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Thijs H C M Meenink, Maarten Beelen, Gerrit Naus, Sicco H Popma, Maarten Steinbuch, Marc D de Smet; Robot-assisted ab-externo drug delivery. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):400.
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Drugs can be delivered to the sub-macular region via ab-externo delivery using a microcatheter [de Smet 2012]. In a previous study, it was demonstrated that robot assistance can reduce the risk of retinal penetrations during the required choroidotomy phase [de Smet 2014]. The purpose of this study is to demonstrate that robot assistance for the catheter insertion phase enables aiming of the catheter for targeted delivery and a high level of control in pausing and resuming procedural steps, which is difficult to achieve manually.
Equatorial sclerotomies down to the choroidal vessels are performed in in-vivo porcine eyes. The choroidotomy is made, while injecting a visco-elastic fluid to create the sub-retinal bleb. Finally the catheter is inserted and fed to the submacular region. The choroidotomy is assisted by the PRECEYES Surgical System [Meenink 2012]. For catheter insertion, a novel approach using a guiding instrument is devised, allowing for a controlled, automated insertion. Using robot assistance, this instrument is inserted into the choroidotomy, and aimed towards the macula. The instrument is oriented such that its tip is near tangential to the choroid. The catheter is introduced through this guiding instrument, and fed to the submacular region, under visual inspection via an endoscope.
In the in-vivo animal tests, a total of 22 catheter insertions were performed. The incidence of retinal perforations during catheter insertion converged to 18%, which is comparable to manual surgery [de Smet 2012]. The study shows that robot assistance provides a high level of control during the procedure. This gives the possibility to anticipate complications when seen with the endoscope and corrective actions can be taken. This allows for example to detect and to resolve high subretinal bleb tension prior to continuing the catheter insertion, which is very difficult manually. Furthermore, robot assistance allows re-aiming of the catheter for targeted delivery, which cannot be safely performed manually. Automation of procedural steps reduced the average catheter insertion time (100s), compared to manual surgery.
Using robot assistance, a high level of control in pausing and resuming steps in the procedure is achieved. In combination with a guiding instrument, robot assistance also allows for targeted delivery of the drug by re-aiming of the catheter. This is especially useful if injection into a critical direction is required.
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