Enabling Dexterous Intraocular Surgery with Robotic Assistance

Project Summary / Abstract The goal of this grant is to develop enabling technology to address fundamental limitations in robotic intraocular microsurgery with a specific focus on high-dexterity micromanipulation. Vitreoretinal surgery may be the most technically demanding type of eye surgery and deals with the surgical treatment of retinal and posterior segment diseases. Following the trend in microsurgery, robotic assistance, enhanced by advanced imaging, has the potential to fundamentally change the field of intraocular surgery. Still in its early stages, robotic retinal surgery has been cautiously introduced into the operating room and has been successfully evaluated in a limited number of clinical trials. Owing to its demonstrated capabilities, robotic intraocular microsurgery has the potential to assist the surgeon and provide super-human physical capabilities, enabling unprecedented as well as safer surgical care for patients. Among the most relevant procedural tasks that may benefit from the use of robotic assistance is epiretinal membrane (ERM) peeling, the most common vitreoretinal surgery performed in the US. The incidence of intra and postoperative complications ranges from 2% to 30%, depending on the circumstances. The main complication is varying degrees of mechanical retinal trauma that result from accessing the membrane edge or due to excess forces applied during membrane removal. Current limitations and challenges of robotic approaches include logistically cumbersome setup, limited access to important portions of the retina, and lack of force feedback to the surgeon at the tool tip and shaft. Similar problems exist in laparoscopic surgery. To date, non-ocular robotic systems have demonstrated significant dexterity enhancement by integrating additional degrees of freedom and force-sensing capabilities at the distal end of the surgical instruments. To prove the hypothesis that a high-dexterity robotic assistant will overcome important limitations in conventional ophthalmic microsurgical procedures, we propose the following specific aims: (1) Clinically compatible high-dexterity robotic system: develop a miniature robotic forceps with snake-like distal end, and embed optical fibers-based sensors on the tool shaft, allowing force-sensing at both the tool tip and sclerotomy, and integrate the dexterous manipulator with the Steady Hand Eye Robot (SHER); (2) Control methods for high- dexterity robotic system: develop teleoperated control for the dexterous manipulator and SHER, combine teleoperated and cooperative control for the integrated system, and develop control schemes able to assist the surgeon with sensorimotor guidance for safe robotic ERM peeling; (3) Validate the high-dexterity robotic system for ERM peeling: validate the capabilities of the proposed system for ERM peeling with established ex-vivo phantoms (membrane of fertilized chicken eggs) and in-vivo biological membranes (pig eyes). This highly innovative system will fuse tool-tissue force information with intraoperative guidance via a high-dexterity robotic assistant surgical platform with cooperative and teleoperated control.