Robotic-Assisted Surgical Advances to Improve Intraocular Surgery

Intraocular tissues are micrometers thin and especially fragile. Particularly for the retina, surgical manipulation involves a limited margin of safety and requires fine surgical precision with highly accurate movements and minimal overshoot. Vitreoretinal surgeon Joseph N. Martel, MD, wants to improve upon the techniques and procedures of retinal microsurgery through the use of robotic-assisted platforms and new technologies that can afford surgeons greater degrees of flexibility, dexterity, and control.

Dr. Martel is an assistant professor in the Department of Ophthalmology at the University of Pittsburgh School of Medicine and one of the vitreoretinal surgeons practicing at the UPMC Eye Center. Dr. Martel’s research is focused on two broad categories of investigations: vision restoration therapies for retinal diseases, and advances in vitreoretinal surgical techniques and devices. With respect to the former category of research interests, Dr. Martel currently is the primary investigator of the PRIMA clinical trial (NCT03392324) in which participants at two sites in the United States — UPMC in Pittsburgh and the Bascom Palmer Eye Institute in Miami, Florida — with atrophic dry age-related macular degeneration (AMD) are undergoing subretinal implantation of a photovoltaic prosthesis in an attempt to restore some visual capabilities in the damaged areas of their retinas.

One of Dr. Martel’s current investigations related to his vitreoretinal surgical work involves the development of a type of tremor-canceling forceps device for use in microsurgical procedures involving the retina. Dr. Martel is collaborating on this research with Cameron Riviere, PhD, from The Robotics Institute at Carnegie Mellon University, who has specific interests in robotic-assisted surgery and surgical platforms.

Their collaboration involves developing robotic instrumentation and tracking that can allow for the dampening of the natural tremors that occur in a surgeon’s hands during microsurgical procedures.

“The goal of our research is to develop surgical instrumentation that is safer and more effective, and that may allow a surgeon to perform maneuvers previously not possible with the human hand alone,” says Dr. Martel.

Operating at essentially the microscopic level in the human retina does not afford the surgeon the same level of tactile response through the instruments that occur when operating on larger structures or organs — the heart, for example. The tissues of the retina or even individual layers of the retina are far too fine to give back useful tactile stimulation to the surgeon performing the procedure. 

“You receive essentially no tactile feedback when you are peeling off a piece of the retina that is 20 microns thick,” says Dr. Martel. “Any motion or tremor from the hands to the instrument is greatly magnified when you are working on such small structures or layers of the retina.”

The research that Dr. Martel and Dr. Riviere are conducting will attempt to give the robotic instruments the ability to perceive some of the tactile stimulation that is below the threshold of what humans can perceive, ultimately opening the door to advances in surgical techniques and safety.

Dr. Martel and Dr. Riviere have collaborated on other studies in the past. In 2019, they and other collaborators published their work on “EyeSAM: Graph-based Localization and Mapping of Retinal Vasculature During Intraocular Microsurgery” in the International Journal of Computer Assisted Radiology and Surgery. This study continues their work to develop mapping algorithms for tracking eyeball motion during intraocular surgery.

In 2018, Drs. Martel and Riviere published research in the International Journal of Robotics Research on “Techniques for Robot-aided Intraocular Surgery Using Monocular Vision.” In the paper, the research team discusses their experiments and work to develop techniques for robot-assisted intraocular surgery using the Micron robot and a new retinal surface estimation method they developed, which is based on a structured-light approach.

Further Reading

Mukherjee S, Kaess M, Martel JN, Riviere CN. EyeSAM: Graph-based Localization and Mapping of Retinal Vasculature During Intraocular Microsurgery. Int J Comput Assist Radiol Surg. 2019; 14(5): 819-828.

Yang S, Martel JN, Lobes LA Jr, Riviere CN. Techniques for Robot-aided Intraocular Surgery Using Monocular Vision. Int J Rob Res. 2018; 37(8): 931-952.

MacLachlan RA, Hollis RL, Jaramaz B, Riviere CN, Martel JN, Urish KL. Multirate Kalman Filter Rejects Impulse Noise in Frequency-Domain-Multiplexed Tracker Measurements. Proc IEEE Sens. Epub 2017 Dec 25.

Mukherjee S, Yang S, MacLachlan RA, Lobes LA Jr, Martel JN, Riviere CN. Toward Monocular Camera-Guided Retinal Vein Cannulation With an Actively Stabilized Handheld Robot. IEEE Int Conf Robot Autom. 2017 May-Jun; 2017: 2951-2956.

Braun D, Yang S, Martel JN, Riviere CN, Becker BC. EyeSLAM: Real-time Simultaneous Localization and Mapping of Retinal Vessels During Intraocular Microsurgery. Int J Med Robot. 2018 Feb; 14(1). doi: 10.1002/rcs.1848. Epub 2017 Jul 18.