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Marc D de Smet, Sicco H Popma, Gerrit Naus, Thijs H C M Meenink, Maarten J Beelen, Maarten Steinbuch; Robot-assisted choroidotomy and sub-retinal bleb creation. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2324.
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Delivery of drugs or cells to the sub-retinal space can be achieved via ab-externo catheterization . The required choroidotomy and the sub-retinal bleb creation by visco-dissection of the retina and choroid can lead to retina perforation and tearing. The purpose of this study is to demonstrate the feasibility of using robot-assistance to make the procedure available to a wider range of surgeons.
Equatorial sclerotomies down to the choroidal vessels were performed in porcine eyes. The choroidotomy was assisted by the PRECEYES Surgical System , executing a scratching motion with a wiretip instrument (iScience Interventional). By filtering hand tremors and by scaling hand movements, micrometer manipulation precision is achieved. The penetration depth was increased incrementally, preventing accidental penetration of the retina. While executing the scratching motion, a visco-elastic fluid is injected to dissect the retina from the choroid and to create the sub-retinal bleb. The bleb size and the retinal integrity are visually inspected using an endoscope.
The results of this study are compared to a previous study  in which 106 manual procedures were performed on similar porcine eye models by an experienced surgeon. The incidence of peripheral retinal perforations was 17% and the average required time of the total procedure was 24 minutes. In this study, 17 robot-assisted procedures were performed by a surgically unexperienced user. The incidence of peripheral retinal perforations was 12%, with retinal perforations in 2 cases. The average preparation time was 15 ±2 minutes, while the robot-assisted choroidotomy and the sub-retinal bleb creation took 6 ±3 minutes.
Using robot assistance, the precision, the steadiness and the reproducibility of instrument manipulation are improved. This is crucial for a successful choroidotomy and the sub-retinal bleb creation, making the procedure available to a wider range of surgeons. References  M. D. de Smet, et al. (2012), Repeated ab-externo catheterization of the sub-retinal space using a microcatheter for targeted delivery of a cell therapy product in a pig model, ARVO 2012 Annual meeting  H.C.M. Meenink, R. Hendrix, M.J. Beelen, G.J.L. Naus, E.J.G.M. van Oosterhout, M.D. de Smet, H. Nijmeijer, M. Steinbuch (2012) Robot-assisted vitreoretinal surgery, in Surgical Robotics, Part II - Applications, edited by Paula Gomes, Cambridge Consultants
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