160 research outputs found
Optical coherence tomography-based consensus definition for lamellar macular hole.
BackgroundA consensus on an optical coherence tomography definition of lamellar macular hole (LMH) and similar conditions is needed.MethodsThe panel reviewed relevant peer-reviewed literature to reach an accord on LMH definition and to differentiate LMH from other similar conditions.ResultsThe panel reached a consensus on the definition of three clinical entities: LMH, epiretinal membrane (ERM) foveoschisis and macular pseudohole (MPH). LMH definition is based on three mandatory criteria and three optional anatomical features. The three mandatory criteria are the presence of irregular foveal contour, the presence of a foveal cavity with undermined edges and the apparent loss of foveal tissue. Optional anatomical features include the presence of epiretinal proliferation, the presence of a central foveal bump and the disruption of the ellipsoid zone. ERM foveoschisis definition is based on two mandatory criteria: the presence of ERM and the presence of schisis at the level of Henle's fibre layer. Three optional anatomical features can also be present: the presence of microcystoid spaces in the inner nuclear layer (INL), an increase of retinal thickness and the presence of retinal wrinkling. MPH definition is based on three mandatory criteria and two optional anatomical features. Mandatory criteria include the presence of a foveal sparing ERM, the presence of a steepened foveal profile and an increased central retinal thickness. Optional anatomical features are the presence of microcystoid spaces in the INL and a normal retinal thickness.ConclusionsThe use of the proposed definitions may provide uniform language for clinicians and future research
Microsurgery robots: addressing the needs of high-precision surgical interventions
Robots can help surgeons perform better quality operations, leading to reductions in the hospitalisation time of patients and in the impact of surgery on their postoperative quality of life
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Semiautomated optical coherence tomography-guided robotic surgery for porcine lens removal.
PurposeTo evaluate semiautomated surgical lens extraction procedures using the optical coherence tomography (OCT)-integrated Intraocular Robotic Interventional Surgical System.SettingStein Eye Institute and Department of Mechanical and Aerospace Engineering, University of California, Los Angeles, USA.DesignExperimental study.MethodsSemiautomated lens extraction was performed on postmortem pig eyes using a robotic platform integrated with an OCT imaging system. Lens extraction was performed using a series of automated steps including robot-to-eye alignment, irrigation/aspiration (I/A) handpiece insertion, anatomic modeling, surgical path planning, and I/A handpiece navigation. Intraoperative surgical supervision and human intervention were enabled by real-time OCT image feedback to the surgeon via a graphical user interface. Manual preparation of the pig-eye models, including the corneal incision and capsulorhexis, was performed by a trained cataract surgeon before the semiautomated lens extraction procedures. A scoring system was used to assess surgical complications in a postoperative evaluation.ResultsComplete lens extraction was achieved in 25 of 30 eyes. In the remaining 5 eyes, small lens pieces (≤1.0 mm3) were detected near the lens equator, where transpupillary OCT could not image. No posterior capsule rupture or corneal leakage occurred. The mean surgical duration was 277 seconds ± 42 (SD). Based on a 3-point scale (0 = no damage), damage to the iris was 0.33 ± 0.20, damage to the cornea was 1.47 ± 0.20 (due to tissue dehydration), and stress at the incision was 0.97 ± 0.11.ConclusionsNo posterior capsule rupture was reported. Complete lens removal was achieved in 25 trials without significant surgical complications. Refinements to the procedures are required before fully automated lens extraction can be realized
Healthcare Robotics
Robots have the potential to be a game changer in healthcare: improving
health and well-being, filling care gaps, supporting care givers, and aiding
health care workers. However, before robots are able to be widely deployed, it
is crucial that both the research and industrial communities work together to
establish a strong evidence-base for healthcare robotics, and surmount likely
adoption barriers. This article presents a broad contextualization of robots in
healthcare by identifying key stakeholders, care settings, and tasks; reviewing
recent advances in healthcare robotics; and outlining major challenges and
opportunities to their adoption.Comment: 8 pages, Communications of the ACM, 201
Haptics in Robot-Assisted Surgery: Challenges and Benefits
Robotic surgery is transforming the current surgical practice, not only by improving the conventional surgical methods but also by introducing innovative robot-enhanced approaches that broaden the capabilities of clinicians. Being mainly of man-machine collaborative type, surgical robots are seen as media that transfer pre- and intra-operative information to the operator and reproduce his/her motion, with appropriate filtering, scaling, or limitation, to physically interact with the patient. The field, however, is far from maturity and, more critically, is still a subject of controversy in medical communities. Limited or absent haptic feedback is reputed to be among reasons that impede further spread of surgical robots. In this paper objectives and challenges of deploying haptic technologies in surgical robotics is discussed and a systematic review is performed on works that have studied the effects of providing haptic information to the users in major branches of robotic surgery. It has been tried to encompass both classical works and the state of the art approaches, aiming at delivering a comprehensive and balanced survey both for researchers starting their work in this field and for the experts
Robot Autonomy for Surgery
Autonomous surgery involves having surgical tasks performed by a robot
operating under its own will, with partial or no human involvement. There are
several important advantages of automation in surgery, which include increasing
precision of care due to sub-millimeter robot control, real-time utilization of
biosignals for interventional care, improvements to surgical efficiency and
execution, and computer-aided guidance under various medical imaging and
sensing modalities. While these methods may displace some tasks of surgical
teams and individual surgeons, they also present new capabilities in
interventions that are too difficult or go beyond the skills of a human. In
this chapter, we provide an overview of robot autonomy in commercial use and in
research, and present some of the challenges faced in developing autonomous
surgical robots
Cable-driven parallel robot for transoral laser phonosurgery
Transoral laser phonosurgery (TLP) is a common surgical procedure in otolaryngology.
Currently, two techniques are commonly used: free beam and fibre delivery. For free beam
delivery, in combination with laser scanning techniques, accurate laser pattern scanning can
be achieved. However, a line-of-sight to the target is required. A suspension laryngoscope is
adopted to create a straight working channel for the scanning laser beam, which could
introduce lesions to the patient, and the manipulability and ergonomics are poor. For the fibre
delivery approach, a flexible fibre is used to transmit the laser beam, and the distal tip of the
laser fibre can be manipulated by a flexible robotic tool. The issues related to the limitation
of the line-of-sight can be avoided. However, the laser scanning function is currently lost in
this approach, and the performance is inferior to that of the laser scanning technique in the
free beam approach.
A novel cable-driven parallel robot (CDPR), LaryngoTORS, has been developed for TLP.
By using a curved laryngeal blade, a straight suspension laryngoscope will not be necessary
to use, which is expected to be less traumatic to the patient. Semi-autonomous free path
scanning can be executed, and high precision and high repeatability of the free path can be
achieved. The performance has been verified in various bench and ex vivo tests. The technical
feasibility of the LaryngoTORS robot for TLP was considered and evaluated in this thesis.
The LaryngoTORS robot has demonstrated the potential to offer an acceptable and feasible
solution to be used in real-world clinical applications of TLP.
Furthermore, the LaryngoTORS robot can combine with fibre-based optical biopsy
techniques. Experiments of probe-based confocal laser endomicroscopy (pCLE) and
hyperspectral fibre-optic sensing were performed. The LaryngoTORS robot demonstrates the
potential to be utilised to apply the fibre-based optical biopsy of the larynx.Open Acces
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