Advancements in robotic surgery for vitreoretinal diseases: current trends and the future

Medical robotics, such as the da Vinci Surgical System, Hinotori, and Saroa, has been rapidly expanding in the field of general surgery in recent years. Because of the need for high precision in vitreoretinal surgery, general surgery robots are not applicable; therefore, a variety of robots specifically designed for vitreoretinal surgery have been developed around the world. These robotic systems can be broadly categorized into operation systems, operation assistance systems, and observation systems. The purpose of the operation robots is mainly internal limiting membrane peeling and retinal vascular cannulation. The PRECEYES Surgical System was already approved in the European Union in 2019 on the basis of positive clinical results. The aim of operation assistance robots, such as iARMs, is to suppress tremors. Meanwhile, we have developed an observation robot, an intraocular endoscope-holding robot (OQrimo), which was approved as a medical device in Japan in 2023. This robot allows surgeons to perform intraocular manipulations using both hands during vitreoretinal surgery for proliferative diabetic retinopathy and other intractable retinal diseases and may also make it easier to manipulate the anterior tissues around the ciliary body. In the future, by being combined with artificial intelligence in vitreoretinal clinics, robotic surgery will be applied to preoperative, intraoperative, and postoperative surgical procedure decisions, programs, and education.