Robotic augmentation of surgical skills in subretinal injection: a novel semiautomated system

Subretinal injection (SRI) is a microsurgical procedure requiring micron-level precision and stable hand control, where technical difficulty and reliance on surgeon expertise often compromise consistency and safety. We developed a semiautomated high-precision ophthalmic surgical robot (HiPOSuR) to enhance precision and reduce variability.

A total of 48 pigmented rabbits were randomized into manual (n = 24) and robot-assisted (n = 24) groups. Each procedure was performed by two retinal specialists and four residents. The primary outcome was the first-attempt success rate of SRI. Secondary outcomes included overall success rate, intraoperative complications, surgical duration, injection site healing, retinal recovery, and tremor amplitude based on video analysis. Surgeon perceptions were evaluated via post-procedure questionnaires.

The robot-assisted group demonstrated a first-attempt success rate of 91.7% (22/24), significantly surpassing the manual group's success rate of 37.5% (9/24; P < 0.001, 95% CI: 30.6%-77.7%). Intraoperative complications decreased from 54.2% (manual) to 8.3% (robot-assisted; P < 0.001, 95% CI: - 69.9% to -21.7%). Notably, robot-assisted residents achieved an 83.3% success rate (vs. 33.3% manually; P = 0.036, 95% CI: 12.4%- 87.6%), with complications decreasing from 58.3% to 16.7% (P = 0.003, 95% CI: - 99.6% to -33.7%). In the robot-assisted group, average tremor amplitude was markedly reduced (34.56 ± 18.75 μm vs. 95.32 ± 46.92 μm, P < 0.001) and questionnaire scores were significantly higher across all 10 items (P < 0.05).

HiPOSuR improves subretinal injection by minimizing tremor, and reducing dependence on surgeon experience. It offers a promising platform for robotic assistance in complex intraocular procedures.