Several 10-0 nylon filament sutures were placed to close each corneal and scleral wound. Robotic external ocular surgery was performed with robotic arms each equipped with sterile Black Diamond microforceps (Intuitive Surgical). All procedures were performed by an experienced retinal surgeon with no prior practice in robotic surgery. Viewing the operative field via a 3-D image and placing the hands on the master controls below the display, the surgeon was seated comfortably. The surgical console was located approximately 15 feet from the surgical table and robotic arms. The robotic arms were placed on either side of the globe at approximately 45ยก angles, resembling the approach used by an operating surgeon. Visualization of the eye was achieved with the 3-D endoscope placed above the globe in the midline, thus mimicking the axis of standard ocular surgery using an operating microscope. The initial step was to manually inflate the eye with balanced salt solution to reach good intraocular pressure. The head was placed on a surgical table positioned directly under the robotic apparatus. All the experiments were performed on harvested porcine eyes secured with pins on a Styrofoam mannequin head in the anatomic position. 17-19 First-time demonstrations of external ocular surgery (corneal and scleral wounds), anterior segment surgery (foreign body removal and capsulorrhexis), and posterior segment surgery (25-gauge vitrectomy) while utilizing the da Vinci surgical robot have been performed at the Center for Advanced Surgical and Interventional Technology at the University of California, Los Angeles. Recently, the feasibility and applicability of robotic ocular surgery were analyzed through a series of pioneering studies. Advantages of robotic surgery include increased precision, improved range of motion, elimination of tremor, ability to maneuver in small anatomic spaces, and surgeon safety. Robotic surgery addresses some of the limitations of traditional surgery, allowing the completion of advanced procedures. The robotic arms can be equipped with a variety of instrumentation to allow for specialized surgical procedures. ![]() The robotic arms are capable of tilt in two planes, achieved with two "elbow" joints. The architecture of the instruments and the da Vinci system allows the surgeon to insert, extract, roll, pitch, yaw, and grip with the robotic tools. The processor eliminates tremors and minor movements. There is no measurable delay between the movement of the surgeon's controls and the mirrored movement of the robot apparatus. The surgeon manipulates the controls using fingers, wrists, hands, and arms, while a computer processor filters, scales, and relays the movements to the robotic arms and instruments (Figure 4). An ocular viewfinder on the console provides a stereoscopic view of the operative field from the endoscope (Figure 3). The da Vinci Surgical System consists of two primary components, a control console that allows the surgeon to manipulate the robotic arms remotely (Figure 1), and the robotic apparatus with three arms (or four arms in a recent addition) that holds a dual-channel endoscope (Figure 2). ![]() 8-10 Multiple robotic surgical systems have been developed over the years, and the current standard is the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA). Since then, robotic surgical systems have proliferated 1 in several disciplines such as urologic surgery, 2-5 gynecologic surgery, 6,7 and cardiovascular surgery. Robotic systems have been utilized in the surgical environment for more than 15 years. Innovations in ophthalmology have expanded greatly in recent years, and we believe that the next major advancement in ophthalmology will be the integration of robotic surgery.
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