World’s first robotic eye surgery

21 June 2018

A robot has assisted surgeons during an operation on the human eye for the first time. The breakthrough demonstrates that robot-assisted surgery is as safe and effective as traditional surgery, and could open up new possibilities for novel operating techniques and more ambitious surgeries in future...

This is not the first time a robot has been used in human surgery: robots are already routinely used in bladder and prostate surgery. Until now though, the eye has been off the operating table so to speak, because surgeons regarded it as far too small and delicate for present robotic systems to handle.

The internal volume of the eye is about 6cm3, only just larger than the dice we play board games with, meaning the robots in use in today's operating theatres are simply not accurate enough. But now, a team from the University of Oxford, in collaboration with researchers from Eindhoven University of Technology, have developed a robot capable of taking on the challenge.

The researchers used a "tele-manipulation" set-up for their robot. In this system, the surgeon holds traditional instruments in one hand and a joystick in the other: this controls the robot’s arm, which holds with the required surgical instrument. According to study author Tom Edwards, "You move the joystick, which simultaneously moves the robotic arm, which is controlling the instrument of choice. This allows you to do every possible movement at much finer level of control and detail than if you were holding the instruments directly with your hand."

To put the robot through its paces, the team compared the success rates of robot-assisted versus standard surgery for a routinely-performed eye operation.

"Whilst we were all obviously quite proficient operating in a regular manner, with using the robot, we were all beginners,” says Edwards. "We were much more cautious and really took our time, so the robotic surgery took longer, but it was very clearly superior in terms of precision and accuracy."

So will we be seeing more robots in our operating theatres in the near future? Edwards isn’t sure. "Probably the main limitation is that current surgical techniques are mostly done very well with the human hand, so it’s up against stiff competition! The other barrier is the cost, so I think at least initially, robots will be limited to larger centres where there’s a lot of research going on."

Where robots will likely come into their own is in helping us to perform operations that are beyond human capability. "We need to be imaginative about the types of operation we might like to create," says Edwards.

One example he gives is of a potentially sight-threatening condition in which one of the small blood vessels that supply the retina with nutrients and oxygen becomes blocked by a blood clot caleld a thrombus. "At this stage, it’s impossible to inject anything into the vessels to clear the blockage; you simply can’t hold a needle still enough to do that with the human hand. But with a robot, that could potentially be possible..."

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