Skip to main content

Advertisement

SpringerLink
Log in

A comparison of robotic and manual surgery for internal limiting membrane peeling

  • Retinal Disorders
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To compare the Preceyes Surgical Robotic System (Eindhoven, Netherlands) to manual internal limiting membrane (ILM) peeling using the Eyesi surgical simulator (VRmagic, Mannheim, Germany) as the operative platform.

Methods

A comparative study was carried out with surgeons initially performing ILM peeling manually and then with the robot. Twenty-three vitreoretinal surgeons agreed to participate and all consented to the use of their surgical data from the Eyesi surgical simulator. Surgeons were given a 5-min demonstration of the devices and were allowed to practice for 10 min before attempting the membrane peel. Initially, the peel was performed manually and afterwards, this was repeated using the robot-controlled forceps. Surgical simulator outcome measures were compared between approaches.

Results

The average time required for the procedure was 5 min for the manual approach and 9 min with the robot (paired t test, p = 0.002). Intraocular instrument movement was reduced by half with the robot. On average 344 mm was required to complete the ILM peeling with the robot compared with 600 mm using the manual approach (paired t test, p = 0.002). There were fewer macular retinal hemorrhages with the robot: 53 with manual surgery, 32 with the robot (Mann-Whitney U test, p = 0.035). Retinal injuries were eliminated with the robot.

Conclusions

Intraocular robotic surgery is still in its infancy and validation work is needed to understand the potential benefits and limitations of emerging technologies. Safety enhancements over current techniques may be possible and could lead to the broader adoption of robotic intraocular surgery in the future.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

ILM:

Internal limiting membrane

OCT:

Optical coherence tomography

References

  1. Cheng-maw H, Wakabayashi G, Nitta H, Ito N, Hasegawa Y, Takahara T (2013) Systematic review of robotic liver resection. Surg Endosc 27:732–739. https://doi.org/10.1007/s00464-012-2547-2

    Article  Google Scholar 

  2. Ramsay C, Pickard R, Robertson C, et al. (2012) Systematic review and economic modelling of the relative clinical benefit and cost-effectiveness of laparoscopic surgery and robotic surgery for removal of the prostate in men with localised prostate cancer. Health Technol Assess (Rockv). ;16(41)

  3. Lane T (2018) A short history of robotic surgery. Ann R Coll Surg Engl 100:5–7. https://doi.org/10.1308/rcsann.supp1.5

    Article  PubMed  PubMed Central  Google Scholar 

  4. Matanes E, Lauterbach R, Boulus S, Amit A, Lowenstein L (2018) European Journal of Obstetrics & Gynecology and reproductive biology robotic laparoendoscopic single-site surgery in gynecology : a systematic review. Eur J Obstet Gynecol 231:1–7. https://doi.org/10.1016/j.ejogrb.2018.10.006

    Article  Google Scholar 

  5. Morelli L, Guadagni S, Franco G Di, Palmeri M, Candio G Di. (2016) Da Vinci single site © surgical platform in clinical practice : a systematic review. Int J Medial Robot Comput Assist Surg. ;(November 2015):724–734. doi:https://doi.org/10.1002/rcs

  6. De Smet MD, Meenink TCM, Janssens T, et al. (2016) Robotic assisted cannulation of occluded retinal veins. PLoS One. ;(September 27, 2016):1–17. doi:https://doi.org/10.1371/journal.pone.0162037

  7. Molaei A, Abedloo E, de Smet M et al (2017) Toward the art of robotic-assisted vitreoretinal surgery. J Ophthalmic Vis Res 12(2):2120218

    Google Scholar 

  8. De Smet MD, Naus GJL, Faridpooya K, Mura M (2018) Robotic-assisted surgery in ophthalmology. Curr Opin Ophthalmol 29(3):248–253. https://doi.org/10.1097/ICU.0000000000000476

    Article  PubMed  Google Scholar 

  9. Edwards TL, Xue K, Meenink HCM et al (2018) First-in-human study of the safety and viability of intraocular robotic surgery. Nat Biomed Eng 2:649–656. https://doi.org/10.1038/s41551-018-0248-4

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Nezhat C, Lakhi N (2016) Learning experiences in robotic-assisted laparoscopic surgery. Best Pract Res Clin Obstet Gynaecol 35:20–29. https://doi.org/10.1016/j.bpobgyn.2015.11.009

    Article  PubMed  Google Scholar 

  11. Moglia A, Ferrari V, Morelli L, Ferrari M, Mosca F, Cuschieri A (2016) A systematic review of virtual reality simulators for robot-assisted surgery. Eur Urol 69(6):1065–1080. https://doi.org/10.1016/j.eururo.2015.09.021

    Article  PubMed  Google Scholar 

  12. Bourcier T, Chammas J, Becmeur PH et al (2017) Robot-assisted simulated cataract surgery. J Cataract Refract Surg 43(4):552–557. https://doi.org/10.1016/j.jcrs.2017.02.020

    Article  PubMed  Google Scholar 

  13. Deuchler S, Wagner C, Singh P et al (2016) Clinical efficacy of simulated vitreoretinal surgery to prepare surgeons for the upcoming intervention in the operating room. PLoS One 11(3):1–12. https://doi.org/10.1371/journal.pone.0150690

    Article  CAS  Google Scholar 

  14. Vergmann AS, Vestergaard AH, Grauslund J (2017) Virtual vitreoretinal surgery: validation of a training programme. Acta Ophthalmol 2:60–65. https://doi.org/10.1111/aos.13209

    Article  Google Scholar 

  15. Rossi JV, Verma D, Fujii GY et al (2004) Virtual vitreoretinal surgical simulator as a training tool. Retina. 24(2):231–236. https://doi.org/10.1097/00006982-200404000-00007

    Article  PubMed  Google Scholar 

  16. van Romunde S, Faridpooya K, Vermeer KA et al (2018) Evaluation of OCT versus surgeon guided robotic manipulation in a simulated vitreoretinal model. Invest Ophthalmol Vis Sci 59(9):5930

    Google Scholar 

  17. Cereda MG, Faridpooya K, van Meurs JC, et al. (2018) First in-human clinical evaluation of a robot-controlled instrument with a real-time distance sensor in the vitreous cavity. In: Annual Meeting of the American Academy of Ophthalmology. American Academy of Ophthalmology; :PO224

Download references

Author information

Authors and Affiliations

  1. Department of Ophthalmology and Visual Sciences, The University of British Columbia, Vancouver, British Columbia, Canada

    David A L Maberley

  2. Preceyes B.V., Eindhoven, The Netherlands

    Maarten Beelen, Jorrit Smit, Thijs Meenink, Gerrit Naus & Marc D de Smet

  3. VRmagic Holding AG, Mannheim, Germany

    Clemens Wagner

  4. MicroInvasive Ocular Surgery Center (MIOS sa), Lausanne, Switzerland

    Marc D de Smet

Authors
  1. David A L Maberley
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maarten Beelen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jorrit Smit
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Thijs Meenink
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gerrit Naus
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Clemens Wagner
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Marc D de Smet
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David A L Maberley.

Ethics declarations

Conflict of interest

David Maberley has recently conducted phase 3 trials for Alcon, Roche, Abvie, and Ophthotech and declares no other conflicts of interest related to this study. Maarten Beelen, Jorrit Smit, Thijs Meenink, and Gerrit Naus are employees of Preceyes B.V., Eindhoven, The Netherlands, and declare no other conflicts of interest. Clemens Wagner is an employee of VRmagic Holding AG, Mannhein, Germany, and declares no other conflict of interest. Marc de Smet is Chief Medical Officer of Preceys B.V., Eindhoven, The Netherlands, and of Oxular Ltd.; he has received honoraria from Allergan, has been a part of advisory boards for Abbvie, Allergan, and Janssen and declares no other relevant conflicts of interest.

Ethical approval

All surgeons consented to the use their surgical data for research purposes. This study conforms to the 1964 Declaration of Helsinki and its later amendments. IRB/Ethics Committee approval was not required for this study as there were no human or animal subjects. Exemption has been confirmed by the Central Committee on Research Involving Human Subjects (CCMO), The Hague, Netherlands.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Meeting presentation

1. Oral presentation at FLORetina meeting – Florence, Italy (June 7, 2019)

2. ePoster theatre presentation at American Academy of Ophthalmology 2019 – San Francisco (October 13, 2019)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Maberley, D.A.L., Beelen, M., Smit, J. et al. A comparison of robotic and manual surgery for internal limiting membrane peeling. Graefes Arch Clin Exp Ophthalmol 258, 773–778 (2020). https://doi.org/10.1007/s00417-020-04613-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-020-04613-y

Keywords

Search

Navigation