Zhang Peiyao, Kim Ji Woong, Gehlbach Peter, Iordachita Iulian, Kobilarov Marin
Department of Mechanical Engineering and the Laboratory for Computational Sensing and Robotics (LCSR), Johns Hopkins University, Baltimore, MD 21211, USA.
Peter Gehlbach is with the Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD 21211, USA.
IEEE Robot Autom Lett. 2024 May;9(5):4154-4161. doi: 10.1109/lra.2024.3375710. Epub 2024 Mar 11.
Subretinal injection is an effective method for direct delivery of therapeutic agents to treat prevalent subretinal diseases. Among the challenges for surgeons are physiological hand tremor, difficulty resolving single-micron scale depth perception, and lack of tactile feedback. The recent introduction of intraoperative Optical Coherence Tomography (iOCT) enables precise depth information during subretinal surgery. However, even when relying on iOCT, achieving the required micron-scale precision remains a significant surgical challenge. This work presents a robot-assisted workflow for high-precision autonomous needle navigation for subretinal injection. The workflow includes online registration between robot and iOCT coordinates; tool-tip localization in iOCT coordinates using a Convolutional Neural Network (CNN); and tool-tip planning and tracking system using real-time Model Predictive Control (MPC). The proposed workflow is validated using a silicone eye phantom and porcine eyes. The experimental results demonstrate that the mean error to reach the user-defined target and the mean procedure duration are within an acceptable precision range. The proposed workflow achieves a 100% success rate for subretinal injection, while maintaining scleral forces at the scleral insertion point below 15mN throughout the navigation procedures.
视网膜下注射是一种将治疗药物直接递送至眼内以治疗常见视网膜下疾病的有效方法。对于外科医生而言,挑战包括生理性手部震颤、难以分辨单微米级别的深度感知以及缺乏触觉反馈。术中光学相干断层扫描(iOCT)的引入使得视网膜下手术过程中能够获得精确的深度信息。然而,即便依赖iOCT,实现所需的微米级精度仍然是一项重大的手术挑战。本文介绍了一种用于视网膜下注射高精度自主进针导航的机器人辅助工作流程。该工作流程包括机器人与iOCT坐标之间的在线配准;使用卷积神经网络(CNN)在iOCT坐标中进行工具尖端定位;以及使用实时模型预测控制(MPC)的工具尖端规划和跟踪系统。所提出的工作流程通过硅胶眼模型和猪眼进行了验证。实验结果表明,到达用户定义目标的平均误差和平均操作持续时间均在可接受的精度范围内。所提出的工作流程在视网膜下注射中实现了100%的成功率,同时在整个导航过程中将巩膜插入点处的巩膜力维持在15mN以下。