A Robotic Injection System for Consistent Pneumo-dissection of the Deep Stroma in Big Bubble DALK Surgery

Area of Science:

• Ophthalmology
• Robotics
• Biomedical Engineering

Background:

• The big bubble Deep Anterior Lamellar Keratoplasty (DALK) procedure requires precise pneumo-dissection of the deep corneal stroma.
• Current manual techniques using a horizontal needle approach often result in inconsistent dissection, potentially impacting surgical outcomes.

Purpose of the Study:

• To develop and evaluate a novel robotic injection system for automated, consistent pneumo-dissection of the deep corneal stroma.
• To compare the performance of the robotic system against manual freehand injections in ex vivo corneas.

Main Methods:

• A robotic injection system was designed to employ a vertical approach for pneumo-dissection.
• Bench testing was performed to assess pressure generation and stability.
• The system was used to perform pneumo-dissection on five ex vivo rabbit corneas.

Main Results:

• The robotic system generated a maximum pressure of 90 kPa with minimal deviation (0.07 kPa).
• Successful pneumo-dissection was achieved in ex vivo rabbit corneas, with dissection area of 87.50 ± 2.70%, circularity of 89.20 ± 0.77%, and off-center percentage of 3.10 ± 2.20%.
• These robotic dissection metrics were significantly superior to those achieved by surgeons performing freehand injections.

Conclusions:

• This study presents the first report of automatic robotic injections for deep stroma pneumo-dissection.
• The robotic system demonstrates potential for improving consistency and uniformity in DALK procedures.
• Future integration may allow for precise control over injection parameters, leading to enhanced surgical outcomes.