For the first time, a robot has performed eye surgery on humans. It’s success hints that in the near future robots will be performing operations that are too delicate for a human to do manually.
Each of the six participants in the study needed a membrane removed from their retina to improve vision. This procedure involves cutting out a collection of cells that have clumped together, distorting what the person can see.
Twelve people in total had the surgery, with half of them conducted using a robot. The device is made by Eindhoven-based firm Preceye, and has a moveable arm directed using a joystick-style controller. It can be fitted with various different surgical instruments and filters out the imperceptible tremors from the surgeon’s hand.
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In all twelve cases, both robotic and manual, the operations were successful. The trials started in 2016, but this is the first time the results have been published.
Slow but steady
The robotic approach took nearly three times as long as performing the surgery manually. “The robot took a bit longer, but that was to be expected,” says Robert MacLaren at the University of Oxford. That is because they were new to using the robot, so were especially cautious.
Those who had the robotic surgery appeared to experience less haemorrhaging overall, although the study was too small to fully rule out the possibility that this was a statistical fluke.
However, the aim of the study was not to improve on this particular type of surgery. Instead, it was a proof of concept for using the robot in far trickier surgeries, which are impossible for humans to perform manually.
“Using the robot, we might also be able to directly unblock blood vessels or possibly inject things into the optic nerve,” says MacLaren. Both of these would require such fine motor control that surgeons simply can’t do it.
Another such surgery would be gene therapy to the retina. Using this technique several people who were blind have been able to see again. But to extend the treatment to people who still have some vision, but which could be improved with gene therapy, the accuracy of the procedure needs to be increased beyond human ability.
Even the best surgeons don’t have a completely steady hand. When registered at an instrument’s tip, the vibrations are in the order of around 0.1 millimetres. Though this is very small, there are parts of the retina, such as the inner limiting membrane, that are only 0.02 millimetres thick – nearly a fifth of the size.
For a human surgeon it is very difficult to engage the tip of a needle with these parts without damaging deeper structures below from natural hand vibrations. In comparison, the surgical robot can be moved forward in increments of 0.01 millimetres – easily good enough to avoid damaging nearby areas.
“People have been trying to do this since the 1980s, and it’s the first time anyone has made it this far,” says Bradley Nelson at the Swiss Federal Institute of Technology in Zurich.
In the future, robots will be able to do these procedures more quickly, less expensively, and with better outcomes, he says. “However, we are not there yet. It’s very difficult to make a machine that can replicate a human with years and years of experience.” he says.
Nature Biomedical Engineering
