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Comparison of Surgical Times Between Manual and Robot-Assisted Epiretinal Membrane Peeling
Alexander Eberle1,2, Ferhat Turgut1,2,3,4, Gábor Márk Somfai1,2,3
1Department of Ophthalmology, Stadtspital Zürich, Zurich, Switzerland.
Purpose:
Epiretinal membranes (ERM) pose a common challenge in vitreoretinal pathology, often causing vision impairment in older adults. The Preceyes Surgical System (PSS) supports the surgical removal of ERM through robot-assisted membrane peeling (RA-MP). This study compares surgical times and iatrogenic hemorrhages between manual membrane peeling (MMP) and RA-MP using PSS.
Methods:
Nine patients underwent RA-MP with PSS, whereas 16 patients (18 eyes) underwent MMP for comparative analysis. Surgical durations were categorized into RA-MP, manual forceps utilization in PSS surgeries (mRA-MP), and traditional MMP. Cumulative manual manipulation duration (cMMP), instrument grasps, and intraoperative hemorrhages were statistically analyzed using the Mann-Whitney U test.
Results:
RA-MP showed significantly longer peeling times compared to MMP (P < 0.001). Flap initiation grasps were similar between methods (P = 0.86), RA-MP demonstrated a significant reduction in peeling grasps (P = 0.01) and mean grasps per minute (P < 0.001). Although RA-MP resulted in fewer hemorrhages, the difference did not reach statistical significance relative to MMP (P = 0.08).
Discussion:
Although RA-MP tended to extend surgical time, it offered advantages in reducing tissue trauma and intraoperative hemorrhages. Further research is needed to explore the learning curve for novice surgeons and evaluate the safety profile of RA-MP.
Translational Relevance:
RA-MP may offer potential advantages over manual surgery, particularly in terms of reduced tissue trauma and intraoperative hemorrhages. Despite its longer duration compared with manual techniques, RA-MP may lead to fewer grasping maneuvers and lower rates of hemorrhages, thereby enhancing the safety and precision of vitreoretinal surgeries.
Insights
Robot-assisted membrane peeling (RA-MP) using the Preceyes Surgical System (PSS) for epiretinal membranes (ERM) may reduce tissue trauma and hemorrhages. While RA-MP had longer peeling times, it significantly reduced grasping maneuvers compared to manual membrane peeling (MMP).
Area of Science:
- Ophthalmology
- Vitreoretinal Surgery
- Medical Robotics
Background:
- Epiretinal membranes (ERM) are a prevalent cause of vision impairment, particularly in older adults.
- Surgical removal of ERM is standard, but manual techniques carry risks of tissue trauma and hemorrhage.
- Robot-assisted surgery offers potential for enhanced precision and reduced invasiveness in ophthalmic procedures.
Purpose of the Study:
- To compare surgical times and iatrogenic hemorrhages between robot-assisted membrane peeling (RA-MP) using the Preceyes Surgical System (PSS) and traditional manual membrane peeling (MMP).
- To evaluate the impact of RA-MP on tissue trauma, specifically the number of instrument grasps during ERM removal.
Main Methods:
- A comparative study involving 9 patients undergoing RA-MP with PSS and 16 patients (18 eyes) undergoing MMP.
- Surgical durations, including peeling time and manual forceps utilization within the PSS system (mRA-MP), were recorded.
- Instrument grasps, cumulative manual manipulation duration (cMMP), and intraoperative hemorrhages were analyzed using the Mann-Whitney U test.
Main Results:
- RA-MP demonstrated significantly longer peeling times compared to MMP (P < 0.001).
- RA-MP significantly reduced the number of peeling grasps (P = 0.01) and mean grasps per minute (P < 0.001), though flap initiation grasps were similar (P = 0.86).
- RA-MP resulted in fewer intraoperative hemorrhages, but this difference was not statistically significant (P = 0.08).
Conclusions:
- Robot-assisted membrane peeling (RA-MP) using PSS may offer advantages in reducing tissue trauma and intraoperative hemorrhages, despite longer surgical durations.
- The reduction in grasping maneuvers suggests enhanced precision and potentially decreased tissue damage during ERM surgery.
- Further research is warranted to investigate the learning curve for novice surgeons and fully elucidate the safety profile and long-term benefits of RA-MP.
