Vitreoretinal Surgery Robotic and OCT-Aided Systems in Review

Suzann Pershing^*
*Correspondence: Suzann Pershing, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California, USA, Email:

Keywords

Guided surgery • Medical robotics • Micromanipulator

Introduction

In order to assist vitreoretinal (VR) surgeons in performing the surgery and maintaining the patient at the lowest possible risk of contamination, we have outlined a number of additional measures. For the proper management of a Vitreoretina Unit during the COVID-19 pandemic, the creation of a deferrable and non-deferrable VR patient list should be considered first. If a patient already has lens opacities, phacoemulsification surgery should be considered as part of the VR procedure for all patients. The patient would actually be put at even greater risk of exposure if phaco surgery was postponed for the upcoming weeks or months. When required, the same is true for intravitreal injections of both steroid and anti-VEFG at the conclusion of the surgery.

Discussion

The number of robotic systems that have been described in vitreoretinal surgery has increased. One of several approaches is utilized by experimental robotic surgical systems made to carry out intraocular surgery. Comanipulation and tele-operation, both of which require the use of a computer interface, are the most common methods. The Preceyes Surgical System (Preceyes BV, Eindhoven, Netherlands), which has a remote center of motion and was developed to improve surgical precision during vitreoretinal surgery, is one of these systems. Although it is anticipated that it will also provide benefits for conventional surgical tasks, its precision and stability make it possible for prolonged injections in the retinal and subretinal space with micrometer positioning precision. This includes cannulation of retinal veins and subretinal injections. According to a recent study, the system can be used with either general or local anesthesia on human subjects. However, objective, quantifiable data must be generated and evaluated in order to make a more thorough comparison of the Preceyes Surgical System to conventional surgical procedures.

Join's case is a fascial layer of connective tissue that encompasses the globe and contributes the extraocular muscles. The fascial sheath continues anteriorly in the conjunctiva, 1.5 millimeters post-lingual margin. Near the point where the optic nerve enters the globe, the layer fuses with the meninges posteriorly. The Sub-Tenon's or episcleral space is the potential space that exists between the inner capsule surface and the outer sclera. Lymphatic fluid fills this space, which extends into the subdural space and contains numerous delicate connective tissue bands and provides a low-resistance environment for globe travel. Short ciliary nerves that enter the posterior portion of the capsule on their way to the globe provide the innervation of the capsule. To the equator of the globe, the tendons of all six extrinsic eye muscles penetrate the Tenon's capsule posteriorly. Akinesia is probably caused by blocking the motor nerves as they travel through the space before the extraocular muscles are innervated.

Despite the obvious sophistication and success of vitreoretinal surgery, surgical technique can be improved for all procedures, from routine procedures like laser photocoagulation and membrane peeling to those that are rarely performed due to the physiologic limitations of the majority of surgeons. For instance, robotic surgery makes it possible for all surgeons to perform a variety of standard laser burns only on the ischemic retina in a single procedure. Similarly, the use of "smart" instruments that measure physiological parameters and systems that provide auditory feedback to the surgeon during robotic surgery can inform the surgeon of the instrument tip's distance from the retina or the force generated during epiretinal membrane peeling, both of which can be used to optimize each surgical movement [1,2].

When the equator was reached, the injection began. The anesthetic solution contained: 5 milliliters (50/50) of a mixture containing 15 IU mL-1 hyaluronidase, ropivacaine and lidocaine (4%), A single injection was sufficient to induce akinesia and anesthesia within three minutes in ninety percent of cases. Five times, after three minutes, the first injection caused anesthesia but not akinesia; consequently, a second Sub-Tenon's block was required to provide additional anesthesia. The patient's and the surgeon's level of comfort was evaluated during surgery. Estimates were made regarding the difficulty of surgical maneuver (trocar insertion, indentation, peeling, suturing of sclerotomies), the length of time it would take to achieve complete anesthesia and akinesia, the cleanliness of the surgical field and the surgeon's comfort [3,4].

Based on a previous calculation of the sample size14, we wanted to include 20 people in the study. These people were both novices and experienced vitreoretinal surgeons who had performed more than 200 surgeries. The study invited all vitreoretinal surgeons from Denmark's Eastern and Northern regions to participate. The study's novice participants were ophthalmic residents in their third and fourth years who had never performed intraocular surgery before. The study excluded surgeons and novices who had trained on the Eyesi simulator for more than two hours within the previous six months. Before participating in the study, each participant gave written and verbal consent [5].

Conclusion

Robert G. Radwin is Duane H. furthermore, Dorothy M. Bluemke Teacher in the School of Designing at the College of Wisconsin-Madison, where he propels new strategies for exploration and practice of human elements designing and word related ergonomics. He has a BS degree from New York College Polytechnic School of Designing and MS and PhD degrees from the College of Michigan (Ann Arbor, MI).

Acknowledgement

None.

Conflict of Interest

There are no conflicts of interest by author.

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