In Oxford, conducted the first high-precision eye surgery using a robot

Robert Mac Laren and Thomas Edwards, surgeons from Oxford, performed a human eye surgery using a robot. During the entire operation, the surgeons managed a robotic system, performing all the work remotely. The main task of the surgeons is to remove the membrane with a thickness of 1/100 mm from the retina of the eye on the back of the eyeball (right eye).

The patient is William Beaver, a 70-year-old man who agreed to go under the knife of a robot. This is the first surgical operation of this type, not only in the UK, but throughout the world. The surgical unit is called the Robotic Retinal Dissection Device (R2D2). Funds for developing the system and conducting the operation were provided by the University of Oxford and several other organizations.

A robotic surgical set performs very precise manipulations with the eyeball. The robot operates through a hole with a diameter of less than a millimeter. During this operation, the robot had to remove the manipulator from the hole several times and re-insert it after some time. At the same time, the eyeball itself was not immobilized and could rotate.
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The developers of the Robotic Retinal Dissection Device have provided a surgeon's hand-shake damping mechanism. When performing an operation of this type, each movement is important, and if you work with microscopically small elements of the eyeball, the tremor of the surgeon’s hands (imperceptible to the eyes and most devices) can lead to failure.

The robot is a mechanical manipulator with built-in servo drives in the amount of seven pieces, which are controlled by a computer. The system can perform movements with an accuracy of one thousandth of a millimeter.

The operation was necessary for the patient because a specific membrane appeared on the surface of his retina. This led to the patient seeing a distorted “picture”, similar to what we see on deformed mirrors in the so-called “room of laughter”. The thickness of this membrane is only a hundredth of a millimeter, and it was necessary to remove it without damaging the retina.

The disease itself is called epiretinal membrane. This is a fairly common eye disease, which is a consequence of disorders in the vitreous body (the cause may be, for example, diabetes). Otherwise, it is called the macular fold. In some cases, the cells converge in the macular region, as the vitreous body ages and moves outward, forming the vitreous detachment (PVD). PVD can slightly damage the retina, stimulating exudate, inflammatory and, as a result, leukocytosis.

This is how the operation is performed manually:


Cells of this type can form a transparent layer gradually, dragging on and creating tension in the retina, causing it to stick out into folds (macular folds, for example) or even cause swelling or swelling of the macula. The consequence of this process is a distortion of the visual field. Most often, the process first occurs in one eye and can lead to binocular diplopia or double vision in the eyes, if the image from one eye is very different from the other. Distortion can make objects different in size. In people under the age of 50, these cells can decay on their own. Unfortunately, in most patients over 60, the state of these cells remains constant.

And this is how the robot performs the operation:


If the operation is performed manually by the surgeon, then even the pulse affects the movements of the person. Therefore, surgeons have to monitor the pulse and their actions, synchronizing them. This, of course, is very uncomfortable. The robot also simplifies the operation, increasing the accuracy of the human surgeon.

To control the R2D2 machine, the doctor uses a touchscreen and a joystick . A magnified image of the area of ​​operation is displayed in front of the surgeon. Until now, a surgical robot capable of performing movements in three dimensions with an accuracy of one thousandth of a millimeter simply did not exist. Scientists from Oxford decided to develop such a device, and implemented their project, which took more than two years. "There is no doubt that now we have determined the future of eye surgery," said the head of the research group after the successful completion of the operation.

“My vision has returned. I am very pleased that the surgery was so successful, and I am proud to have been the first person to undergo this procedure, ”says William Beaver.

According to the surgeons, the developed surgical apparatus can be useful not only for carrying out operations on the elimination of the epiretinal membrane, but also for restoring the vision of a number of patients by introducing stem cells under the retina. For such operations, extremely high precision of the surgeon’s actions is needed

In addition to William Beaver, another 12 people participate in the project. Moreover, the complexity of the operations will only increase - the removal of the membrane is one of the simplest procedures performed using R2D2. In particular, it is planned to carry out an operation with the introduction of a hollow needle under the retina with fluid injection. If the operation is successful, it will open the possibility of mass procedures of gene therapy of the retina. This is a promising direction of eye surgery, which allows to treat blindness of some types. According to surgeons, this type of therapy can help treat retinitis pigmentosa . It is a hereditary, degenerative eye disease that causes severe visual impairment and often blindness.

The disease is a form of retinal dystrophy that is caused by abnormalities of photoreceptors (rods and cones) or retinal pigment epithelium (RPE). Often, this leads to progressive loss of vision. People with retinitis pigmentosa may experience a so-called defective adaptation from light to dark, from dark to light or nyctalopy (night blindness), as a result of the degeneration of the peripheral visual field (tunnel vision). In some cases, the central vision is lost first, forcing a person to look askance at objects.

Now robotics is used in many areas of medicine. Developed new devices and systems that allow for surgical operations with unprecedented accuracy.