RESUMO
Surgical robots have the advantages of high precision,high flexibility,high repeatability,and merging with minimally invasive surgery to solve the shortcomings of traditional minimally invasive surgery,and gradually into all fields of medicine.Foreign scholars have extensive research on medical surgical robots.Currently,Da Vinci surgical robots are the most widely used and most mature surgical robot system.Although our scholars started later,they also successfully developed a corneal transplant robot,MiaoShou-A robot,robotic vitreoretinal microsurgery system and so on.At present,Robot-assisted surgery are widely used in various medical fields,which has also been used in ophthalmology.Robot-assisted surgery can reduce the physiological tremor of the surgeon;improve surgical stability and accuracy;shorten the learning curve and so on.At present,Da Vinci surgical robots can perfectly complete the ocular surface surgery such as suturing of the corneal laceration,corneal whole-layer transplantation,amniotic membrane transplantation and pterygium excision.The corneal transplantation microsurgery robot developed by our country can also complete corneal looping incision and suturing of the corneal.As Da Vinci surgical robots have some limitations and can't be well used in complex intraocular surgery such as vitreoretinal surgery.Handheld robot system,steady-hand robot system,master-slave robot system and various kinds of robots based on these systems are used in intraocular surgery.The pars plana vitrectomy (PPV),retinal foreign body Removal,retinal vascular sheath sclerosis,retinal vascular cannulation had successfully performed in harvested porcine eyes and endolaser for retinal photocoagulation was done in Irish rabbit.It offers the possibility for future intraocular surgery with robot-assisted.At the same time,wider application research of robotic surgery and improvement of a robotic system should be continued.
RESUMO
Objective To observe the preliminary application of intraoperative optical coherence tomography (iOCT) in vitreous retinal surgery and the influencing factors of the imaging quality.Methods A retrospective case study.A total of 132 subjects were chosen in June 2015 and April 2016 in our hospital.All the subjects were taken vitreous retinal surgery and iOCT scanning.The patients included 46 males and 86 females,with an average age of 61.7 years.111 cases had macular diseases and 21 cases had vitreous hemorrhage.Cases are divided into high myopia and non high myopia group according to ocular axial length (AL),28 eyes in high myopia group (AL≥26 mm),104 eyes in non-high myopia (AL＜26 mm).The scanning time,image quality and eye conditions were observed during the operation.The discordance between surgeon microscope visualization of the pathology and the findings of the iOCT and the postoperative adverse reactions were also observed.Results The iOCT images were identified in 124 of 132 subjects,while were not identified in 8 eyes.For the macular area morphology change,iOCT tips and surgeon judgment rate was inconsistent in 22 eyes (16.7％).For the operation guidance value,change the operation rate of 12/132,accounted for 9.1％.The iOCT imaging quality of high myopia groups was lower than the non-high myopia groups (x2-17.13,P=0.001).Corneal edema and operation time were considered as influencing factors on the quality of the imaging in the non-high myopia groups (r =3.75,6.18;P 0.049,0.013).There were no complications such as endophthalmitis.Conclusions The surgeon can observe morphological changes in the macular area through iOCT which is difficult to be observed by operating microscope and selected reasonable operation method during the surgery.High myopia,corneal edema and operation time affect the image quality.
