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Feasibility study of intraocular robotic surgery with the da Vinci surgical system
Dan H Bourla1, Jean Pierre Hubschman, Martin Culjat
1Jules Stein Eye Institute, Department of Ophthalmology, University of California, David Geffen School of Medicine, Los Angeles, California, USA. bourla@jsei.ucla.edu
Purpose:
To assess the feasibility of performing intraocular robotic surgery with the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA).
Methods:
Using modified robotic instruments, 25-gauge pars plana vitrectomy, intraocular foreign body removal, and anterior capsulorhexis were performed with the da Vinci system on porcine eyes. We assessed the surgical system's ability to provide the control, dexterity, maneuverability, and visualization necessary for intraocular surgery.
Results:
Control of the robotic wristlike instruments allowed for full range of movement. The dexterity of the robotic arms was excellent, with steady instrument motion. Controlling the robotic arms was not as intuitive as moving the wrist. A high stable point of rotation induced motion-related stress at the site of instrument insertion. Visualization of the external operative field during intraocular procedures required camera realignment, and absent retroillumination made anterior segment surgery hard to perform.
Conclusions:
The da Vinci Surgical System provided adequate dexterity for performing delicate intraocular manipulations. In the current design, the kinematics of the robotic arms was found to be insufficient for standard intraocular surgery. The system's endoscope did not did not yield the same detail acquired by an ophthalmic microscope.
