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Optic Nerve Sheath Fenestration With a Multi-Arm Continuum Robot.

Zisos Mitros1, Seyedmohammadhadi Sadati2, Carlo Seneci2

  • 1Robotics and Vision in Medicine (RViM) Lab, School of Biomedical Engineering & Imaging Sciences, King's College London, London E14 3WF, U.K.; Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London WC1E 6BT, U.K.

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Summary

A novel robotic system offers a minimally invasive approach for deep orbital interventions like Optic Nerve Sheath Fenestration (ONSF). This system successfully navigated and performed simulated interventions, potentially reducing risks associated with current invasive ophthalmic surgeries.

Keywords:
Surgical roboticsmechanism designmedical robots and systemssteerable catheters/needles

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Area of Science:

  • Ophthalmology
  • Medical Robotics
  • Surgical Technology

Background:

  • Deep orbital interventions, such as Optic Nerve Sheath Fenestration (ONSF), are crucial for managing elevated intracranial pressure.
  • Current ONSF procedures are invasive, posing risks to vision and requiring careful surgical execution.
  • The development of minimally invasive robotic systems is essential for improving ophthalmic surgical outcomes.

Purpose of the Study:

  • To present a novel multi-arm medical robotic system designed for deep orbital interventions.
  • To focus on the end-effector design and navigation capabilities for Optic Nerve Sheath Fenestration (ONSF).
  • To evaluate the system's feasibility and performance in simulated and ex vivo environments.

Main Methods:

  • Engineering a prototype multi-arm concentric tube robot system with independent control.
  • Designing a bespoke guide for securement on the eye sclera.
  • Conducting ex vivo experiments on porcine optic nerves to assess mechanical properties and penetration capabilities.
  • Utilizing a custom-made realistic eye phantom for deployment and navigation trials.

Main Results:

  • The robotic system demonstrated dexterous manipulation and visualization of the optic nerve area.
  • Ex vivo experiments confirmed the feasibility of optic nerve penetration, with porcine optic nerves serving as a comparable model for human tissue stiffness.
  • Successful deployment and navigation within the realistic eye phantom were achieved.
  • Simulation studies and experimental results validated the system's ability to reach the target site and perform the intervention.

Conclusions:

  • The developed medical robotic system provides a viable minimally invasive approach for deep orbital interventions like ONSF.
  • The system's design and demonstrated capabilities show promise for enhancing the safety and efficacy of ophthalmic surgeries.
  • Further research and clinical translation could lead to reduced complications and improved patient outcomes in managing optic nerve conditions.