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Shaping the future of eye surgery - Robotic assistance for retinal microsurgeons

  • Hands-on use

  • The complete setup in a simulated operating room.

  • Planar motion of the mechanism, visualising the Remote Center of Motion (RCM).

  • Close-up during use

  • (left) Initial experimental prototype -> (right) Latest design iteration

What it does

This breakthrough technology enables eye surgeons to perform surgery with superhuman precision. With this device, surgeons aspire to perform groundbreaking new procedures for currently untreatable blindness, including high-precision delivery of gene-therapy.

Your inspiration

Sight is mankind’s most highly developed sense and plays a vital role in nearly all aspects of daily life. Today, an estimated 244 million people suffer from vision impairment for which no cure exists, and which generally situates itself at the retina. Given the scale and fragility of the retina, retinal surgery is already being performed at the limits of human physiologic performance. In order to safely attempt innovative new treatments, surgeons seek the aid of performance-enhancing technology.

How it works

The robotic device aids the surgeon in three distinct ways. Firstly, surgical precision is improved. This is done by generating counteracting forces at key locations in the mechanism in function of the user's hand velocity. By doing so, unwanted hand tremor is reduced, enabling surgeons to operate with greater precision. Secondly, unwanted eye rotations are prevented. This is done by design, via a clever combination of joints and linkages. While moving in unison, these mechanically maintain a fixed point in space through which the instrument always moves. When aligned with the surgical incision, the eye is kept in a stable position throughout the procedure. Thirdly, the surgeon is able to immobilize the instrument at a moment's notice using a foot pedal by locking the mechanism. By doing so, the instrument tip can be maintained at the area of treatment with both increased precision as well as for much longer time periods.

Design process

Throughout the past five years, two major iterations were conceptualized, developed, manufactured, experimentally validated, and finally used by surgeons within the context of clinical research. What is shown here is the latest design iteration of the surgical system. While maintaining the foundational principles, a complete electromechanical re-design was undertaken. Three key improvements were made in terms of overall mechanism volume as well as overall design complexity. 1) Total mechanism volume was almost halved, reducing the overall footprint of the system in the operating room. This was achieved by carefully designing the passive gravity compensation counterweights to move within the movement plane of the linkages, while avoiding any unwanted contacts. 2) Overall design complexity was reduced by implementing design for assembly/manufacturing principles, leading to a total part count reduction of 67% when compared to the first prototype. This reduces the overall cost of the technology and eases the manufacturing and assembly process. 3) Available instrument motion was increased by 2.4x by increasing the mechanism workspace. This was achieved through careful re-positioning of constraining mechanical contacts within the mechanism, via functional re-design the linkage shapes.

How it is different

Currently, surgical robotic technology is not applied conventionally and remains the topic of early clinical research. This technology was among the first in the world to reach this point, offering patients access to promising new treatments which would otherwise not be possible to safely perform. Furthermore, in contrast to conventional surgical robots, no joystick is required to operate the robot. For maximum safety and intuitiveness, the surgeon retains direct control of the instrument and its motion. Also, the system is dimensioned in such a way that the surgeon can manually override the mechanism if needed in an adverse event - for instance during power failure. Finally, to the best knowledge of the author, this technology is the only cooperative technology for retinal surgery which features these safety features inherently by mechanical design, and remains one of only two platforms which are being actively used by surgeons for advancing clinical research.

Future plans

Key areas for further design improvement have been the topic of research, and have been advanced from ideation up to either dimensioned concepts or initial prototypes. These include a re-design of the system kinematics using a custom optimal design algorithm and a dedicated positioning guidance method enabling more hands-on motion capabilities for the surgeon. These conceptual building blocks will provide the basis for a next-generation device, enabling surgeons to use this technology for a wide range of surgical techniques. At the time of writing the first steps are taking place, with early subsystem prototypes being built and tested.


Hamlyn surgical robot challenge 2017

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