title: Cooperative robot assistant for vitreoretinal microsurgery: development of the RVRMS and feasibility studies in an animal model.
abstract: OBJECTIVE
  The purpose of the study was to describe the development of a robotic aided surgical system named RVRMS (robotic vitreous retinal microsurgery system) and to evaluate the capability for using it to perform vitreoretinal surgery.
  
  
  METHODS
  The RVRMS was designed and built to include the key components of two independent arms. End-effectors of each arm fix various surgical instruments and perform intraocular manipulation. To evaluate properly the RVRMS, robot-assisted 23-gauge surgical tasks including endolaser for retinal photocoagulation, pars plana vitrectomy (PPV), retinal foreign body removal and retinal vascular cannulation were performed in two different sizes of an animal model. Endolaser was performed in the eye of a living Irish rabbit and the other tasks were done in a harvested porcine eye. For each evaluation, the duration and the successful completion of the task was assessed.
  
  
  RESULTS
  Robot-assisted vitreoretinal operations were successfully performed in nine rabbit eyes and 25 porcine eyes without any iatrogenic complication such as retinal tear or retinal detachment. In the task of using an endolaser, three rows of burns around the induced retinal hole were performed in nine rabbit eyes with half size intervals of laser spots. Nine procine eyes underwent PPV followed by successful posterior vitreous detachment (PVD) induction assisted with triamcinolone acetonide (TA). Nine porcine eyes completed removal of a fine stainless steel wire, which was inserted into prepared retinal tissue. Finally, retinal vascular cannulation with a piece of stainless steel wire (6mm length, 45 μm pipe diameter and one end cut to ∼30° slope) was successfully achieved in seven porcine eyes. The average duration of each procedure was 10.91±1.22 min, 11.68±2.11min, 5.90±0.46 min and 13.5±6.2 min, respectively.
  
  
  CONCLUSIONS
  Maneuverability, accuracy and stability of robot-assisted vitreoretinal microsurgery using the RVRMS were demonstrated in this study. Wider application research of robotic surgery and improvement of a robotic system should be continued.
authors.affiliation: Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China.|Wenzhou Medical University, Wenzhou, Zhejiang, China.
authors.forename: Yi-Qi
authors.initials: YQ
authors.lastname: Chen
authors.affiliation: Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China.
authors.forename: Ji-Wei
authors.initials: JW
authors.lastname: Tao
authors.affiliation: Wenzhou Medical University, Wenzhou, Zhejiang, China.
authors.forename: Ling-Ya
authors.initials: LY
authors.lastname: Su
authors.affiliation: Wenzhou Medical University, Wenzhou, Zhejiang, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Li
authors.affiliation: Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China.
authors.forename: Shi-Xin
authors.initials: SX
authors.lastname: Zhao
authors.affiliation: School of Mechanical Engineering and Automation, Beihang University, Beijing, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China. slj20101119@163.com.|Wenzhou Medical University, Wenzhou, Zhejiang, China. slj20101119@163.com.
authors.forename: Li-Jun
authors.initials: LJ
authors.lastname: Shen
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D005240:Feasibility Studies; D008866:Microsurgery / Q000379:methods*; D011817:Rabbits; D012163:Retinal Detachment / Q000175:diagnosis / Q000601:surgery*; D012371:Robotics / Q000295:instrumentation*; D013552:Swine; D016896:Treatment Outcome; D014792:Visual Acuity; D014821:Vitrectomy / Q000379:methods*
keywords: Pars plana vitrectomy; Retinal vascular cannulation; Robot-assisted surgery; Robotic aided surgical system; Vitreoretinal microsurgery