic systems have been trialled, evaluate their performance, and explore future directions for research and development of robotic techniques. Methods The Cochrane Library, Embase, MEDLINE, Scopus, and Web of Science were searched. Screening adhered to five criteria: (1) English language; (2) primary research article; (3) human patients; (4) ophthalmological surgery; and (5) robot-assisted surgery. Quality assessment was conducted with Joanna Briggs Institute Tools for Critical Appraisal. The study protocol was registered prospectively (PROSPERO ID CRD42023449793). Results Twelve studies were included. In comparative studies, there was no difference in the occurrence of ocular harms in robot-assisted procedures and conventional surgery. However, robotic assistance did not demonstrate consistent benefits over manual surgery in terms of effectiveness or practicality, likely reflecting the learning curve associated with these systems. Single studies indicated the potential of robotic assistance to improve the consistency of subretinal drug infusion and efficiency of instrument manipulation in vitreoretinal surgery. Conclusions Proof-of-concept studies have demonstrated the potential of robotic assistance to facilitate procedures otherwise infeasible or impractical, and may broaden access to surgery. However, robot-assisted surgery has not yet demonstrated any significant benefits over standard surgical practice. Improving the speed and reducing perioperative requirements of robot-assisted surgery are particular priorities for research and innovation to improve the practicality of these novel techniques. Translational Relevance This systematic review summarizes the potential and limitations of robotic systems for assisting eye surgery and outlines what is required for these systems to benefit patients and surgeons.
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Affiliation(s)
- Arun J Thirunavukarasu
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford University Clinical Academic Graduate School, University of Oxford, Oxford, UK
| | - Monica L Hu
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - William P Foster
- University of Cambridge School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Kanmin Xue
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jasmina Cehajic-Kapetanovic
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Robert E MacLaren
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Alafaleq M. Robotics and cybersurgery in ophthalmology: a current perspective. J Robot Surg 2023; 17:1159-1170. [PMID: 36637738 PMCID: PMC9838251 DOI: 10.1007/s11701-023-01532-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/08/2023] [Indexed: 01/14/2023]
Abstract
Ophthalmology is one of the most enriched fields, allowing the domain of artificial intelligence to be part of its point of interest in scientific research. The requirement of specialized microscopes and visualization systems presents a challenge to adapting robotics in ocular surgery. Cyber-surgery has been used in other surgical specialties aided by Da Vinci robotic system. This study focuses on the current perspective of using robotics and cyber-surgery in ophthalmology and highlights factors limiting their progression. A review of literature was performed with the aid of Google Scholar, Pubmed, CINAHL, MEDLINE (N.H.S. Evidence), Cochrane, AMed, EMBASE, PsychINFO, SCOPUS, and Web of Science. Keywords: Cybersurgery, Telesurgery, ophthalmology robotics, Da Vinci robotic system, artificial intelligence in ophthalmology, training on robotic surgery, ethics of the use of robots in medicine, legal aspects, and economics of cybersurgery and robotics. 150 abstracts were reviewed for inclusion, and 68 articles focusing on ophthalmology were included for full-text review. Da Vinci Surgical System has been used to perform a pterygium repair in humans and was successful in ex vivo corneal, strabismus, amniotic membrane, and cataract surgery. Gamma Knife enabled effective treatment of uveal melanoma. Robotics used in ophthalmology were: Da Vinci Surgical System, Intraocular Robotic Interventional Surgical System (IRISS), Johns Hopkins Steady-Hand Eye Robot and smart instruments, and Preceyes' B.V. Cybersurgery is an alternative to overcome distance and the shortage of surgeons. However, cost, availability, legislation, and ethics are factors limiting the progression of these fields. Robotic and cybersurgery in ophthalmology are still in their niche. Cost-effective studies are needed to overcome the delay. Technologies, such as 5G and Tactile Internet, are required to help reduce resource scheduling problems in cybersurgery. In addition, prototype development and the integration of artificial intelligence applications could further enhance the safety and precision of ocular surgery.
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Affiliation(s)
- Munirah Alafaleq
- Ophthalmology Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
- Artificial Intelligence and Business School, 18 Rue du Dôme, 92100, Boulogne Billancourt, France.
- Ophthalmology Department and Centre for Rare Ophthalmological Diseases OPHTARA, Necker Enfants-Malades University Hospital, AP-HP, University Paris Cité, Paris, France.
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Yang K, Jin X, Wang Z, Fang Y, Li Z, Yang Z, Cong J, Yang Y, Huang Y, Wang L. Robot-assisted subretinal injection system: development and preliminary verification. BMC Ophthalmol 2022; 22:484. [PMID: 36510151 PMCID: PMC9744060 DOI: 10.1186/s12886-022-02720-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND To design and develop a surgical robot capable of assisting subretinal injection. METHODS A remote center of motion (RCM) mechanical design and a master-slave teleoperation were used to develop and manufacture the assisted subretinal surgery robot (RASR). Ten fresh isolated porcine eyes were divided into the Robot Manipulation (RM) group and Manual Manipulation (MM) group (5 eyes for each group), and subretinal injections were performed by the robot and manual manipulation methods, respectively. A preliminary verification of the robot was performed by comparing the advantages and disadvantages of the robot manipulation and manual manipulation by using optical coherent tomography (OCT), fundus photography, and video motion capture analysis after the surgery. RESULTS Both the robot and the manual manipulation were able to perform subretinal injections with a 100% success rate. The OCT results showed that the average subretinal area was 1.548 mm2 and 1.461 mm2 in the RM and MM groups, respectively (P > 0.05). Meanwhile the volume of subretinal fluid obtained using the retinal map mode built in OCT was not statistically different between the RM and MM groups (P > 0.05). By analyzing the surgical video using Kinovea, a motion capture and analysis software, the results suggest that the mean tremor amplitude of the RM group was 0.3681 pixels (x direction), which was significantly reduced compared to 18.8779 pixels (x direction) in the MM group (P < 0.0001). CONCLUSION Robot-assisted subretinal injection system (RASR) is able to finish subretinal injection surgery with better stability and less fatigue than manual manipulation.
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Affiliation(s)
- Kunkun Yang
- grid.414252.40000 0004 1761 8894Graduate School of Chinese PLA General Hospital, 100853 Beijing, China ,grid.414252.40000 0004 1761 8894Senior Department of Ophthalmology, the Third Medical Center, Chinese PLA General Hospital, 100039 Beijing, China
| | - Xin Jin
- grid.414252.40000 0004 1761 8894Senior Department of Ophthalmology, the Third Medical Center, Chinese PLA General Hospital, 100039 Beijing, China
| | - Zhaodong Wang
- grid.64939.310000 0000 9999 1211School of Mechanical Engineering and Automation, Beihang University, 100191 Beijing, China
| | - Yifan Fang
- grid.414252.40000 0004 1761 8894Graduate School of Chinese PLA General Hospital, 100853 Beijing, China ,grid.414252.40000 0004 1761 8894Senior Department of Ophthalmology, the Third Medical Center, Chinese PLA General Hospital, 100039 Beijing, China
| | - Zhao Li
- grid.414252.40000 0004 1761 8894Senior Department of Ophthalmology, the Third Medical Center, Chinese PLA General Hospital, 100039 Beijing, China ,grid.216938.70000 0000 9878 7032School of Medicine, Nankai University, 300071 Tianjin, China
| | - Zhe Yang
- grid.414252.40000 0004 1761 8894Graduate School of Chinese PLA General Hospital, 100853 Beijing, China ,grid.414252.40000 0004 1761 8894Senior Department of Ophthalmology, the Third Medical Center, Chinese PLA General Hospital, 100039 Beijing, China
| | - Jinju Cong
- Aier Eye Hospital, 433199 Qianjiang City, Hubei Province China
| | - Yang Yang
- grid.64939.310000 0000 9999 1211School of Mechanical Engineering and Automation, Beihang University, 100191 Beijing, China
| | - Yifei Huang
- grid.414252.40000 0004 1761 8894Senior Department of Ophthalmology, the Third Medical Center, Chinese PLA General Hospital, 100039 Beijing, China
| | - Liqiang Wang
- grid.414252.40000 0004 1761 8894Senior Department of Ophthalmology, the Third Medical Center, Chinese PLA General Hospital, 100039 Beijing, China ,grid.414252.40000 0004 1761 8894State Key Laboratory of Kidney Diseases, 100853 Beijing, China
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Wang Y, Sun J, Liu X, Li Y, Fan X, Zhou H. Robot-Assisted Orbital Fat Decompression Surgery: First in Human. Transl Vis Sci Technol 2022; 11:8. [PMID: 35536720 PMCID: PMC9100477 DOI: 10.1167/tvst.11.5.8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To explore the safety and feasibility of robot-assisted orbital fat decompression surgery. Methods Ten prospectively enrolled patients (18 eyes) with Graves’ ophthalmopathy underwent robot-assisted orbital fat decompression surgery with the da Vinci Xi surgical system. Intraoperative blood loss, operative time, and complications were recorded. For every patient, the exophthalmos of the operated eyes and Graves’ orbitopathy quality of life (GO-QoL) were measured both preoperatively and 3 months postoperatively to assess the surgical effect. Results All surgical procedures were successfully performed. The mean duration to complete the whole procedure was 124.3 ± 33.2 minutes (range, 60–188). The mean intraoperative blood loss was 17.8 ± 6.2 mL (range, 7.5–28). There were neither complications nor unexpected events in terms of either orbital decompression surgery or robot-assisted procedures. The mean exophthalmos was 20.2 ± 1.8 mm before surgery and 17.9 ± 1.4 mm postoperatively (P < 0.0001). The preoperative and postoperative GO-QoL on the visual function arm was 84.38 ± 20.04 and 93.75 ± 9.32, respectively. The preoperative and postoperative GO-QoL on the appearance arm was 42.50 ± 14.97 and 64.38 ± 21.46, respectively (P = 0.027). Conclusions The da Vinci Xi surgical system provided the stability, dexterity, and good visualization necessary for orbital fat decompression surgery, indicating the safety and feasibility of robot-assisted orbital fat decompression surgery. Translational Relevance Based on a literature search using EMBASE and MEDLINE databases, we believe that this study reports the first in-human results of the safety and effectiveness of da Vinci robot-assisted orbital fat decompression surgery.
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Affiliation(s)
- Yi Wang
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Jing Sun
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xingtong Liu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yinwei Li
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xianqun Fan
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Huifang Zhou
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
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Lu ES, Reppucci VS, Houston SKS, Kras AL, Miller JB. Three-dimensional telesurgery and remote proctoring over a 5G network. Digit J Ophthalmol 2021; 27:38-43. [PMID: 34924881 DOI: 10.5693/djo.01.2021.06.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Purpose To present 2 cases of vitreoretinal surgery performed on a three-dimensional (3D) heads-up display surgical platform with real-time transfer of 3D video over a fifth-generation (5G) cellular network. Methods An epiretinal membrane peel and tractional retinal detachment repair performed at Massachusetts Eye and Ear in April 2019 were broadcast live to the Verizon 5G Lab in Cambridge, MA. Results Both surgeries were successful. The heads-up digital surgery platform, combined with a 5G network, allowed telesurgical transfer of high-quality 3D vitreoretinal surgery with minimal degradation. Average end-to-end latency was 250 ms, and average round-trip latency was 16 ms. Fine surgical details were observed remotely by a proctoring surgeon and trainee, with real-time communication via mobile phone. Conclusions This pilot study represents the first successful demonstration of vitreoretinal surgery transmitted over a 5G network. Telesurgery has the potential to enhance surgical education, provide intraoperative consultation and guidance from expert proctors, and improve patient outcomes, especially in remote and low-resource areas.
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Affiliation(s)
- Edward S Lu
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Vincent S Reppucci
- Vitreoretinal Surgeons LLC, Danbury, Connecticut.,Retina Service, New York Eye and Ear Infirmary of Mt. Sinai, New York
| | | | - Ashley L Kras
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston
| | - John B Miller
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.,Retina Service, Massachusetts Eye and Ear, Boston
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Bourcier T, Dormegny L, Sauer A, Nardin M, Becmeur PH, Chammas J, Gaucher D, Ballonzoli L, Speeg C, Liverneaux P, Vix M, Marescaux J, Mutter D. State of the Art in Robot-Assisted Eye Surgery. Klin Monbl Augenheilkd 2021; 238:1290-1293. [PMID: 34571552 DOI: 10.1055/a-1562-2350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Despite the advantages that robot-assisted surgery can offer to patient care, its use in ophthalmic surgery has not yet progressed to the extent seen in other fields. As such, its use remains limited to research environments, both basic and clinical. The technical specifications for such ophthalmic surgical robots are highly challenging, but rapid progress has been made in recent years, and recent developments in this field ensure that the use of this technology in operating theatres will soon be a real possibility. Fully automated ocular microsurgery, carried out by a robot under the supervision of a surgeon, is likely to become our new reality. This review discusses the use of robot-assisted ophthalmic surgery, the recent progress in the field, and the necessary future developments which must occur before its use in operating theatres becomes routine.
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Affiliation(s)
- Tristan Bourcier
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Léa Dormegny
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Arnaud Sauer
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Mathieu Nardin
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Pierre-Henri Becmeur
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Jimmy Chammas
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - David Gaucher
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Laurent Ballonzoli
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Claude Speeg
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Philippe Liverneaux
- Department of Hand Surgery, Hautepierre Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | - Michel Vix
- IRCAD, European Institute of Telesurgery, Strasbourg, France
- IHU, Institute of Image-Guided Surgery, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
- Department of Digestive Surgery, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
| | | | - Didier Mutter
- IRCAD, European Institute of Telesurgery, Strasbourg, France
- IHU, Institute of Image-Guided Surgery, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
- Department of Digestive Surgery, New Civil Hospital, Strasbourg University Hospital, FMTS, University of Strasbourg, Strasbourg, France
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Observation on the Curative Effect of Microsurgery in 154 Children with Strabismus and Analysis of Its Influencing Factors. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:3597084. [PMID: 34707667 PMCID: PMC8545540 DOI: 10.1155/2021/3597084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 09/29/2021] [Indexed: 11/29/2022]
Abstract
Strabismus is a common ophthalmic disease in the process of child body development, in which the two eyes cannot gaze at the target at the same time, and the incidence of this disease of children is higher. In children with esotropia, exotropia, and up and down strabismus and other typical symptoms, the cause is genetic, innerve, and refractive and regulated, and not receiving timely treatment may lead to stereo vision and diplopia and other phenomena, affecting their learning and life. Surgical treatment is the main treatment for strabismus at present. Traditional orthodontic surgery is performed by doctors under the naked eye, often due to improper operation or suture error and other factors, resulting in more postoperative complications, such as more tissue damage, conjunctival congestion, and muscle suture reaction, which seriously affect the clinical effect of surgical treatment. In recent years, with the continuous development of microsurgical technology, the correction of strabismus under a microscope has been widely carried out in clinic. The operation under the microscope makes the operation more delicate and accurate, overcomes the defects of traditional surgery, and highlights the advantages of minimally invasive surgery. The purpose of this study was to investigate the effect of microsurgical techniques in the treatment of strabismus in children and to analyze the factors influencing the outcome. The results showed that microsurgical strabismus correction in the treatment of strabismus children has short operation time, less intraoperative blood loss, short hospital stay, high efficiency, and less complications, which is worthy of popularization. Age, preoperative strabismus angle, refractive error, distance stereopsis injury, near stereoscopic injury, and duration of disease were all independent influencing factors of postoperative efficacy.
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Pujari A, Rakheja V, Modaboyina S, Das D, Tripathi M, Phuljhele S, Saxena R, Agarwal T, Sharma N, Titiyal JS. Simulation of complex strabismus surgical procedures on goat eyes. Eur J Ophthalmol 2021; 32:1978-1990. [PMID: 34496674 DOI: 10.1177/11206721211045190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To describe the possibility of complex strabismus surgical simulation on goat eyes. METHODS The goat eyes were procured from local slaughterhouse with retained extra ocular muscle tissues. The obtained eyes were inspected for globe integrity, muscle quality, muscle length, and the surrounding teno-conjunctival layers. The included eyes were then segregated for surgical simulation based on their insertion and orientation (as oblique or recti), and they were mounted on a mannequin head, with a fixation suture at free end to simulate the resting tension. Additionally, as per necessary, extra muscles were also transplanted along desired sites to simulate human extra ocular muscle anatomy. RESULTS The inferior oblique, superior oblique, and all other four recti were successfully simulated in varying proportions in more than 50 eyes. Primarily, by simulating the lateral rectus, inferior rectus, and the inferior oblique muscle, staged weakening procedures of inferior oblique were successfully practiced (Fink's recession, Park's recession, Elliot and Nankin procedure, total anterior positioning, and antero-nasal trans-position or Stager's procedure). Similarly, by simulating superior rectus, inferior rectus, lateral rectus, and the medial rectus muscles, half width transposition, full width transposition, and other complex procedures were practiced (Knapp's procedure, augmented Knapp's, Nishida's procedure, Faden operation, and Y splitting procedure). Furthermore, by simulating superior oblique and the superior rectus muscles, superior oblique tuck, posterior tenectomy, loop tenotomy, and Harada Ito procedures were successfully practiced. CONCLUSIONS On goat eyes, the complex strabismus surgical procedures can be successfully simulated and practiced after re-organizing the existing muscles in different patterns.
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Affiliation(s)
- Amar Pujari
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Vaishali Rakheja
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Sujeeth Modaboyina
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Deep Das
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Manasi Tripathi
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Swati Phuljhele
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Rohit Saxena
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Tushar Agarwal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Namrata Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Jeewan S Titiyal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
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Vision-Based Suture Tensile Force Estimation in Robotic Surgery. SENSORS 2020; 21:s21010110. [PMID: 33375388 PMCID: PMC7796030 DOI: 10.3390/s21010110] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/23/2020] [Accepted: 12/24/2020] [Indexed: 12/14/2022]
Abstract
Compared to laparoscopy, robotics-assisted minimally invasive surgery has the problem of an absence of force feedback, which is important to prevent a breakage of the suture. To overcome this problem, surgeons infer the suture force from their proprioception and 2D image by comparing them to the training experience. Based on this idea, a deep-learning-based method using a single image and robot position to estimate the tensile force of the sutures without a force sensor is proposed. A neural network structure with a modified Inception Resnet-V2 and Long Short Term Memory (LSTM) networks is used to estimate the suture pulling force. The feasibility of proposed network is verified using the generated DB, recording the interaction under the condition of two different artificial skins and two different situations (in vivo and in vitro) at 13 viewing angles of the images by changing the tool positions collected from the master-slave robotic system. From the evaluation conducted to show the feasibility of the interaction force estimation, the proposed learning models successfully estimated the tensile force at 10 unseen viewing angles during training.
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