What are the Challenges of Opthalmic Robotic Surgery

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MedTech Outlook | Tuesday, May 11, 2021

The learning curve for robotic surgery is expected to be 150 to 250 procedures, which is a huge number for every residency program preparing the next generation of ophthalmic surgeons.

FREMONT,CA: Urologists were among the early adopters to embrace robotic surgery, aiming to reduce the invasiveness, blood loss, and complication rate associated with traditional suprapubic prostatectomy. Today, robotic surgery proponents can be found in cardiothoracic surgery, neurosurgery, gastrointestinal and general surgery, transplant surgery, spine surgery, orthopedics, and nearly every surgical specialty.

The field of ophthalmology is a late adopter. There are a variety of explanations for this. To begin with, eye surgery is already minimally invasive, requiring just a few minor incisions and no blood loss. In addition, visualization is typically very good. Finally, robotic systems are costly, need a steep learning curve for surgeons, and take longer per operation. Quality robots range in price from 1 million to 2.5 million dollars, with per-case costs averaging about 1,500 dollars. For procedures like cataract surgery, where facility reimbursement is lower than the average robotic system per procedure charge, this is a no-go.

Furthermore, a skilled cataract surgeon can complete the operation in less time than it takes to set up a robotic surgery system. The learning curve for robotic surgery is expected to be 150 to 250 procedures, which is a huge number for every residency program preparing the next generation of ophthalmic surgeons. It is also a daunting number for an ophthalmic surgeon in practice.

However, there is a major unmet need in ophthalmology, and that is surgical precision, especially in retina surgery. Several retina-vitreous procedures like epiretinal membrane removal and, in particular, groundbreaking work in the subretinal placement of pharmaceuticals, cell therapy/transplants, and gene therapy need micron-level precision. In ophthalmology, the retina is the logical goal for robotic surgery. It will not be any less invasive, costly, or time-consuming. Heads-up systems with magnification, computer image enhancement, intraoperative OCT (Optical coherence tomography), and micron-level slow-controlled maneuvers that offer greater precision could all be used to improve visualization.

Costs, longer procedure times, and a steep learning curve would initially limit ophthalmic robotic surgery to large institutions. Still, as more vitreoretinal fellows complete robotic surgery training, it will spread to the private sector. Robotic surgery may also play a significant role in anterior segment surgery.  There will undoubtedly be groundbreaking surgeons and companies advancing the art and science of robotic surgery in our field in the decades ahead.



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Elena Johaness

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