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SPOTLIGHTS
Robots, A Potential Staple in Eye Surgery

Would you trust a robot to help you restore your eyesight? The ophthalmology department at the Swiss Triemly City Hospital noticed that a surprising number of people were open to the idea of receiving eye surgery from a robot, if a doctor was present. [1] Robotic surgery alone is not new - robotic tools such as the Da Vinci system have already been commonly deployed to operate on patients’ bodies. However, robotic machines small enough to operate on the eye have recently gained traction in the field of ophthalmology. [2] While there may be some lingering discomfort about letting a machine get so close to our delicate eyes, robotic eye surgeries bears some advantages that may play an essential role in the evolving healthcare landscape.

Ophthalmologists face a number of unique challenges in performing eye surgeries as they have to operate with extreme precision in a small area. During cataract surgery, for instance, a small cut has to be made on the surface of the lens of the eye, which is a mere 4mm thin. [3] Certainly, robotic surgery has the potential to make an impact in this area, as 50% of the world’s blindness is caused by cataract, a condition where eyesight deteriorates due to the clouding of the lens. [4] Another application of robotic eye surgery would be the treatment of retinal vein occlusion (blockage), which requires a surgical process that could tax even the steadiest of surgeon's hands. Across the world, 16.4 million people suffer from blockages in the retinal blood vessel, which is located at the delicate light-sensitive tissue lining the back of the eye. [5]

However, the vessel is thinner than a hair’s breadth, meaning that even the smallest tremor in the surgeon’s hand could result in an inaccurate injection that could damage the eye. Even slight tremors caused by the pulsing of blood through the surgeon's hands could result in unnecessary damage and bleeding. [6] The surgery is made even more demanding by the fact that after the insertion, the needle has to be held stationary in the blood vessel for up to 10 minutes so that the drug can be gradually released into the bloodstream, in order to defuse the blockage. [5]

At Belgium’s University Hospitals Leuven, robot-assisted surgery has been utilised to address the challenge of diffusing thrombosis (blood clots) in the retinal vein. [5] Instead of operating directly on the patient’s eye, the doctor can operate remotely by using a joystick to manipulate a robotic arm, which has a thin needle attached to it. The robotic arm is able to hold the needle perfectly still while the drug is injected into the patient’s eye, eliminating the chance of hand tremors. [7]

Besides enhancing the safety of surgery, robotic systems in eye surgery have also contributed to a more efficient treatment process. Stephan Michels, head of medical retina at Triemly Hospital, highly advocates the use of robotic technology in eye surgery. “Eye injections are a very repetitive task. After a while, when you have done like 20 patients, the nurse may give the wrong drug and you don’t realise, or you call in the wrong patient, there’s always a risk of making a mistake.” he said. Robotic surgery has resulted in productivity gains and improved service standards at Triemly City Hospital. By using robots to facilitate eye injection operations, 16-18 injections can be delivered per hour, almost one every three minutes, cutting down on patient waiting times at the ophthalmology department. [1] As a result of this success, future collaborations between ETH Zurich robotics lab and Triemly City Hospital are currently in the works to identify additional areas in which robots can improve services while reducing the risk of surgical errors.

The potential of robotic surgery does not end there. With the integration of robotic surgery systems into existing tools, robotic surgery is becoming even more versatile. For instance, modular designs ensure that robotic surgery systems are compatible with other tools like X-ray units, lasers and scalpels, in addition to needles. [8] This ease of integration has opened up opportunities for further automation and innovation. For example, the Multi-Scale Robotics Lab in ETH Zurich has created a fully automated surgery system which includes a pre-surgery iris scan, which has the dual function of identifying the patient and calculating the exact distance that the instrument has to move in order to remain in the safe region of the eye. [5] While there are staff on hand to check that the machinery is correctly positioned, eye recognition systems are also in place as a second layer of security to ensure that the instrument is perfectly aligned with the eye before the automated operation begins.

ROBOTS: TOOLS OR TEACHERS?

At present, robots may just be assistants in the operating theatre. However, in the future, it might be possible for robots to become teachers as well. As trained medical professionals may be scarce in rural areas, robotic eye surgeries could prove especially life saving in low-resource contexts by helping to guide inexperienced medical personnel with surgery.

The robotic system developed by Cambridge Consultants is one such example. Programmed to prevent the surgeon from exceeding certain boundaries in movement [2], the system essentially plays the role of a supervising mentor that intervenes when one’s mentee is on the brink of making fatal mistakes. Another approach enlists the use of artificial intelligence-esque software. A team at John Hopkins University is investigating how sequences of commonly performed procedures, such as suturing and blunt dissection, can be stored in the robot’s memory. This data can then be used to recognise and sound alerts when trainee surgeons have performed improperly. [9] Both approaches prevent instances whereby an inexperienced trainee makes a overly deep incision in the eye during cataract surgery, for instance.

Ultimately, while robotic surgery is developing at an astounding pace, it remains to be seen if it can truly become a disruptive technology in the market. Admittedly, robots might not be able to entirely replace the expertise and practical guidance of an experienced surgeon mentor. Some patients may also have fears about automated operations despite the safeguards put in place, preferring to put their trust in the human touch of doctors with credentials. However, with regard to monotonous and regimented tasks, it is undeniable that robots have an edge over humans in terms of reliability. For those with an open mind, robots could be very well be Man’s best friend.

References

  1. https://www.bbc.co.uk/radio/player/p051skfk
  2. https://www.newscientist.com/article/2111445-robot-surgeon-can-slice-eyes- finely-enough-to-remove-cataracts/
  3. https://www.nature.com/eye/journal/v23/n7/full/eye2008315a.html
  4. https://www.who.int/blindness/causes/priority/en/index1.html
  5. https://nieuws.kuleuven.be/en/content/2017/surgical-eye-robot-performs- precision-injection-in-patient-with-retinal-vein-occlusion
  6. https://www.ndcn.ox.ac.uk/research/clinical-ophthalmology-research-group/public/media
  7. https://www.bbc.com/news/av/uk-37337455/world-s-first-successful-robotic-eye-procedure-saves-sight
  8. https://www.researchgate.net/publication/2497571_A_Modular_Surgical_ Robotic_System_For_Image_ Guided_Percutaneous_Procedures
  9. https://spectrum.ieee.org/automaton/robotics/medical-robots/using-robots-to-train-the-surgeons-of-tomorrow

By Clarissa Kwok
Clarissa is an avid fan of the Harry Potter franchise. Her ambitions include becoming a kickass communications professional, raising a puppy and personally sampling and shortlisting the top 50 best matcha desserts around the world.

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APBN Editorial Calendar 2018
January:
Obesity / Outlook for 2018
February:
Searching for the fountain of youth
March:
Women in Science - Making a difference
April:
Digestive health in the 21st century - Trust your guts
May:
Dental health - The root to good health
June:
Cancer - Therapies and strategies for better patient outcomes
July:
Water management - Technologies for biotech and pharmaceutical industries
August:
Regenerative technology - Meat of the future
September:
Doctor Robot - The digital healthcare revolution
October:
Bones / Breast cancer
November:
Liver health / Top science research nations & institutions
December:
AIDS / Breakthrough of the year/Emerging trends
Editorial calendar is subjected to changes.
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