Ophthalmology has traditionally been slow to embrace automated technology in the operating room.
However, researchers at the University of California, Los Angeles (UCLA) are changing that narrative with promising results from a new robotic platform designed for vitreoretinal and cataract surgery.
Dr Aya Barzelay-Wollman, co-director of the Advanced Robotic Micro Surgery (ARMS) Laboratory, presented the innovative technology at the European Society of Retina Specialists (EURETINA) 2024 conference.
The robotic system, powered by artificial intelligence and guided by advanced imaging techniques, has shown remarkable precision during preclinical testing.
She said: ‘The robot has a 1-micron increment of resolution, meaning I could command the robot to move at 1-micron increments. The platform boasts an impressive 10-micron precision, 40-micron accuracy, and less than 20-micron targeting accuracy, with a mere 0.15-micron orientation error. So it is highly precise.’
Noting that typical hand tremors in surgery range from 30 to 50 microns, the robot’s capabilities are particularly significant for retinal procedures where pathology is measured in microns.
The robotic arm, developed by Tsu-Chin Tsao, PhD, a co-director at the ARMS Laboratory, enhances surgical performance by eliminating tremors and offering unparalleled resolution.
Dr Barzelay-Wollman explained to Medscape Medical News: ‘The robotic system can be super-human, which results in increased precision and accuracy.’
She described the study as ‘a pivotal leap’ toward the future of robotic-assisted retina surgery.
While the platform can be utilised for cataract and vitreoretinal surgeries, challenges remain in visualising retinal pathology.
Existing commercial surgical microscopes, which rely on top-down imaging, often provide limited views of the intricate structures inside the eye.
To address this, the UCLA team has developed intraocular imaging probes that attach to the vitrector, enabling enhanced visibility of the retina.
‘Our algorithms allow us to obtain detailed anatomical data of the relevant ocular structures,’ Dr Barzelay-Wollman noted.
Coupled with intraoperative optical coherence tomography, which captures images of the retinal layers, the system can autonomously control the robot’s trajectory to perform a fully automated vitrectomy.
The platform operates in two modes: a fully automated mode, where the robot carries out the procedure under the surgeon’s oversight at a console, and a teleoperation mode, where the surgeon utilises a joystick to guide the robotic arm.
The research remains in the preclinical phase. Dr Barzelay-Wollman highlighted the need for in vivo studies on live animals and clearance from the US Food and Drug Administration before the technology can be tested in humans.
