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Ex-vivo experiments with a microrobotic surgical system for vitreo-retinal surgery

Citation for published version (APA):

Meenink, H. C. M., Naus, G. J. L., Beelen, M. J., Steinbuch, M., Rosielle, P. C. J. N., & Smet, de, M. D. (2012). Ex-vivo experiments with a microrobotic surgical system for vitreo-retinal surgery. E-Abstract 3789-. Poster session presented at conference; Annual meeting: Association for Research in Vision and Ophthalmology; 2012-05-05; 2012-05-11.

Document status and date: Published: 01/01/2012

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3789

3789

3789

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Wi h A Mi

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*Thijs Meenink MSc PhD

Ex vivo Experiments With A Microrobotic Surgical System For Vitreo retinal Surgery

Department of Mechanical Engineeringj

Ex‐vivo Experiments With A Microrobotic Surgical System For Vitreo‐retinal Surgery

Department of Mechanical Engineering C t l S t T h l

Ex vivo Experiments With A Microrobotic Surgical System For Vitreo retinal Surgery

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Control Systems Technology group PO Box 513,  Gem‐N ‐1.62

* 5600 MB Eindhoven

Thijs MEENINK

1‐*

Gerrit NAUS

1

Maarten Beelen

1

Maarten STEINBUCH

1

Nick ROSIELLE

1

and Marc DE SMET

2‐3 5600 MB EindhovenThe Netherlands

Thijs MEENINK , Gerrit NAUS , Maarten Beelen , Maarten STEINBUCH , Nick ROSIELLE and Marc DE SMET

The Netherlands

1 Mechanical Engineering Technische Universiteit Eindhoven Eindhoven The Netherlands; 2 Retina & Inflammation Unit Montchoisi Clinique Lausanne Switzerland; 3 University of Amsterdam The Netherlands Tel. +31 40 247 4789 1. Mechanical Engineering, Technische Universiteit Eindhoven, Eindhoven, The Netherlands; 2. Retina & Inflammation Unit, Montchoisi Clinique, Lausanne, Switzerland;  3. University of Amsterdam, The Netherlands

Fax. +31 40 246 1418 Fax. +31 40 246 1418 h c m meenink@tue nl h.c.m.meenink@tue.nl

Figure 1 Experimental setup of the PRECEYES robotic system

Ab

Figure 1. Experimental setup of the PRECEYES robotic system.

Abstract

The

P

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EYE

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robotic system for vitreoretinal surgery

Abstract

The 

P

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EYE

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robotic system for vitreoretinal surgery

Purpose

Purpose

p

D l t i it ti l li it d b

Developments in vitreoretinal eye surgery are limited byp y g y y

Introduction

h biliti T i t it ti l i l

Introduction

human capabilities. To improve current vitreoretinal surgicalp p g The PRECEYES robotic system consists of a master console operated by the surgeon that controls

d d t bl d b ti t The PRECEYES robotic system consists of a master console operated by the surgeon that controls

procedures and to enable new procedures, a robotic system two robotic arms (slave) which perform the actual surgery (Meenink 2011; Hendrix 2011 Figure

p p , y

has been developed called PRECEYES extending human two robotic arms (slave) which perform the actual surgery (Meenink, 2011; Hendrix, 2011, Figure

has been developed calledp PRECEYES, extending humang 1) The haptic interfaces of the master console provide the motion reference for the instrument

capabilities 1). The haptic interfaces of the master console provide the motion reference for the instrument

capabilities.p manipulators of the slave system (Figure 3) The slave system performs the actual surgery bymanipulators of the slave system (Figure 3). The slave system performs the actual surgery by

controlling instrument manipulators that directly handle the instruments A comfortable and

M th d

controlling instrument manipulators that directly handle the instruments. A comfortable and

Methods

intuitive working environment is created by manipulating the haptic interfaces to simulate the

Methods

l h h b l

intuitive working environment is created by manipulating the haptic interfaces to simulate the

A compact, lightweight, easy to setup robotic master‐slave instrument tip inside the eye (figure 2) The PRECEYES robotic system is designed compact

A compact, lightweight, easy to setup robotic master slave

h b li d f i i l

instrument tip inside the eye (figure 2). The PRECEYES robotic system is designed compact,

system has been realized to perform vitreo‐retinal eye surgery lightweight and easy to setup to fit the current OR layout With the PRECEYES robotic system

system has been realized to perform vitreo retinal eye surgery

( Fi 1 3) Th ’ h h j f

lightweight and easy to setup to fit the current OR layout. With the PRECEYES robotic system

(see Figure 1‐3). The system’s reach covers the major part of instruments can be changed automatically hand tremor can be filtered out movements can be

(see Figure 1 3). The system s reach covers the major part of

h i i ( h i h l i ) A

instruments can be changed automatically, hand tremor can be filtered out, movements can be

the vitreous cavity (up to the peripheral region). A scaled, which allows µm precise movements. This could enable procedures as retinal vein

the vitreous cavity (up to the peripheral region). A

bi i f d d h i l d l d i

scaled, which allows µm precise movements. This could enable procedures as retinal vein

combination of advanced mechanical and control designg cannulation for treating CRVO and BRVO

f ilit t hi h ( 10 ) t di h biliti

cannulation for treating CRVO and BRVO.

facilitates high accuracy (<10µm) extending human capabilitiesg y ( µ ) g p

d i ifi t ti i Th d d ibilit f

and significant time saving. The accuracy and reproducibility ofg g y p y

System evaluation

th t lid t d i b h i t i l di

System evaluation

the system are validated via bench experiments, includingy p , g The compact lightweight and easy to setup design contributes to a fast installation The time to

i ti d i k d l t Vit ti l i l The compact, lightweight and easy to setup design contributes to a fast installation. The time to

pointing and pick‐and‐place movements. Vitreo‐retinal surgical prepare a surgical table (Maquet 1120) with the PRECEYES and to activate it takes only a few

p g p p g

d i l t d i d l d i prepare a surgical table (Maquet 1120) with the PRECEYES and to activate it takes only a few

procedures were simulated in an eye model, eggs and porcine minutes Using a laserfibrometer (Polytec OVF 5000 with OVF 552 at 500 µm/V) the

p y , gg p

i i i t Th i t i l d l minutes. Using a laserfibrometer (Polytec OVF‐5000 with OVF‐552, at 500 µm/V), the

eyes via ex‐vivo experiments. The experiments include cannulay p p repeatability and smallest step accuracy was measured at the instrument tip at 25 mm insertion

placement vitrectomy and membrane peeling repeatability and smallest step accuracy was measured at the instrument tip at 25 mm insertion

placement, vitrectomy and membrane peeling. depth The result was an intrinsic accuracy of < 10 µm which corresponds to the requirements

p , y p g depth. The result was an intrinsic accuracy of < 10 µm, which corresponds to the requirements.

φ

R

lt

φ

Results

User tests

Results

f ll f l l b f l

User tests

A fully functional master‐slave robotic system for vitreo‐retinal Θ,Z The first user tests included a training program with simple tasks on paper and more advanced

A fully functional master slave robotic system for vitreo retinal

h b l d f l h φ Ψ The first user tests included a training program with simple tasks on paper and more advanced

eye surgery has been realized. First functional tests show a Ψ i l t k hi k h ig p gll t i b p (L 2004) Th t tp p h

eye surgery has been realized. First functional tests show a

h i i i i i bi i i h d surgical tasks on a chicken egg chorioallantoic membrane (Leng, 2004). The tests show an

short setup time, an intuitive usage in combination with good Ψ intuitive usage combined with good ergonomics and satisfactory instrument reach and accuracyg gg ( g )

short setup time, an intuitive usage in combination with good

i d i f i h d intuitive usage combined with good ergonomics and satisfactory instrument reach and accuracy.

ergonomics and satisfactory instrument reach and accuracy.g y y User tremor is effectively filtered and a motion scaling of 10 to 40 times was consideredg g g

Si l ti f it ti l i l d i di t User tremor is effectively filtered and a motion scaling of 10 to 40 times was considered

Simulation of vitreo‐retinal surgical procedures indicates adequate The intuitive usage resulted in a short learning curve; users adapt in minutes and are

Simulation of vitreo retinal surgical procedures indicates

i d d i ffi i d adequate. The intuitive usage resulted in a short learning curve; users adapt in minutes and are

improved accuracy and time efficient surgery compared top y g y p able to perform surgical tasks successfully within an hour of first usage Pointing tasks on

l able to perform surgical tasks successfully within an hour of first usage. Pointing tasks on

manual surgery. virtual squared mm paper show an accuracy down to 38 µm ±28 µm The accuracy of these tasks is

Θ Z

g y squared mm‐paper show an accuracy down to 38 µm ±28 µm. The accuracy of these tasks is

entry point Θ,Z

limited by the magnification of the currently implemented visualization system (Sony A33 with

entry point

C

l i

limited by the magnification of the currently implemented visualization system (Sony A33 with

Conclusion

90mm macro lens projected onto a 24”HD monitor)

Conclusion

90mm macro lens, projected onto a 24 HD monitor).

Figure 3 Realized robotic slave setup with two instrument

Figure 2 Similar movements of the haptic interface

A microrobotic surgical system for vitreo‐retinal surgery is Figure 2. Similar movements of the haptic interfaced h i ib Figure 3. Realized robotic slave setup with two instrument

A microrobotic surgical system for vitreo retinal surgery is and the instrument contribute to an manipulators

realized that meets the requirements and constraints imposed

E

i

i

p intuitive usage

realized that meets the requirements and constraints imposed

Ex‐vivo experiments

intuitive usage.

by this type of specialized surgery First functional tests

Ex vivo experiments

by this type of specialized surgery. First functional tests

The chorioallantoic membrane (CAM) of chicken eggs is used as a model to practice surgical

validate the realization of these requirements and constraints The chorioallantoic membrane (CAM) of chicken eggs is used as a model to practice surgical

validate the realization of these requirements and constraints,

tasks see Figure 4 and 5; the transparent membrane in the right image The CAM of chicken eggs

improving current vitreo‐retinal surgical procedures in time tasks, see Figure 4 and 5; the transparent membrane in the right image. The CAM of chicken eggs

improving current vitreo retinal surgical procedures in time

is commonly used as a model for the retina as the membrane has similar characteristics as the

efficiency and accuracy, and enabling new, high‐precision is commonly used as a model for the retina as the membrane has similar characteristics as the

efficiency and accuracy, and enabling new, high precision

d retina (Leng 2004) The first task involved peeling of the white inner shell membrane from the

procedures. retina (Leng, 2004). The first task involved peeling of the white inner shell membrane from the

procedures.

underlying CAM With a knife and pick the peel was successfully executed on the first attempt It underlying CAM. With a knife and pick, the peel was successfully executed on the first attempt. It was performed within 2 minutes and without any complications such as bleeding. Similar results

R f

was performed within 2 minutes and without any complications such as bleeding. Similar results

References

were realized using forceps to peel the membrane (Figure 4). After removing a piece of the inner

References

H d i R (2011) R b ti i t d A h ti t l PhD th i were realized using forceps to peel the membrane (Figure 4). After removing a piece of the inner

h ll b d h l l l d f ll

Hendrix, R. (2011), Robotic assisted eye surgery. A haptic master console, PhD thesis

shell membrane and exposing the CAM, retinal vein cannulation was simulated successfully to

(supervisors: Nijmeijer, H., Steinbuch, M.), Eindhoven University of Technology, Eindhoven, shell membrane and exposing the CAM, retinal vein cannulation was simulated successfully to

h h h d d ( ) h f h

( p j j , , , ), y gy, , the Netherlands

the veins on the CAM, having a diameter down to 35 µm (Figure 5). The outcome of these

the Netherlands

Meenink H C M (2011) Vitreo retinal eye surgery robot: sustainable precision PhD thesis the veins on the CAM, having a diameter down to 35 µm (Figure 5). The outcome of these

i l k i i b i i h i i

Meenink, H.C.M. (2011), Vitreo‐retinal eye surgery robot: sustainable precision, PhD thesis

surgical tasks were consistent in subsequent experiments with various users. Ex‐vivo

(supervisors: Steinbuch, M., De Smet, M.D.), Eindhoven University of Technology, Eindhoven, g q p

i t i h d t d t ti i t t th t i t th h th

the Netherlands.

experiments on porcine eyes showed a steady rotation point at the entry point through the pars‐

the Netherlands.

Leng T Miller J M Bilbao K V Palanker D V Huie P and Blumenkranz M S (2004) The experiments on porcine eyes showed a steady rotation point at the entry point through the pars

l d i f d

Leng, T., Miller, J.M., Bilbao, K.V., Palanker, D.V., Huie, P. and Blumenkranz, M.S. (2004), The

Figure 5 Vein cannulation at a chicken CAM

Figure 4 Peeling of the inner white shell membrane plana and a vitrectomy was performed.

chick chorioallantoic membrane as a model tissue for surgical retinal research and simulation, Figure 4. Peeling of the inner white shell membrane Figure 5. Vein cannulation at a chicken CAM. plana and a vitrectomy was performed.

24(3): 427‐434 from a chicken CAM.

24(3): 427 434 f

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