Robotic Microsurgical Repair of Corneal Lacerations in Rabbit Eyes

Abstract

Abstract: : Purpose: This study's purpose was to determine whether a robotic surgical device could be used to remotely repair standardized corneal lacerations in an enucleated rabbit eye model. The device used, the Robotic Slave Micromanipulator Unit (RSMU), allows both remote magnified stereoscopic video imaging and microsurgical tissue manipulation. Additional objective and subjective quality measures about the RSMU were also made. Methods: 5 mm central full-thickness corneal wounds were repaired either with a standard ‘by-hand’ surgical technique, or via the RSMU. The primary outcome measure was the ability to complete a watertight surgical repair capable of maintaining an intraocular pressure (IOP) of 25 mm Hg. Secondary measures included time required for closure and wound burst pressure. Watertight closure and burst pressure were tested by inflating the eye with fluorescein dye-stained solution while submerged in a water bath until wound leakage was noted. Wound leak pressure was recorded when fluorescein-stained fluid emanating from the wound. Repair time and leakage pressure provided objective performance measures of the RSMU. Subjective data, such as instrument feel and ease of surgical field visualization, were also recorded. Results: 5 eyes were repaired remotely with the RSMU, 10 by hand. All eyes maintained an IOP of 25 mm Hg without leak. Repair times varied between 50 to 130 minutes (RSMU) and 8 to 35 minutes (by hand). Burst pressure varied between 30 to 110 mm Hg in the RSMU group and 60 to 280 mm Hg in the traditional closure group. Using the RSMU, tissue manipulation, visualization, and movement about the surgical field were adequate, but limited compared to the traditional ‘by hand’ technique. Conclusions: Robotic assisted watertight closure of 5 mm corneal wounds is possible using the RSMU. RSMU closure took longer, but surgical times trended lower as familiarity with the device developed. While limitations currently exist, this technology holds promise and warrants further exploration.  

Keywords: cornea: clinical science • trauma • animal model