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Subretinal injection is a delicate and complex microsurgery. The main surgical difficulties come from the surgeon's hand tremor, dexterous motion, and insufficient visual feedback. In order to begin addressing these challenges, this article presents a robot system for subretinal insertion integrated with intraoperative optical coherence tomography (OCT). The surgical workflow using this system consists of two main parts. The first part is the manual robot control, which aims the target before approaching the retinal surface, while considering the remote center of motion (RCM) constraint. When the injection area has been located precisely, needle is inserted into retina. To ensure surgical safety, needle insertion depth is estimated using OCT images on a continuous basis. A soft RCM control method is designed and integrated for the controller of our hybrid parallel-serial surgical robot. Safety and accuracy performance evaluation with a 15-ms control loop shows that the worst-case RCM deviation error is within 1 mm. Experimental results demonstrated that the proposed system has the ability to improve surgical outcomes by surgeons overcoming their physical limitations in order to enable a better dexterous motion, and furthermore enhancing their visual feedback for a better intraocular perception.
Zhou et al. (Wed,) studied this question.