Abstract
Purpose :
The shortage of high-quality resources for vitreoretinal procedures, particularly in low- and middle-income countries, necessitates innovative solutions. In this study, we explore the feasibility and safety of employing a high-precision robotic system to perform remote vitreoretinal surgery, addressing the challenges posed by limited resources and geographical disparities.
Methods :
A randomized controlled animal study was conducted using a specially designed remote robotic system with a remote center of motion architecture and micron-scale precision for vitreoretinal surgery. 51 pigmented rabbits were randomly assigned to either the remote robotic surgery group (n=27) or the traditional surgery group (n=24) for subretinal injections. Additionally, 15 porcine eyes with 1-mm suture in the vitreous cavity were remotely received foreign body removal. Surgical videos were recorded to analyze the success rates, intraoperative complications, and duration. Postoperative retinal conditions were monitored using OCT and fundus photography at 1, 3, 7, and 14 days. All the remote procedures were executed on three different centers at distances of approximately 3 km, 20 km, and 600 km across the sea.
Results :
The remote robotic surgery group exhibited a significantly higher first-attempt success rate for subretinal injections (96% vs. 54%, P=0.001) and fewer intraoperative complications, including hemorrhage and lens injury, compared to the traditional surgery group. Only 1 (4%) rabbit had localized hemorrhage in remote robotic group (P=0.035); while 7 (29%) rabbits occurred hemorrhage and 3 (13%) had lens injury in traditional surgery group. The mean total surgery duration was longer in the remote robotic group (11:54 vs. 7:39, P=0.001). Retinal recovery occurred more rapidly in the remote robotic group, with 85.2% achieving recovery before the seventh day compared to 31.2% in the traditional group. Furthermore, remote foreign body removal success rate was 100%, with a first-attempt success rate of 53%. The average overall delay in three distances was 429 ms for remote robotic surgery, with no significant differences among them.
Conclusions :
We introduce a novel robot-assisted surgical system, demonstrating its safety and reliability for remote vitreoretinal procedures. This innovative approach has the potential to overcome temporal and spatial barriers, thereby contributing to the reduction of healthcare disparities worldwide.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.