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  • First Human Study of Intraocular Robotic Surgery

    By Lynda Seminara
    Selected By: Deepak P. Edward, MD
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    Journal Highlights

    Nature Biomedical Engineering
    Published online June 18, 2018

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    Edwards et al. have pioneered a first-in-human study of remotely controlled robot-assisted retinal surgery per­formed through a telemanipulation de­vice. Their findings indicate that such a system, although still in its infancy for human use, has potential to achieve the precision warranted for many intraocular procedures. Specifically, surgical outcomes with the robotic system were comparable to those of manual surgery, but operating time was longer with the new technology.

    For this double-armed study, 12 patients who required removal of an epiretinal or inner limiting membrane peel for macular hole repair were assigned randomly to receive robot-assisted surgery or manual retinal surgery (all procedures were conducted with the patients under general anes­thesia).

    The robotic system used by the investigators (Preceyes) had already been applied successfully in ani­mals. The system combines a motion controller, held by the surgeon, with an instrument manipulator that can be fitted with a host of microsurgical instruments. Features include tremor filtering, adjustable virtual boundary, dynamic motion scaling, and a clutch mechanism that can freeze the position of the instrument inside the eye. In pigs, the system was able to cannulate and deliver drugs into retinal venules of approximately 80 μm in diameter, which would not be possible with man­ual surgery.

    Main outcomes for the present study in humans were surgical success, duration of surgery, and the amount of retinal microtrauma (as a proxy for safety).

    Surgical success and the amount of retinal microtrauma were compara­ble for the 2 study groups. However, dissection time was much longer with robotic surgery (4 minutes, 55 seconds vs. 1 minute, 20 seconds). To simulate potential use for subretinal gene ther­apy, the authors also used the robotic system to inject recombinant tissue plasminogen activator subretinally in 3 patients who had acute central vision loss caused by subretinal hemorrhage, secondary to age-related macular degeneration. These patients received local anesthesia. The robotic system accomplished the task, effectively dis­placing sight-threatening hemorrhage in their eyes.

    The original article can be found here.