Ophthalmologists come in all shapes and sizes. But this tiny Robotic Retinal Dissection Device (aptly named "R2D2"), is the smallest we've seen so far. What's more, it operates from inside a single hole in your eye, travelling back in and out to make incisions - even as the eye rotates. Read more: Ferdinand Monoyer is the reason your eyesight is measured in decimals
Created by Preceyes BV, a Dutch medical robotics firm, the R2D2 robot debuted in 2016 at Oxford University's Nuffield Laboratory of Ophthalmology, when it was first used by Robert MacLaren to perform surgery on a patient. The robot was remotely controlled to lift a 0.01mm thick membrane from the retina at the back of the right eye of Reverend Dr William Beaver. After the operation, Beaver's membrane growth had been removed and his vision returned to normal. It was the first time the procedure had been used and was highly experimental – essentially guiding a small automated knife with nothing more than a joystick and touchscreen.
The need for an automated surgeon in small-scale surgeries of this kind is to remove the hindrances that plague human surgeons. When operating on the eye, even the slightest tremor of the hand can have unwanted consequences – the potential to damage or tear nerves or retina. The membrane inside the eye has a thickness of 0.01mm.
To put this into perspective, a standard A4 sheet of paper is 0.05mm. Surgeons typically carry out these procedures in the space between heartbeats, literally focusing on slowing their pulse and timing movements between beats to try to control the pulsing of blood through their hands. But controlling the flow of blood within your own body is an unreliable safeguard.
In contrast, a robot doesn't shake, it has no pulse, and its movements are without human frailty. In other words, ask a human to play operation and their tweezers can go astray, either as a result of nerves, poor hand-eye-coordination or just dumb luck. A robot designed with the sole purpose of precision will only follow a set path to a certain goal and (in the case of R2D2) has seven independent computer-controlled motors to guide its way. This isn't to say the R2D2 removes the possibility of error, after all, it is still controlled by a human. But it will carry out surgeries in such minute detail that humans struggle to carry out.
Stage Two of the clinical trial is now underway, where the robot is tasked with placing a fine needle under the retina of the eye and injecting fluid into it.
Patients undergoing one of two operations at the Oxford Eye Hospital have been invited to enrol in the study, including those having epiretinal or inner limiting membrane peels, and those undergoing subretinal haemorrhage displacement surgery. All trial participants are selected on a voluntary basis and are aware that the experimental procedures are performed by a robot.
After completing the first operation, Professor Robert MacLaren said: "There is no doubt in my mind that we have just witnessed a vision of eye surgery in the future."
While it may be a future with a certain Minority Report vibes, it showcases the evolving dynamics between doctors and robots. The Da Vinci Surgical System was approved by the Food and Drug Administration in 2000 and has since found its way into hospitals across the United States and Europe. The system provides a monitor that displays a three-dimensional, high definition of the surgery, as well as a control to operate using a robotic arm. While none of the benefits of robotic surgery can be guaranteed, they are often minimally invasive, able to operate through tiny incisions and can reduce the risk of pain, infection and blood loss.
With this in mind, the potential for small-scale operations, such as those performed by the R2D2, could be a natural partner for more radical treatment methods. Professor MacLaren claims the next phase in the R2D2's development will hopefully tackle a variety of eyesight issues.
"This will help to develop novel surgical treatments for blindness, such as gene therapy and stem cells, which need to be inserted under the retina with a high degree of precision."
This article was originally published by WIRED UK
