Development of Teleoperated Robotic System for Remote Intraocular Microsurgery

Microsurgery has revolutionized modern surgery through its precision and favorable outcomes, but it remains limited by operational difficulty and the scarcity of skilled surgeons. Advances in robotics and communication technology have enabled the development of robotic telesurgery, with the goal of eliminating healthcare disparities. However, insufficiencies regarding system precision, surgical image transmission quality, and operational latency have made remote microsurgery challenging, particularly in intraocular microsurgery. A teleoperated robotic system is presented, featuring micrometer-scale precision and remote center of motion design, to ensure safety and flexibility within the confined operating space of the vitreous cavity. To validate its feasibility and safety, a randomized multicenter study is conducted involving in vivo subretinal injections in 51 pigmented rabbits. Surgeons using teleoperated system achieve nearly twice the first-attempt success rate and significantly fewer surgical complications than manual surgery. Furthermore, the system's versatility is showcased by successfully removing microscale intraocular foreign bodies in 15 porcine eyes and the communication stability is validated in multicenter remote surgeries, including procedures across the Qiongzhou Strait. These findings establish the system's safety, reliability, and versatility for performing remote intraocular procedures, highlighting its potential of remote microsurgery to improve surgical outcomes and broaden access to specialized care.