A team of surgeons from Oxford’s John Radcliffe Hospital have performed a pioneering surgical technique using a joystick-controlled robot to remove a membrane growing on the surface of a patient’s retina.
The surgeons used the Preceyes surgical robot developed by a Dutch medical robotics company to remove a membrane 100thof a millimetre thick growing at the back of the patient’s right eye.
This is the first time a robotic device has been used to operate inside the human eye, giving hope that the procedure will pave the way for more complex eye surgery than is currently possible with the human hand.
According to the surgeons, current technology with laser scanners and microscopes enables doctors to monitor retinal diseases at the microscopic level, but there are physiological limits to what the human hand can operate on.
“Operating at the back of the eye needs great precision, and the challenge has been to get a robot system to do that through a tiny hole in the wall of the eye without causing damage as it moves around,” said Professor and Surgeon at the University of Oxford who led the procedure, Robert MacLaren.
“Most robots in theatre are big, with big engineering whereas this is tiny – everything had to be shrunk down,” continued Prof MacLaren.
To operate the robot, a surgeon uses a joystick and touch-screen to guide a thin needle into the eye, while monitoring its progress through a microscope. The robot, which acts like a mechanical hand, has seven motors and is able to filter out hand tremors from the surgeon. Large movements of the joystick result in tiny movements of the robot, and if the surgeon releases their grip any movement is frozen.
“Normally when we do this operation by hand we touch the retina and there is some haemorrhage, but when we used the robot the membrane was lifted cleanly away,” said Prof MacLaren.
According to the researchers, the new procedure could help to develop novel surgical treatments for blindness, such as gene therapy and stem cells, which need to be inserted under the retina with a high degree of precision.
Currently 12 patients are undergoing the robotic surgical procedures in a clinical trial funded by the NIHR Oxford Biomedical Research Centre and Zizoz, a Dutch charity for patients with choroideremia, a genetic form of blindness which might be a future target for treatment using the robot.
In the first part of the trial, the robot is used to peel membranes off the delicate retina without damaging it. The second phase of the trial will assess how the robot can place a fine needle under the retina and inject fluid through it.
“In the future we could see this being used in an office based setting, where only the robot would touch the eye and it would be fully automated, which would improve efficiency and reduce costs,” said Engineer at Preceyes Medical Robotics, Maarten Beelen.