The Robotic Revolution in Cataract Surgery
Benefits from robotics system expected to have revolutionary impact on multiple fronts.
Cheryl Guttman Krader
Published: Friday, December 1, 2023
Robotics-assisted cataract surgery can lead to better surgical outcomes, improved surgeon performance, opened doors to new surgical manipulations, increased patient throughput, and eventually lower surgery costs, according to Jean-Pierre Hubschman MD.
“Although there is currently perfect visualisation and high manoeuvrability in cataract surgery, robotics technology can help address multiple existing challenges and improve every surgical step,” said Dr Hubschman.
“Robotics-assisted cataract surgery also provides a solution for overcoming the current and increasing gap in supply and demand for cataract surgery services, as well as democratise superior outcomes by negating the impact of differences in surgeon skill sets.”
Dr Hubschman is co-founder of a company developing a fully integrated, image-guided, artificial intelligence-enabled microsurgery platform for cataract surgery. Named Polaris, the system reconstructs anatomy in real time and proposes a trajectory supervised and validated by the surgeon before being executed autonomously by the robotic platform.
Technical groundwork for the system began 14 years ago at UCLA, where Dr Hubschman is a faculty member in the ophthalmology and engineering departments. The platform has demonstrated capability for performing cornea incision, viscoelastic injection, lens extraction, and IOL implantation and achieved promising outcomes in preclinical research conducted in cadaver and porcine eyes.
Although details about the system remain confidential, Dr Hubschman said it combines four major components - microsurgical robotic arms that allow for more precise and accurate manipulations; image guidance combining optical coherence tomography, a digital microscope, and other sensors that reconstruct anatomy in real time; machine learning allowing for real-time tissue differentiation and continuous improvement; and automation for increased throughput and consistent outcomes.
Outperform human surgeons?
“Whether considering sensing, processing, or precision, the robotics system can outperform human surgeons on every metric,” Dr Hubschman said.
Comparisons between human surgeons and the robotics system show the maximum achieved precision for humans is 80 microns versus less than 5 microns for the robotics system. The robotic technology’s reaction time of less than 20 milliseconds far exceeds the 250-millisecond time for humans. The robotics system also overcomes human limitations in visualising microanatomy and depth perception sensing through its ability to simultaneously process input from multimodal imaging and provide much better detection of all anatomy.
“With its level of visualisation and precision, we believe this technology can drastically reduce the rate of posterior capsule rupture, allow for much better cleaning of the capsular bag, and achieve better refractive outcomes through a more accurate selection and positioning of the IOL,” he said.
Assuring colleagues that a robotics platform will not circumvent their role, he noted that even though it performs all steps autonomously, it does so with human supervision.
“This technology will not replace surgeons but allow them to do a better job and [perform] more surgeries in a shorter period,” Dr Hubschman emphasised.
“Surgery is an art, and today, depending on the surgeon, the outcomes may be very different from one to another. With robotics technology, we can make cataract surgery a science and allow every patient and every surgeon to achieve the best care.”
Dr Hubschman spoke during the 2023 ESCRS Congress in Vienna.
Jean-Pierre Hubschman MD is Professor in Ophthalmology and Mechanical and Aerospace Engineering, UCLA and chief executive officer and co-founder of Horizon Surgical Systems, Los Angeles, California, US.
Mapinduzi ya roboti katika upasuaji wa cataract Faida kutoka kwa mfumo wa roboti inatarajiwa kuwa na athari ya mapinduzi katika pande nyingi. Upasuaji wa cataract unaosaidiwa na roboti unaweza kusababisha matokeo bora ya upasuaji, utendaji bora wa daktari wa upasuaji, kufungua milango kwa udhibiti mpya wa upasuaji, kuongeza upatikanaji wa mgonjwa, na hatimaye kupunguza gharama za upasuaji, kulingana na Daktari Jean-Pierre Hübschmann. "Ijapokuwa kwa sasa kuna visualization kamili na maneuverability ya juu katika upasuaji wa cataract, teknolojia ya roboti inaweza kusaidia kushughulikia changamoto nyingi zilizopo na kuboresha kila hatua ya upasuaji, "alisema Dk Hubschman. "Upasuaji wa cataract unaosaidiwa na roboti pia hutoa suluhisho la kushinda pengo la sasa na kuongezeka kwa mahitaji ya huduma za upasuaji wa cataract, na pia kuunda matokeo bora kwa kukataa athari za tofauti katika seti za ustadi wa daktari wa upasuaji. "" - Dr. Hubschman, mwanzilishi mwenza wa kampuni inayoendeleza jukwaa la upasuaji mdogo wa picha iliyoongozwa na akili bandia kwa upasuaji wa cataract." Mfumo huo unaoitwa Polaris, unarudisha anatomia kwa wakati halisi na kupendekeza mwendo unaosimamiwa na kuthibitishwa na daktari wa upasuaji kabla ya kutekelezwa kwa kujitegemea na jukwaa la roboti. Kazi ya msingi ya kiufundi ya mfumo huo ilianza miaka 14 iliyopita katika UCLA, ambapo Dk Hubschman ni mwanachama wa kitivo katika idara za ophthalmology na uhandisi. Programu hiyo imethibitisha uwezo wa kufanya upasuaji wa cornea, sindano ya viscoelastic, uchimbaji wa lensi, na upandikizaji wa IOL na imepata matokeo ya kuahidi katika utafiti wa kabla ya kliniki uliofanywa katika maiti na macho ya nguruwe. Ingawa maelezo kuhusu mfumo huo bado ni siri, Dr. Hubschman alisema unajumuisha vipengele vinne vikuu: mikono ya roboti ya microsurgical ambayo inaruhusu udhibiti sahihi zaidi na sahihi; mwongozo wa picha unaounganisha tomografia ya mwelekeo wa macho, darubini ya dijiti, na sensorer nyingine ambazo huunda upya anatomia kwa wakati halisi; kujifunza mashine kuruhusu tofauti ya tishu ya wakati halisi na uboreshaji wa kuendelea; na automatisering kwa kuongeza throughput na matokeo thabiti. Kufaulu kuliko madaktari wa upasuaji wa kibinadamu? "Iwe ni kuzingatia kuhisi, usindikaji, au usahihi, mfumo wa roboti inaweza outperform madaktari wa upasuaji wa binadamu juu ya kila kipimo, "Dakt. Hubschman alisema. Ulinganisho kati ya madaktari wa upasuaji wa binadamu na mfumo wa roboti unaonyesha usahihi wa juu uliopatikana kwa wanadamu ni microns 80 dhidi ya chini ya microns 5 kwa mfumo wa roboti. Wakati wa majibu ya roboti ni chini ya milisekunde 20, ambayo ni zaidi ya milisekunde 250 kwa binadamu. Mfumo wa roboti pia hupita mapungufu ya kibinadamu katika kuona microanatomy na utambuzi wa kina kupitia uwezo wake wa kusindika pembejeo kutoka kwa picha za multimodal na kutoa utambuzi bora zaidi wa anatomy. "Kwa kiwango chake cha kuona na usahihi, tunaamini teknolojia hii inaweza kupunguza sana kiwango cha kuvunjika kwa capsule ya nyuma, kuruhusu kusafishwa bora zaidi kwa mfuko wa capsular, na kufikia matokeo bora ya refractive kupitia uteuzi sahihi zaidi na nafasi ya IOL. """ Aliwahakikishia wenzake kwamba jukwaa la roboti halitazunguka jukumu lao, alisema kwamba ingawa hufanya hatua zote kwa kujitegemea, inafanya hivyo kwa usimamizi wa binadamu. "Teknolojia hii haitabadilisha madaktari wa upasuaji lakini itawaruhusu kufanya kazi bora na [kufanya] upasuaji zaidi katika kipindi kifupi", Dk Hubschman alisisitiza. Upasuaji ni sanaa, na leo, ikitegemea daktari-mpasuaji, matokeo yaweza kutofautiana sana kutoka kwa mmoja hadi mwingine. "Kwa teknolojia ya roboti, tunaweza kufanya upasuaji wa cataract kuwa sayansi na kuruhusu kila mgonjwa na daktari wa upasuaji kupata huduma bora. "" - Dr. Hubschman, Mkurugenzi Mtendaji wa Chuo Kikuu cha Vienna, Vienna, 2023." Jean-Pierre Hübschmann, MD, ni Profesa wa Ophthalmology na Uhandisi wa Mashine na Aerospace, UCLA, na Mkurugenzi Mtendaji na Mwanzilishi mwenza wa Horizon Surgical Systems, Los Angeles, California, USA.