Subretinal injection is a delicate and complex microsurgery. The main surgical difficulties come from the surgeon's hand tremor, dexterous motion, and insufficient visual feedback. In order to begin addressing these challenges, this article presents a robot system for subretinal insertion integrated with intraoperative optical coherence tomography (OCT). The surgical workflow using this system consists of two main parts. The first part is the manual robot control, which aims the target before approaching the retinal surface, while considering the remote center of motion (RCM) constraint. When the injection area has been located precisely, needle is inserted into retina. To ensure surgical safety, needle insertion depth is estimated using OCT images on a continuous basis. A soft RCM control method is designed and integrated for the controller of our hybrid parallel–serial surgical robot. Safety and accuracy performance evaluation with a 15-ms control loop shows that the worst-case RCM deviation error is within 1 mm. Experimental results demonstrated that the proposed system has the ability to improve surgical outcomes by surgeons overcoming their physical limitations in order to enable a better dexterous motion, and furthermore enhancing their visual feedback for a better intraocular perception.

中文翻译：

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迈向机器人辅助视网膜下注射：混合并行串行机器人系统设计和初步评估

视网膜下注射是一项精细而复杂的显微手术。主要的手术困难来自于外科医生的手颤、灵巧的动作和视觉反馈不足。为了开始解决这些挑战，本文提出了一种与术中光学相干断层扫描 (OCT) 集成的视网膜下插入机器人系统。使用该系统的手术流程由两个主要部分组成。第一部分是手动机器人控制，在接近视网膜表面之前瞄准目标，同时考虑远程运动中心（RCM）约束。准确定位注射区域后，将针头插入视网膜。为确保手术安全，连续使用 OCT 图像估计进针深度。我们设计并集成了一种软 RCM 控制方法，用于我们的混合并行 - 串行手术机器人的控制器。15 毫秒控制回路的安全性和准确性性能评估表明，最坏情况下的 RCM 偏差误差在 1 毫米以内。实验结果表明，所提出的系统有能力通过外科医生克服他们的身体限制来改善手术结果，以实现更好的灵巧运动，并进一步增强他们的视觉反馈以获得更好的眼内感知。