Randomised controlled trial on robot-assisted versus manual surgery for pucker peeling

Area of Science:

• Ophthalmology
• Robotic Surgery
• Microsurgery

Background:

• Epiretinal membrane (ERM) is a common cause of decreased vision.
• Current surgical techniques for ERM peeling are well-established but can be challenging.
• Robotic assistance offers potential for enhanced precision in microsurgical procedures.

Purpose of the Study:

• To evaluate the feasibility and safety of performing key surgical steps in epiretinal membrane (ERM) peeling using the Preceyes Surgical System (PSS).
• To compare robotic-assisted ERM surgery with conventional manual surgery in terms of outcomes and instrument movement.

Main Methods:

• A randomized controlled trial was conducted with 15 pseudophakic patients with idiopathic ERM, randomized 2:1 to robot-assisted or manual surgery.
• Robot-assisted surgery utilized the PSS for internal limiting membrane (ILM) staining, dye removal, flap creation, peeling, light pipe handling, and fluid-air exchange.
• Primary outcomes were feasibility and safety; secondary outcomes included surgical duration, best-corrected visual acuity (BCVA), central retinal thickness (CRT), and instrument travel distance.

Main Results:

• All surgical steps performed with PSS were feasible and safe, with no adverse events.
• Robot-assisted surgery had a longer initial mean duration (56 min vs. 24 min), but this decreased over time.
• Instrument travel distance was significantly shorter in the robot-assisted group (403 mm vs. 550 mm), with equal improvements in BCVA and CRT for both groups.

Conclusions:

• This is the first randomized controlled trial on robotic surgery for ERM, demonstrating feasibility.
• Despite being more time-consuming initially, robotic assistance with PSS is a safe and potentially advantageous option for ERM peeling.
• Further research may explore optimizing robotic surgical workflows for ERM to reduce operative time.