Early Study Shows Promise for Head-Mounted Retinal Surgery Robot

Researchers at the University of Utah’s John A. Moran Eye Center and John and Marcia Price College of Engineering reported Feb. 19 that they have collaborated to create a new robotic surgery device that aims to give surgeons “superhuman” hands. 

The robot can execute movements as small as 1 micrometer, or smaller than a single human cell. The device is small enough to be mounted directly to the patient’s head using a helmet.

Once the helmet is in place, the robot can compensate for movements of the patient’s head. The robot also scales down the surgeon’s movements, transmitted through a joystick, to the much-smaller surgical site within the eye, and compensate for any hand tremors.  

The device aims to improve outcomes for patients and support cutting-edge procedures such as the delivery of gene therapies for inherited retinal diseases. 

The researchers successfully tested the robot using enucleated pig eyes, publishing their results in the journal Science Robotics. The study was led by mechanical engineering Professor Jake Abbott and Moran Eye Center retina specialist Paul S. Bernstein, MD, PhD. Co-authors included Aaron Nagiel, MD, PhD, of the University of Southern California, who has performed several procedures with the retinal gene therapy Luxturna.  

Luxturna requires an injection into the space between the retina and the retinal pigment epithelium. In addition to the complications presented by eye movement and hand tremors, this subretinal target is vanishingly small; the surgeon must introduce the drug between two submillimeter-thin cell layers.   

Because the robotic device is not yet approved to operate on human subjects, testing required a human volunteer fitted with special goggles that allowed a pig eye to be mounted just in front of the volunteer’s natural eye. This allowed the researchers to test the robot’s ability to compensate for head motion and correct for hand tremors, all while operating on animal tissue, and with no risk to the volunteer. 

The experiments found that the success rate when using the surgical robot was higher than documented manual rates in some studies.

Because only a small number of surgeons are qualified to perform subretinal injections, the device could increase the number of surgeons who can perform them. 

“Retinal surgery is a technically difficult surgery and takes a while to master, so for people in the earlier stages of their career, having robotic assistance can make it safer and more effective,” Bernstein said.