Chen Yi-Qi, Tao Ji-Wei, Su Ling-Ya, Li Liang, Zhao Shi-Xin, Yang Yang, Shen Li-Jun
Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China.
Wenzhou Medical University, Wenzhou, Zhejiang, China.
Graefes Arch Clin Exp Ophthalmol. 2017 Jun;255(6):1167-1171. doi: 10.1007/s00417-017-3656-3. Epub 2017 Apr 8.
The purpose of the study was to describe the development of a robotic aided surgical system named RVRMS (robotic vitreous retinal microsurgery system) and to evaluate the capability for using it to perform vitreoretinal surgery.
The RVRMS was designed and built to include the key components of two independent arms. End-effectors of each arm fix various surgical instruments and perform intraocular manipulation. To evaluate properly the RVRMS, robot-assisted 23-gauge surgical tasks including endolaser for retinal photocoagulation, pars plana vitrectomy (PPV), retinal foreign body removal and retinal vascular cannulation were performed in two different sizes of an animal model. Endolaser was performed in the eye of a living Irish rabbit and the other tasks were done in a harvested porcine eye. For each evaluation, the duration and the successful completion of the task was assessed.
Robot-assisted vitreoretinal operations were successfully performed in nine rabbit eyes and 25 porcine eyes without any iatrogenic complication such as retinal tear or retinal detachment. In the task of using an endolaser, three rows of burns around the induced retinal hole were performed in nine rabbit eyes with half size intervals of laser spots. Nine procine eyes underwent PPV followed by successful posterior vitreous detachment (PVD) induction assisted with triamcinolone acetonide (TA). Nine porcine eyes completed removal of a fine stainless steel wire, which was inserted into prepared retinal tissue. Finally, retinal vascular cannulation with a piece of stainless steel wire (6mm length, 45 μm pipe diameter and one end cut to ∼30° slope) was successfully achieved in seven porcine eyes. The average duration of each procedure was 10.91±1.22 min, 11.68±2.11min, 5.90±0.46 min and 13.5±6.2 min, respectively.
Maneuverability, accuracy and stability of robot-assisted vitreoretinal microsurgery using the RVRMS were demonstrated in this study. Wider application research of robotic surgery and improvement of a robotic system should be continued.
本研究旨在描述一种名为RVRMS（机器人玻璃体视网膜显微手术系统）的机器人辅助手术系统的开发，并评估使用该系统进行玻璃体视网膜手术的能力。
RVRMS的设计和构建包括两个独立臂的关键组件。每个臂的末端执行器固定各种手术器械并进行眼内操作。为了正确评估RVRMS，在两种不同大小的动物模型中进行了机器人辅助的23G手术任务，包括视网膜光凝的眼内激光、玻璃体切除术（PPV）、视网膜异物取出和视网膜血管插管。在活的爱尔兰兔眼中进行眼内激光，其他任务在摘取的猪眼中完成。对于每次评估，评估任务的持续时间和成功完成情况。
在9只兔眼和25只猪眼中成功进行了机器人辅助的玻璃体视网膜手术，未出现任何医源性并发症，如视网膜撕裂或视网膜脱离。在使用眼内激光的任务中，在9只兔眼中围绕诱导的视网膜裂孔进行了三排烧伤，激光光斑间隔为一半大小。9只猪眼接受了PPV，随后在曲安奈德（TA）辅助下成功诱导了玻璃体后脱离（PVD）。9只猪眼完成了插入准备好的视网膜组织中的细不锈钢丝的取出。最后，在7只猪眼中成功实现了用一根不锈钢丝（长度6mm，管径45μm，一端切成约30°斜面）进行视网膜血管插管。每个手术的平均持续时间分别为10.91±1.22分钟、11.68±2.11分钟、5.90±0.46分钟和13.5±6.2分钟。
本研究证明了使用RVRMS进行机器人辅助玻璃体视网膜显微手术的可操作性、准确性和稳定性。应继续进行机器人手术的更广泛应用研究和机器人系统的改进。
