Robotic-assisted simulation of eyelid laceration repair: A proof-of-concept study

To evaluate the feasibility and safety of using the Da Vinci robotic surgical system for simulated eyelid laceration repair in a controlled experimental setting.

A proof-of-concept simulation study was conducted using gloves and sponge. Fingers of gloves were cut and sponges were introduced in the lumen to mimic the architecture of eyelids. These sponge-filled gloves were placed over a goats eye and fixed with pins on a Thermocol block. Anterior lamellar wounds were created by cutting only the superior part of the gloves. Full thickness wounds were created by cutting the full thickness of the glove. An ophthalmologist with prior cumulative robotic training of 12 hours on a virtual robotic surgical simulator performed wound repair using the Da Vinci surgical system. Repair was carried out using 6-0 silk sutures for anterior lamellar wound in an interrupted fashion, and the full thickness margin involving wound was repaired in three layers using 4-0 silk, 6-0 silk, and 6-0 vicryl. Procedural time, accuracy of suturing, and intraoperative safety parameters were assessed.

Multiple interrupted sutures were successfully placed in both the simulated upper and lower eyelid anterior lamellar wounds. The total time required for completion of suturing was 12 minutes. Full thickness wound was repaired by passing a mattress at the margin, and interrupted sutures in layers for simulated tarsus and skin. No unintended contact with the cornea or globe was observed during the procedure. Wound edge approximation was satisfactory in both eyelids, and robotic instrument control allowed precise needle placement in the confined periocular workspace.

This proof-of-concept study demonstrates the technical feasibility and safety of robotic-assisted eyelid laceration repair in a simulated environment. With prior simulator-based robotic training, ophthalmologists may effectively perform delicate periocular suturing using the Da Vinci system. These findings support further preclinical and translational studies exploring the role of robotic platforms in oculoplastic and ophthalmic trauma surgery.