The Surgeon’s Role in Inducing and Controlling Motion Errors During Intraocular Membrane Peeling Procedures
Open Access
- 1 October 2021
- journal article
- research article
- Published by Galenos Yayinevi in Türk Oftalmoloji Dergisi
- Vol. 51 (5), 288-293
- https://doi.org/10.4274/tjo.galenos.2020.40035
Abstract
Objectives: To understand the surgeon's role in inducing and correcting movement inaccuracies during intraocular membrane peeling procedures. Materials and Methods: Optical sensors were used to record movement errors during actuation at the distal tip of 23-gauge pneumatic forceps both when the handle was handheld and when fixed with no human contact. Movements were also recorded at the proximal part of the forceps shaft (near the sclerotomy site) and compared to movement recorded at the distal end. The root mean square (RMS) and range values of the signals obtained from the sensors were calculated before and after applying high (7-13 Hz) and low (<5 Hz) frequency filters. Results: Comparison of RMS and range values of movement errors at the distal end of the forceps during actuation when the forceps handle was fixed and handheld showed that without human contact, these values were significantly lower in the X axis at all frequencies and in the Z axis at high frequencies compared to handheld (p<0.05), while there were no significant differences in the Y axis. Comparison of values from the distal and proximal ends of the forceps showed that when the forceps were fixed, RMS and range values were significantly higher for movement errors at the distal end compared to the proximal end at all frequencies (p<0.05). There was significant positive correlation between the extent of actuation and the RMS and range values for high-frequency movement errors but not low-frequency errors in all three axes with the fixed pneumatic handle (r=0.21-0.51, p<0.05). Conclusion: Surgeon-and non-surgeon-related errors are apparent in all axes, but skilled surgeons correct these errors through visual feedback, resulting in better correction in the visible planes. Sclerotomy sites provide a pivoting and stabilizing point for the shaft of the forceps and it is likely that skilled surgeons make use of the sclerotomy point to dampen motion errors, a skill worth teaching to beginners.Keywords
This publication has 15 references indexed in Scilit:
- Towards robot-assisted vitreoretinal surgery: Force-sensing micro-forceps integrated with a handheld micromanipulatorPublished by Institute of Electrical and Electronics Engineers (IEEE) ,2014
- Dynamics of epiretinal membrane removal off the retinal surface: a computer simulation projectBritish Journal of Ophthalmology, 2013
- Preliminary evaluation of a micro-force sensing handheld robot for vitreoretinal surgeryPublished by Institute of Electrical and Electronics Engineers (IEEE) ,2012
- Active tremor cancellation by a “Smart” handheld vitreoretinal microsurgical tool using swept source optical coherence tomographyOptics Express, 2012
- Nanoscale Topographic and Biomechanical Studies of the Human Internal Limiting MembraneInvestigative Ophthalmology & Visual Science, 2012
- DOES SURGICAL EXPERIENCE HAVE AN EFFECT ON THE SUCCESS OF RETINAL DETACHMENT SURGERY?Retina, 2012
- ‘The Microhand’: a new concept of micro-forceps for ocular robotic surgeryEye, 2009
- OPHTHALMIC SURGICAL TRAINING: A CURRICULUM TO ENHANCE SURGICAL SIMULATIONRetina, 2008
- Ophthalmic microsurgical robot and associated virtual environmentComputers in Biology and Medicine, 1995
- Physiologic tremor and microsurgeryMicrosurgery, 1983