Robot-Assisted Retinal Surgery: Overcoming Human Limitations

Abstract

Robotics offer the potential to improve the precision and safety of retinal surgery. The starting point of advanced mechanical assistance in vitreoretinal surgery may be traced back to the invention of the motorized vitreous cutter by Machemer in the 1970s [1]. This revolutionized vitreoretinal surgical techniques and made it possible to treat complex retinal detachments, vitreous haemorrhage, epiretinal membranes and macular holes. Over the last decade, the use of vital dyes to stain retinal membranes has further improved the safety of some of the most intricate surgical steps such as peeling internal limiting membrane (ILM), stripping epiretinal membrane (ERM) and removing proliferative vitreoretinopathy (PVR), but minor retinal trauma remains inevitable even in experienced hands. Further improvements in the precision of retinal surgery are limited by human physiology, not only in terms of hand tremor and stability but also the resolving power of human vision even with the aid of the operating microscope. Modern laser-based in vivo imaging techniques such as intraoperative OCT can provide histological levels of detail, yet the limitations of human depth perception and hand-eye coordination mean that it remains a challenge for a surgeon to translate detailed imaging information into enhanced surgical performance. Various types of robotic assistance could help propel intraocular surgery beyond these human physiological limitations.