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Force-based Safe Vein Cannulation in Robot-assisted Retinal Surgery: A Preliminary Study.

ABSTRACT: Retinal vein cannulation (RVC) is a potential treatment for retinal vein occlusion (RVO). Manual surgery has limitations in RVC due to extremely small vessels and instruments involved, as well as the presence of physiological hand tremor. Robot-assisted retinal surgery may be a better approach to smooth and accurate instrument manipulation during this procedure. Motion of the retina and cornea related to heartbeat may be associated with unexpected forces between the tool and eyeball. In this paper, we propose a force-based control strategy to automatically compensate for the movement of the retina maintaining the tip force and sclera force in a predetermined small range. A dual force-sensing tool is used to monitor the tip force, sclera force and tool insertion depth, which will be used to derive a desired joint velocity for the robot via a modified admittance controller. Then the tool is manipulated to compensate for the movement of the retina as well as reduce the tip force and sclera force. Quantitative experiments are conducted to verify the efficacy of the control strategy and a user study is also conducted by a retinal surgeon to demonstrate the advantages of our automatic compensation approach.

SUBMITTER: Wu J

PROVIDER: S-EPMC8480430 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Spotlight-based 3D Instrument Guidance for Autonomous Task in Robot-assisted Retinal Surgery.

Project description:Retinal surgery is known to be a complicated and challenging task for an ophthalmologist even for retina specialists. Image guided robot-assisted intervention is among the novel and promising solutions that may enhance human capabilities during microsurgery. In this paper, a novel method is proposed for 3D navigation of a microsurgical instrument based on the projection of a spotlight during robot-assisted retinal surgery. To test the feasibility and effectiveness of the proposed method, a vessel tracking task in a phantom with a Remote Center of Motion (RCM) constraint is performed by the Steady-Hand Eye Robot (SHER). The results are compared to manual tracking, cooperative control tracking with the SHER and spotlight-based automatic tracking with SHER. The reported results are that the spotlight-based automatic tracking with SHER can reach an average tracking error of 0.013 mm and keeping distance error of 0.1 mm from the desired range demonstrating a significant improvement compared to manual or cooperative control methods alone.

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Towards Bimanual Vein Cannulation: Preliminary Study of a Bimanual Robotic System With a Dual Force Constraint Controller.

Project description:Retinal vein cannulation is a promising approach for treating retinal vein occlusion that involves injecting medicine into the occluded vessel to dissolve the clot. The approach remains largely unexploited clinically due to surgeon limitations in detecting interaction forces between surgical tools and retinal tissue. In this paper, a dual force constraint controller for robot-assisted retinal surgery was presented to keep the tool-to-vessel forces and tool-to-sclera forces below prescribed thresholds. A cannulation tool and forceps with dual force-sensing capability were developed and used to measure force information fed into the robot controller, which was implemented on existing Steady Hand Eye Robot platforms. The robotic system facilitates retinal vein cannulation by allowing a user to grasp the target vessel with the forceps and then enter the vessel with the cannula. The system was evaluated on an eye phantom. The results showed that, while the eyeball was subjected to rotational disturbances, the proposed controller actuates the robotic manipulators to maintain the average tool-to-vessel force at 10.9 mN and 13.1 mN and the average tool-to-sclera force at 38.1 mN and 41.2 mN for the cannula and the forcpes, respectively. Such small tool-to-tissue forces are acceptable to avoid retinal tissue injury. Additionally, two clinicians participated in a preliminary user study of the bimanual cannulation demonstrating that the operation time and tool-to-tissue forces are significantly decreased when using the bimanual robotic system as compared to freehand performance.

| S-EPMC7943036 | biostudies-literature

Robotic Assisted Cannulation of Occluded Retinal Veins.

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A safe, reliable, and efficient robot-assisted port site closure for robot-assisted gastrectomy.

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| S-EPMC8606878 | biostudies-literature

Robot-assisted surgery in gynaecology.

Project description: Not available

| S-EPMC6464707 | biostudies-literature

Robot-assisted surgery in gynaecology.

Project description: Not available

| S-EPMC6457792 | biostudies-literature

Robot-Assisted Simulated Strabismus Surgery.

Project description:PurposeThis study aims to investigate the feasibility of robot-assisted simulated strabismus surgery using the new da Vinci Xi Surgical System and to report what we believe is the first use of a surgical robot in experimental eye muscle surgery.MethodsRobot-assisted strabismus surgeries were performed on a strabismus eye model using the robotic da Vinci Xi Surgical System. On the lateral rectus of each eye, we performed a procedure including, successively, a 4-mm plication followed by a 4-mm recession of the muscle to end with a 4-mm resection. Operative time from conjunctival opening to closing and successful completion of the different steps with or without complications or unexpected events were assessed.ResultsRobot-assisted strabismus procedures were successfully performed on six eyes. The feasibility of robot-assisted simulated strabismus surgery is confirmed. The da Vinci Xi system provided the appropriate dexterity and operative field visualization necessary to perform conjunctival and Tenon's capsule opening and closing, muscle identification, suturing, desinsertion, sectioning, and resuturing. The mean duration to complete the whole procedure was 27 minutes (range, 22-35). There were no complications or unexpected intraoperative events.ConclusionsExperimental robot-assisted strabismus surgery is technically feasible using the new robotic da Vinci Xi Surgical System. This is, to our knowledge, the first use of a surgical robot in ocular muscle surgery.Translational relevanceFurther experimentation will allow the advantages of robot-assisted microsurgery to be identified while underlining the improvements and innovations necessary for clinical use.

| S-EPMC6543922 | biostudies-literature

A Modular 3-Degrees-of-Freedom Force Sensor for Robot-Assisted Minimally Invasive Surgery Research.

Project description:Effective force modulation during tissue manipulation is important for ensuring safe, robot-assisted, minimally invasive surgery (RMIS). Strict requirements for in vivo applications have led to prior sensor designs that trade off ease of manufacture and integration against force measurement accuracy along the tool axis. Due to this trade-off, there are no commercial, off-the-shelf, 3-degrees-of-freedom (3DoF) force sensors for RMIS available to researchers. This makes it challenging to develop new approaches to indirect sensing and haptic feedback for bimanual telesurgical manipulation. We present a modular 3DoF force sensor that integrates easily with an existing RMIS tool. We achieve this by relaxing biocompatibility and sterilizability requirements and by using commercial load cells and common electromechanical fabrication techniques. The sensor has a range of ±5 N axially and ±3 N laterally with errors of below 0.15 N and maximum errors below 11% of the sensing range in all directions. During telemanipulation, a pair of jaw-mounted sensors achieved average errors below 0.15 N in all directions. It achieved an average grip force error of 0.156 N. The sensor is for bimanual haptic feedback and robotic force control in delicate tissue telemanipulation. As an open-source design, the sensors can be adapted to suit other non-RMIS robotic applications.

| S-EPMC10255999 | biostudies-literature

Inflammatory cytokines in robot-assisted thoracic surgery versus video-assisted thoracic surgery.

Project description:BackgroundCytokines play a crucial role in the inflammatory response and are essential modulators of injury repair mechanisms. While minimally invasive operations have been shown to induce lower levels of cytokines compared to open thoracotomy, the inflammatory cytokine profile difference between video-assisted (VATS) and robotic-assisted thoracic surgery (RATS) techniques has yet to be elucidated.MethodsIn this prospective observational study of 45 patients undergoing RATS (n=30) or VATS (n=15) lung resection for malignancy, plasma levels of interleukin (IL)-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, vascular endothelial growth factor (VEGF), interferon (IFN)-γ, tumor necrosis factor (TNF)-α, monocyte chemo-attractant protein (MCP)-1, and endothelial growth factor (EGF) were measured before and after surgery via immunoassay.ResultsLevels of IL-6 and MCP-1 were significantly higher in patients undergoing VATS than in patients undergoing RATS (P<0.001 and P=0.005, respectively) 2 hours following surgery. MCP-1 levels were also found to be significantly higher in the VATS group (P<0.001) 24 hours following surgery. IL-1α, IL-1β, IL-2, IL-4, IL-8, IL-10, IFN-γ, TNF-α, and EGF levels were not significantly different at any time-point comparing VATS to RATS.ConclusionsThe VATS approach is associated with a more robust pro-inflammatory cytokine response through the upregulation of MCP-1 and IL-6 when compared to the RATS approach in patients undergoing anatomic lung resection. Further studies are necessary to validate the clinical significance of this finding.

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Dorsal Vein Complex Preserving Technique During Robot-Assisted Radical Prostatectomy.

Project description:Background: Recently, two techniques of robot-assisted radical prostatectomy (RARP), which preserve dorsal vein complex (DVC), endopelvic fascia, and full neurovascular bundle (NVB), through anterior approach were reported. The techniques in a relatively large workspace seem less technically demanding than Retzius-sparing RARP. In this case report, we present a further modified technique of transperitoneal-anterior-antegrade approach with a division of the endopelvic fascia to reduce the technical demands. Case Presentation: In a routine evaluation, a 65-year-old man was shown to have a prostate-specific antigen level of 5.07 ng/mL. Prostatic biopsy revealed a Gleason score of 6 (3 + 3) adenocarcinoma in 2 of the 12 specimens, and the clinical stage was diagnosed as cT2aN0M0. RARP was performed including transperitoneal full NVB sparing, antegrade preservation of DVC, and division of endopelvic fascia to increase the prostate mobility and reduce technical demands. The patient completely gained continence on the day after removal of the catheter, and potency was recovered 30 days after surgery. Conclusion: Our DVC preservation technique in the transperitoneal-anterior-antegrade approach with a division of the endopelvic fascia during RARP may be safe, reduce technical demands, and facilitate early recovery of continence and sexual function after surgery.

| S-EPMC7580670 | biostudies-literature

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