Review Article

Robotics and ophthalmology: Are we there yet?

Suresh K Pandey, Vidushi Sharma

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Ophthalmology is a field that is now seeing the integration of robotics in its surgical procedures and Access this article online
interventions. Assistance facilitated by robots offers substantial improvements in terms of movement Website:
control, tremor cancellation, enhanced visualization, and distance sensing. Robotic technology has only www.ijo.in
recently been integrated into ophthalmology; hence, the progression is only in its initial stages. Robotic DOI:
technologies such as da Vinci Surgical System are integrated into the field of ophthalmology and are 10.4103/ijo.IJO_1131_18
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assisting surgeons in complex eye surgeries. Ophthalmic surgeries require high accuracy and precision PMID:
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to execute tissue manipulation, and some complex ocular surgery may take few hours to complete the
procedures that may predispose high‑volume ophthalmic surgeons to work‑related musculoskeletal Quick Response Code:
disorders. A complete paradigm shift has been achieved in this particular field through the integration of
advanced robotic technology, resulting in easier and more efficient procedures. Where robotic technology
assists the surgeons and improves the overall quality of care, it also projects several challenges including
limited availability, training, and the high cost of the robotic system. Although considerable studies and
trials have been conducted for various robotic systems, only a few of them have made it to the commercial
stage and ophthalmology, on its own, has a long way to go in robotics technology.

Key words: da Vinci robotic system, robotics in ophthalmology, intraocular robotic interventional surgical
system, telerobotic technology, femtosecond laser cataract devices, robot assisted vitreoretinal surgery,
ZEUS Robotic Surgical System (ZRSS), multi‑arm hybrid robotic system

Recent advertisement of femtosecond laser system as “robotic the ability to switch instruments mid‑surgery, manipulation
cataract surgery” generated interest among ophthalmologists of the surgical instrument simultaneously, and an adequate
and patients. Robotics have indeed revolutionized various range of motion.
surgical specialties, including orthopedics, gynecology,
urology, and laparoscopic surgery.[1] Robot‑assisted surgery Robotics in Medicine-A Historical Account
provides plenty of improvement over unassisted human hands Robotics is not a new concept in the medical field. Medical
such as high precision, improved dexterity in small spaces, professionals have been using robot‑based applications in
more range of motion, and tremor filtration.[1,2] Innovations medicine to assist them in various ways. As the meaning
have also been made in the field of ophthalmology and the denotes, robots are essentially meant to provide labor to
robotic surgery integration has been the most major recent make the work easier for humans. Over the past 20 years,
advancement. robotics has made a place in various subspecialties of the
Numerous prototypes and designs have been introduced medical world.
in recent years to utilize in ophthalmic surgery as well.[3] First developed by the Mechatronics in Medicine Laboratory,
Surgical robots in ophthalmology have the ability to advance Imperial College, London, United Kingdom, it has been almost
the treatments, decrease the rates of complications, and also 30 years since robots were devloped for of physician's assistance
offer the potential of treating conditions that remain incurable in the surgical rooms. The first robot, Probot, was designed
even today. primarily to aid the medical team in the transurethral resection
Majority of the robotic surgical systems in this field in the of the prostate in 1991.[5]
past have mostly focused on the singular tasks, typically the With technological progression, the robotics in the surgical
ones that were delicate. Although there is still ongoing research field advanced as well and the world witnessed integration
in this area, there has been an increasing interest in developing of robotics such as Zeus and da Vinci systems in the medical
devices which can perform complete surgical procedures. industry. These systems have been incorporated in the surgical
The main goal for these surgeries would be to include more procedures at a remarkable speed. Within the span of 10 years,
efficiency and speed without losing the ability of increased
precision.[4] Another requirement to meet this goal is to add
This is an open access journal, and articles are distributed under the terms of
the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License,
which allows others to remix, tweak, and build upon the work non-commercially,
Department of Ophthalmology, SuVi Eye Institute and Lasik Laser Center,
as long as appropriate credit is given and the new creations are licensed under
Kota, Rajasthan, India the identical terms.
Correspondence to: Dr.  Suresh K Pandey, Visiting Assistant Professor, For reprints contact: [email protected]
John A Moran Eye Center, University of Utah, Utah, USA;
Director, SuVi Eye Institute and Lasik Laser Center, C-13, Talwandi, Kota,
Rajasthan, India. E‑mail: [email protected] Cite this article as: Pandey SK, Sharma V. Robotics and ophthalmology: Are
we there yet? Indian J Ophthalmol 2019;67:988-94.
Manuscript received: 06.07.18; Revision accepted: 13.02.19

© 2019 Indian Journal of Ophthalmology | Published by Wolters Kluwer - Medknow

 July 2019 Pandey and Sharma: Robotics and Ophthalmology 989

the medical industry transformed as healthcare organizations

started to utilize these systems in the clinical practice.
When taken in literal terms, the robot means a machine
that is designed to execute unintelligible and repetitive tasks.
However, today they are used for performing tasks that require
extreme precision, specification, and entail certain risks and
danger. The robotic technology presently is able to perform
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research and tasks which cannot be possibly done using human

workforce.[6]
Despite the effectiveness of robotics in the field of surgery
and medicine, a slow progress has been witnessed in the Figure 1: A Steady‑hand Eye Robot Developed in Johns Hopkins
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University for Retinal Microsurgery. (Figure courtesy‑ Johns Hopkins

overall integration of technology in the health industry.
University)
They have taken a slow route entering into the field but
are gaining steady advancement with the passage of time.
The telesurgical machines are used for the transcontinental
robot‑assisted cholecystectomy for quite some time now. The
newer technology like voice‑activated robotic arms has joined
the industry recently.
Introduction of robotic technology in the medical field
has instigated a complete paradigm shift. It has made the
procedures easier and more efficient and has improvised the
overall quality of care.[6-8] The subsequent section of the review
article sheds light on how the ophthalmologists can benefit
from this particular advancement.

Robotics in Ophthalmology
Figs. 1-3 illustrate some of the robotics model used in
ophthalmic surgery. Although it has become vital for all
levels and all kinds of surgeries to be highly accurate and
precise when it comes to tissue manipulation, ophthalmologic
surgeries are unique for their limited surgical area and
minuscule tissue structure. The delicate ocular surgical
procedures are subjected to several limitations. Factors such
as hand tremors and the degree of control over the sensitive
tissue can make a huge difference.
Robotic surgery in the medical field is generally
implemented in the context where the surgeon is able to
operate using smart instruments that have a superior level of
functions. Mainstream clinical care has been able to improvise Figure 2: Da Vinci Surgical System. (Figure courtesy‑ Intuitive Surgical,
magnificently because of the assistance offered through USA)
surgical robots. This technology has sufficiently offered
the professionals abilities to have three‑dimensional views,
superior instrument maneuverability, increased magnification,
and diminished error possibility.
As a matter of fact, ophthalmology is a medical specialty
that requires stabilized hand movement, adequate lighting,
and a clear and unobstructed view. Robotic surgery is
clearly suitable for these requirements. It has curtailed
the possibilities of collateral tissue damage and threats
directed towards visualization. Technically, surgeries in
ophthalmology are complicated and unlike other surgical
procedures, ophthalmologists are able to work on the surgical
site and ocular structures directly. This provides them
greater visibility but also enhances the risks involved as the
sensitive and delicate ocular tissue (e.g. retina) is prone to Figure 3: Intraocular Robotic Interventional Surgical System. (Figure
get damaged even on the slightest error from the surgeon’s courtesy‑ Mechatronics)
end. This challenge has been significantly addressed through
the robotics technology. According to the study of Tsirbas surgeons ability to execute a short learning curve and
et al., the robotic instrumentation can offer the performing improve their overall surgical speed.[8]
 990 Indian Journal of Ophthalmology Volume 67 Issue 7

As a matter of fact, the robotic technology is able to a video imaging column and two light sources to illuminate
provide the precision of 1 mm currently. This is only going to the field of surgery. The dual stereoscopic cameras are for the
develop further as the technology is advancing in the field of three‑dimensional vision having progressive magnification,
ophthalmology. Robotic surgery in the ophthalmologic industry, offering a magnified image up to 12‑15 times.
although currently in very early phase, possesses significant
The console in the da Vinci system has an optical
scope. It can sufficiently fulfill the gap where there is a lack of
viewing system, known as the stereo viewer which offers a
professional assistance. Theoretically, developing countries, for
three‑dimensional view of the operating field and showcases
instance, can benefit from this precise technological opportunity
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the messages and icons from the system, indicating the status
if these devices are produced by local manufacturers and are
of the robot in real time. There are two telemanipulation
made accessible to the practitioners. These robotic devices can
handles that allow remote manipulation of the four articulated
facilitate the surgeries that are otherwise unavailable in the
robotic arms. The da Vinci SI, the updated version of the
territory. India can be taken as an example. There are substantial
system, offers two consoles, enabling two surgeons to operate
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implications in the implementation of the robotics technology

simultaneously. However, out of the two operators, one is the
in ophthalmology such as direct robotic costs, availability and
primary robotic surgeon and the other a surgical assistant.
maintenance of the devices, and staff training. However, if the
Contrary to the other newer versions, da Vinci SI has three
technology is successfully implemented, it can bring productive
robotic arms instead of four and they can be utilized by two
outcomes in the field.
operators at the same time.[10]
There are several robotic technologies that have been
successfully integrated into the ophthalmic surgical procedures. da Vinci System in Ophthalmic Surgery
The following sections offer an overview of the da Vinci The da Vinci system can offer tremendous benefits to the
System that is the most commonly used robot in the field of ocular surgical procedures, making them more effective and
ophthalmology. convenient to proceed. The most significant property of the
robotic system is its optical magnification. The stereoscopic
The da Vinci Surgical System camera in the system offers optical and digital magnification
The da Vinci system is the current standard robotic surgical of the field of surgery, enabling the surgeon to have a clear and
system used in the field of ophthalmology. Developed by the unobstructed view of the specific area.[11,12]
Intuitive Surgical, USA, it is a telemanipulation robot that has
Secondly, the ability of the system processor to control
been utilized for performing pterygium surgery in human eyes
and filter the tremors in the surgeon’s movements results
and has been successful in ex vivo corneal surgery.
in limiting the human error and improving the quality of
This system, essentially, comprises of two primary surgical movements. The joints in the robotic arms enable a
components: a control console and the robotic apparatus. The 360º movement which ultimately offers optimal positioning
control console is for the surgeon to manipulate the robotic and accuracy during the surgery. The da Vinci robot surgical
arms using the remote. The robotic apparatus comprises of system is designed in a manner that it simplifies the motion.
three, sometimes four, arms that serve the purpose of holding The console for the surgeons ensures better comfort during
a dual channel endoscope. The console offers an ocular microsurgery. To operate with minimal incisions and for
viewfinder that offers a stereoscopic view of the operative field conducting minimally invasive surgeries, the da Vinci system
from the endoscope. The da Vinci system allows the surgeon offers great support through offering a magnified vision,
to manipulate the controls of the console using their fingers, adequate illumination, and fine surgical movements.[12]
wrists, hands, and arms. These movements are then transferred
The da Vinci system is the only surgical telemanipulator that
to the robotic arms once they are filtered and scaled by the
is available in the market and is currently being introduced in
computer processor. No significant delay is incurred between
the field of ophthalmology for anterior and posterior segment
the movements of the surgeon and that of the robotic arms
procedures. It can be effectively used in the procedures of
and system.[9]
corneal laceration repair, pars plana vitrectomy, intraocular
The movements of the surgeon are almost mirrored by the foreign body removal, anterior capsulorhexis, penetrating
system, except that the tremors and minor movements are keratoplasty, and pterygium surgery.[13-15]
filtered by the processor. The system is designed in a manner
that it allows the surgeon to insert, extract, roll, yaw, and grip Limitations of the da Vinci Robotic System
the tools of the robot. Three arms of system carry surgical Design
instruments, and the fourth arm, which is only recently added,
The design of the da Vinci surgical system in the field of
manipulates the digital stereoscopic camera to visualize the
ophthalmology is not completely sans challenges. There
field or area under surgery. Each of the arms has several joints,
are some limitations in the design that obscure its optimal
allowing the system to have a three‑dimensional movement of
functioning and application in the practical world. The
the surgical instruments and optics. The tools have technology
first limitation is the presence of high remote center of
that offers movement up to 360°. This is called EndoWrist
motion (RCM) in the robot, placed right above the wrist and
technology.
at a long distance from the tip of the instrument. This location
Three arms designated to operate surgical tools can handle of the RCM makes the intraocular movements less controllable
dissecting forceps, scissors, scalpel, spreaders, and other similar and promotes unnecessary tension of the surface of the external
tools. The stereoscopic camera in the fourth arm comprises of eye. This demands the surgeon to utilize another RCM in the
a lens and dual stereoscopic cameras. The lens comprises of procedure during the ocular penetration site.[14]
 July 2019 Pandey and Sharma: Robotics and Ophthalmology 991

This system requires the surgeon to move the robotic diagnosis. The objective of the research is to develop controlled
arms rather vigilantly to ensure the right positioning and magnetic fields that can steer the microrobot, whereas an active
movement of the RCM. These motions, as a matter of fact, are microscope can offer a real‑time, three‑dimensional feedback.
not as sensitive as the human wrists and cannot mirror the This can allow drug delivery in the field of vitreo-retinal surgery
exact movements of the surgeon’s arms. As a result, the range using wireless magnetic microrobots.[18]
of motion gets limited. This, subsequently, results in creating
challenges in the complex ocular procedures such as creating Telerobotic Technology
round, curvilinear capsulorhexis that is mandatory for cataract
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The article of Volpe elaborates the commercial use of the

surgeries.
robot‑assisted microsurgery system.[19] The system utilizes
The second limitation in the process of using the da Vinci the telerobotic technology of NASA to carry out a precision
surgical robots in ophthalmologic procedure is the achievement cable‑driven system that offers efficient functioning. It scales
of intraoperative visualization. The robot entails a video down the human input motions, filters tremors to improve
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capture system that is designed essentially for the endoscopic the accuracy and precision, and offers constrained motion of
use and cannot offer an optimal and detailed image like that of the instrument in the eye to curtail any surgical mishaps and
an operating microscope. Considering that technology is still detrimental impacts.[19]
in its initial stages, it is likely to progress and address these
Utilizing telerobotic systems and programming them to
limitations with advancement.[15]
utilize motion scaling, stepwise nudging, and z bounds can
Application of Robotics in the Ophthalmic enhance both safety and speed when moving towards the
target point.[20] Progressively increased autonomous and
Surgery automated surgeries are most likely the path forward and with
The robots created for operating on the eyes must meet the rapid research and advancements underway currently,
specific basic requirements. There are three designs that are this can be possible in near future and can result in further
being developed currently for telemanipulators utilizing revolutionizing the field of ophthalmology. Application
virtual or fixed remote center of motion, comanipulation of robotics in ophthalmology is summarized in Table 1.
devices, and smart surgical tools such as a steady hand.[16] Table 2 summarizes the studies published on robotics and
There are several potential applications of robotic technology ophthalmology.
in the field of ophthalmology. Some of them are discussed
underneath. The Scope of Robotics in Ophthalmology
Corneal laceration repair In ophthalmology, robotics is in its initial stage but with
increasing development and research in this area, it is expected
According to the study of Tsirbas et al.,[8] the da Vinci surgical
to reach a stage where it can be introduced in the normal
system has been successfully used in the repair of the corneal
ophthalmic practices. It can be rational to presume that there
lacerations in harvested porcine eyes. The research study
are plenty of opportunities for robotics ophthalmic surgeries,
compared the time taken to complete the surgery through
especially in intervention performance that is only rendered
human performance and the robotic arm performance. In the
possible with robotic systems, or might atleast greatly simplify
system‑performed surgery, a videoscope and two 360º rotating,
the existing approaches.[21] Procedures such as intravascular
8‑mm instruments with three robotic arms were positioned over
drug delivery and retinal vessel cannulation may become
the eye. The surgery was performed using a robotic system
feasible since robotic microsurgical manipulations would be
console and was successfully executed with the advanced
safer with reduced iatrogenic complications. Additionally,
visualization offered to facilitate the process and control the
delicate placement of the corneal sutures. advanced imaging integration with robotic systems might also
allow motion guidance or total surgical procedures automation.
Retinal vascular microsurgery
There are numerous more potential pathways of bringing
The study of Jensen et al. presents the application of the da robotics in the field of ophthalmology. Up until now, all the
Vinci surgical system to perform retinal microsurgery.[17] In surgical systems enhance the time of surgery. However, there
their research, they used a six degree of freedom manipulator
is a need to emphasize cost and efficiency as well. The setup
that required a hand‑held trackball to operate. A computer
time can be drastically reduced by utilizing a hybrid system
controller was used to interpret the input of the trackball and
implemented on current surgical tables.[22]
the manipulator was moved according to a pre-programmed
algorithm. The researchers claim that the device can be used Although robotic technology in ophthalmology is still in
in microsurgery and limit the aspects of tremor and fatigue. its startup stages, the trend is expected to follow through
The device, however, has its limitations of size and operational consistently and tremendous advancement is anticipated in
features. the field in the coming times. To gain a better understanding
of how well the robotics technology is developing in the field,
Vitreoretinal surgery
the following section offers a brief overview of the potential
The study conducted by Dogangil et al. refers to the usage of benefits and challenges.
miniature autonomous robots or microrobots.[18] These devices are
so tiny that they can fit into the barrel of a syringe and can execute Potential Benefits of Robotics in
movements like that of a submarine. Alongside, the researchers
Ophthalmology
are working on developing a three‑dimensional visual serving
approach that has the capability to carry microneedles and One of the reasons why robotics technology in ophthalmology
chemical sensors which can help in the process of surgery and is highly anticipated is the meticulousness achieved through
 992 Indian Journal of Ophthalmology Volume 67 Issue 7

Table 1: Application of Robotics in Ophthalmology

Robotics in Ophthalmology Place and Year of Development Functions
1. S
 tereotaxical France, 1980s Allows 4 degrees of rotation with translation to facilitate precise
Micro‑telemanipulator for Ocular movements.
Surgery
2. P
 rototype robotic system based Japan, 1989 Assists in vitreoretinal surgery and increased accuracy. The
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on the S.M.O.S. platform prototype eliminates the interoperator variability to enhance

precision.
3. S
 teady hand manipulator for John Hopkins University, Reduces tremors, and minimizes undesirable eye wall tension.
retinal microsurgery Baltimore, Maryland, USA, 1999
4. Multi‑arm hybrid robotic system Columbia University, USA, 2009 Offers skillful manipulation of eye.
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5. Da Vinci Surgical System The United States, approved in Used in performing suture repair of a corneal laceration,
2000 by FDA executing complete continuous capsulorhexis on the anterior
lens capsule, and to perform 3‑port 25‑gauge pars plana
vitrectomy.
6. Hexapod Surgical System France, 2011 Mounted to the da Vinci Macro Robot, this system offers a
remote center of motion at the site of ocular penetration.
7. M
 icro Hand using the micro USA, 2010 Offers manipulation of fresh retinal tissue and can maneuver
electromechanical systems caliper weights. It is designed in the same manner as a human
technology, (MEMS) hand.
8. Intraocular Robotic Mechatronics and Control It is designed to facilitate telesurgery using a stereoscopic
Interventional Surgical System Laboratory and Stein Eye visualization system, joystick controls, and custom designed
Institute, USA 2011 arms. This system is equipped with tremor filtration and
performs scaled motion.
9. Femtosecond Laser Devices The United States, approved by Facilitates cataract surgery and can be used in wound
FDA in 2001 construction, capsulorhexis creation, and nucleus breakdown
during the cataract surgery.

it. The challenges formerly experienced in form of movement While performing invasive surgeries, the surgeons have
stability are now addressed through the robotics. The surgeons to be careful about their posture and movements as any
are able to scale both movements and speed at the same time. unwatchful movement can cause substantial damage to the
This has promoted their efficiency in performing delicate tissue. This has limited the freedom in the movement for
tasks.[23,24] the surgeons and has led them to suffer from occupational
musculoskeletal disorders. Therefore, it is not just the patient’s
Robotic techniques and high‑precision instruments have
safety and treatment that demands advancement in the surgical
made it achievable for the ophthalmologists to address more
procedures, but the well‑being of the surgeons as well.[28]
complex and accuracy‑sensitive conditions. The robotic systems
are effective for the purposes that require repetitive tasks, Robotic techniques cater to both the demands sufficiently.
making the work easier for the ophthalmologist.[25] Where they have improved the quality of treatment for the
patients with marginalized risks, they have also granted
Micro‑incision cataract surgeries that were once deemed
considerable relaxation and comfort to surgeons. These
difficult to execute, they are now substantially aided with
techniques are able to reduce the physical stress endured
robotic technology such as Femtosecond lasers. These devices
during the surgery.
are effective in performing precise corneal incision, well‑sized
perfect capsulorhexis, and nuclear fragmentation and help to It is difficult to predict the exact scope of robotics in
improve the outcome of refractive cataract surgery. Remaining ophthalmology, but it can be effectively deduced by comparing
steps of phacoemulsification procedures can be performed by the results of robot‑performed and human‑performed
the ophthalmic surgeons. In the future, the robotic system can surgeries. There are ongoing research trials to determine how
take over the tasks that involve repetitive motions, providing surgical robots can be used in improving the ophthalmological
the depth and strength that is ideal for the task to be carried productivity and which procedures can be accelerated without
out.[26] causing any negative impact.
To achieve optimum results, it is important that the Challenges: Robotics in Ophthalmology
surgeon knows well how to operate the robotic system.
With this challenge, there are several opportunities rising Robotic‑assisted advancement is not sans challenges. There
as well. According to the latest trend, the surgeons are now are issues which need to be carefully considered so that they
trained on simulators. The information and steps that are are effectively resolved. Ophthalmological procedures need
preprogrammed into the simulators and the robot make it logical processing for effective execution aside from accuracy.
easier for the surgeons to execute the transition from one step For an ophthalmic surgeon, who is taking the assistance of a
to another. This makes the work easier for surgeons to perform robotic system, he/she must be able to carry out the procedure
and in less time.[27] in a sequence of steps that are logical.
 July 2019 Pandey and Sharma: Robotics and Ophthalmology 993

Table 2: Studies Published on Robotics and Ophthalmology

Name of Author/ Type of Surgery Robotics & Ophthalmology Comments
Year
1. T
 sirbas, A., Bimanual, Ocular microsurgery was performed using Robotic ocular microsurgery has proven to
Mango, C. and three‑dimensional a da Vinci surgical robot. Repair of corneal be successful. Moreover, it can make the
Dutson, E., robotic surgery. laceration done in a porcine model. procedure more time‑efficient.
2007 Ocular microsurgery Excellent visualization was obtained
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was performed during the surgery and the sutures were

using da Vinci placed delicately at the corneal level with
Surgical Robot. controlled movements.
2. S
 met, MD., Presents overview Reviewed three robotics used in Several eye‑specific systems have proven to be
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Naus, GJL., of intraocular ophthalmic procedures: steady hand successful in different ocular surgeries, but only
Faridpooya, K., surgery, ex vivo manipulator for retinal microsurgery, a few of these robotic systems have been able
and Mura, M., corneal surgery, and Preceyes surgical system for intraocular to make it to the commercial platform. Despite
2018 semiautonomous surgery, and da Vinci Surgical Robot for the development, robotic systems will take time
surgery ex‑vivo corneal surgery. to get incorporated in the surgical procedures.
3. H
 ubschman, Robotic external Robotic arms were used to carry out a 25 Robotic arms are not much feasible to use in
JP., ocular surgery was gauge robotic vitrectomy. Robotic forceps ocular surgery. The visualization gets hindered
Tsirbas, A., and performed using were used to grasp and subsequently and continuously requires realignment.
Schwartz, SD., robotic arms. remove the foreign body from the anterior Conversely, robotic forceps offer more ease in
2008 chamber. A 360 degree capsulorhexis was manipulation and control of the instruments.
achieved through the movement of the However, the procedure can be improved
robotic arms. substantially through miniaturization.
4. N
 oda Y, Ida Y, Application of The capability of robotics application Robotic assistance in approaching the target on
and Tanaka S., robotic instruments to target the fundus was analyzed in the fundus, and to stabilize the manipulator tip
et al., 2013 and system for comparison to the manual procedure and above the fundus ensures more accuracy and
vitreoretinal surgery performance. improves the contact with the target. This has
proven to be beneficial for both experienced
and inexperienced hands.
5. R
 oizenblatt M, Robot‑assisted Robotic systems considerably suppress Improved control, dexterity, diminished tremors,
Edwards TL, vitreoretinal surgery tremor during the vitreoretinal surgery and micron‑scale distance sensing has been
and and improves the coordination between achieved in vitreoretinal surgery through
Gehlbach PL., the surgeon and the robot. Vitrectomy is robotics. However, there are substantial
2018 executed with more precision by robotics challenges in implementation including costs,
when it is combined with intravenous clinical risks and complications.
thrombolysis.
6. B
 ourla DH, Intraocular Robot The da Vinci Surgical System was utilized The da Vinci Surgical System successfully
Hubschman JP, surgery using da in performing different surgical procedures offered complete range of movement. Steady
Culjat M, et al., Vinci Surgical including 25‑gauge pars plana vitrectomy, motion with optimum dexterity was achieved.
2008 System. intraocular foreign body removal, and To retain excellent visualization, realignment
anterior capsulorhexis. The aim of the was required. This highlights the shortcomings
study was to assess the robot’s ability of da Vinci Surgical System in ocular surgeries.
to offer control to the surgeon, improve
dexterity and maneuverability, and
enhance visualization.

The devices utilized must be innately perceptive. For an the visualization of the surgical field. These issues denote that
optimally functioning robot, it is important that it functions the da Vinci robotic system is not completely appropriate as
as a highly skilled and proficient human being.[29] If the device yet for ocular surgeries.
deviates from the logical progression, it will not achieve the
purpose it is designed for. With the current and existing progression of surgical
robot systems in ophthalmology, it has become difficult
If the robotic surgical device, da Vinci, is taken into to predict how robotic technology is going to proceed.
consideration, it does allow the surgeon to achieve a magnified The future is mostly dependent on the clinical trial data
view of the eye and perform corneal incision but its frame that is to be achieved through ongoing pilot studies. Once
rigidity does not reciprocate the flexible movements like that the relevant data is achieved, more in‑depth analysis can
of a surgeon.[30] be conducted for the scope of robotics in ophthalmology.
We can regard da Vinci as one of the indirect devices used Several obstacles remain before robotic surgery will become
in ophthalmology and, ophthalmology, on its own, has a long popular in ophthalmology. A high cost, steep learning
way to go in robotics technology. The study of Bourla, et al., curve, and patient trust present other challenges in robotics
however, advocates the suitability of the da Vinci robotic system in ophthalmology. At present, considerable studies and
for ocular surgeries.[31] There are several issues highlighted in trials have been conducted for various robotic systems,
terms of levels of stress at the entry points and in relation to only a few of them have made it to the commercial stage
 994 Indian Journal of Ophthalmology Volume 67 Issue 7

and ophthalmology, on its own, has a long way to go in manipulator for retinal surgery. InRobotics and Automation, 2007
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Conflicts of interest
surgery in ophthalmology. Curr Opin Ophthalmol 2018;29:248‑53.
There are no conflicts of interest.
17. Jensen PS, Grace KW, Attariwala R, Colgate JE, Glucksberg MR.
Downloaded from http://journals.lww.com/ijo by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWn

Toward robot‑assisted vascular microsurgery in the retina. Graefes

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Cover Page Illustration

A three-dimensional slab showing a peripheral retinal pigment epithelial detachment
Contributed by: P C Ranjith, Anantharaman Giridhar, Mahesh Gopalakrishnan,
Department of Vitreo‑Retina, Giridhar Eye Institute, Kochi, Kerala, India
Cover Page Design: T Shiva Shankar, Centre for Sight, Hyderabad, India