Robotically Assisted Amniotic Membrane Transplant Surgery

Abstract

Amniotic membrane transplant (AMT) is a surgical technique for ocular surface reconstruction that should be considered for acute chemical or thermal burns, painful bullous keratopathy, shield ulcers, severe bacterial keratitis, necrotizing herpetic keratitis, corneal thinning, refractory neurotrophic keratitis, and other persistent epithelial defects (PED). 1 The literature describes several techniques to place and fix the amniotic membrane (AM). 2The amniotic membrane may be used as a graft (inlay technique), patch (overlay technique), or combination of both (filling-in or multilayer technique).When used as a patch, the AM covers the epithelial defect without stromal loss and is temporarily sutured to the episclera near the limbus.The patch technique is safe, easy to perform, and effective in promoting corneal epithelial healing and reducing ocular surface inflammation underneath the AM.Robotic surgery has expanded during the last 20 years in abdominal and endoscopic procedures and macrosurgery in general. 3icrosurgical specialties, including ophthalmology, have progressed neither to the same extent nor at the same pace. 4To our knowledge, no human clinical procedures have been reported.Potential reasons for this discrepancy include the following: (1) ocular surgery is minimally invasive microsurgery yielding excellent results; (2) a true microsurgical robot does not currently exist; and (3) the cost of robotic systems.We used the high-definition robotic da Vinci Si Surgical System (Intuitive Surgical Inc) to perform robotically assisted AMT, penetrating keratoplasties, and pterygium surgeries on porcine eyes.This version provided greater magnification and better resolution of the operative field than the previous high-definition model.Our conclusions were that robotically assisted ocular surface surgeries such as AMT might be technically feasible for humans.This study aims to investigate the feasibility and safety of robotically assisted AMT and report the first human cases of robotic ocular surgery, to our knowledge.