A World First
Robots operating on people is a common theme in science fiction—the emergency surgery pod in Prometheus, the birth of Luke and Leia Skywalker, and the Elysium healing pods which magically shoo away any nasty diseases and cancers. The real world, however, has taken its time in catching up to fiction.
But robotic surgeries are just around the corner thanks to a team of surgeons at Oxford’s John Radcliff Hospital. With the help of Oxford University and the creators of a cutting-edge surgical machine—the Preceyes—the world’s first robotic eye surgery took place and has restored the vision of British priest, Bill Beaver.
Robotic eye surgery, a world first. Image courtesy of Oxford University.
Robotic arms and devices are common in large-scale surgeries having to do with the abdominal cavity and lung tissue but are not found in places such as the eye. This is because of the tiny movements required in eye surgery which are not available with most current medical equipment. So what has changed and why was the robot needed?
The Patient and the Operation
The patient, Bill Beaver, had begun to grow a membrane on his retina which distorted the incoming light and began to create a “blur” in the centre of his sight. The membrane was only 100th of a millimetre (10µm) and this would have been difficult to remove for even the steadiest surgeon's hands.
The surgery took place at the end of August and was a complete success with the retina undamaged and his sight restored. A gas bubble did form in his eye which has resulted in short sightedness but this is only temporary.
The patient, Father Bill Beaver. Image courtesy of the BBC.
In order for a surgeon to operate on the eye, they have to time their movements in between heart beats! If you have access to a microscope and try to hold a needle steady you will notice that your heartbeat will move the needle slightly. This is not a problem for repairing an artery, for example, but when you have to remove something that is only 10µm thick, you can imagine that those tiny bumps could be the difference between a successful operation and permanently blinding the patient.
On top of that, all of the surgery has to be done through a 1mm diameter needle while the eye can still move (and does). If that was not bad enough, during the procedure the surgeon has to retract the tool from the eye multiple times throughout the surgery. While it is possible for a surgeon to do this manually, it is a difficult operation to attempt!
An operation in progress. Image courtesy of Merton College, Oxford.
To counteract this issue, a Dutch company has designed a robotic assist called the Robotic Retinal Dissection Device (R2D2). What this machine does is scale down the movements of the surgeon’s hands using seven motors, a controller, and touchscreen. This helps to remove tiny tremors in movement (from breathing or their heartbeat, for example) and thus increase the chance of success significantly.
This machine is being sponsored by the University of Oxford and funded by the NIHR Oxford Biomedical Research Centre.
The robotic needle and controller used in the operation. Image courtesy of the BBC.
Potential Future Applications
This operation represents a significant step for medical engineering. The idea of a machine that can scale down the movements of a surgeon opens up many new opportunities in surgery that did not exist before. But the inventors have bigger plans for this technology. One plan is to use the robot to inject stem cells below the retina to restore sight to those who are blind. While this is possible by hand, the robot would be able to achieve this operation in just 10 minutes (something that is impossible if done by hand).
This robot, itself, is just the beginning of a whole world of potential robotic procedures.
For example, a clot inside the brain cannot typically be reached (if it is too deep inside), but a tool like this could potentially avoid important areas and reach the clot. Spinal cords would be easier to repair and even fighting cancer could be benefited where individual cells could be targeted and removed.
Robotic devices may even replace the surgeon completely and replace human error with precise movement and accuracy. Then there is the length of the operation: With faster operations, more patients can be seen which would help to fight the growing issue with space in hospitals.
Need that eye surgery done by 2PM to make that meeting? No problem! Sit in this chair, enter the fee, and push the button when ready. This science-fiction scenario is a lot less fictional than it was a decade ago.
But no matter how far into the future we peer, there is no doubt that this extraordinary surgery is a milestone in the path to getting there.