Comparison of robot-assisted vitreoretinal surgery and manual surgery in different preclinical settings: a randomized trial

BACKGROUND: Progress in the field of surgical robotics has the potential to allow surgeons to reduce the limitations of human hands and has substantially improved the dexterity and accuracy of surgery. This study aimed to compare robot-assisted vitreoretinal surgery with manual surgery in a simulated setting involving donor porcine eyes. METHODS: A randomized controlled trial was conducted involving 10 experienced vitreoretinal experts and 10 residents. Participants were randomized to start with either manual or robot-assisted surgery (n=5 in each group). Participants completed 3 tests consisting of 2 vitreoretinal modules on a virtual-reality simulator and microcannulation in donor porcine eyes. The primary outcome measures were as follows: test completion time, surgical accuracy and tremor control provided by the simulator, and the feasibility of microcannulation in donor porcine eyes. RESULTS: Robot-assisted surgery supported better accuracy and tremor control than manual surgery for vitreoretinal experts (P=0.028 and P=0.002, respectively) and residents (P=0.025 and P<0.001, respectively). Residents improved their microcannulation performance with the assistance of the robot (P=0.038) to a level comparable to that of experts (P=0.49). Robot-assisted surgery was less time-efficient than manual surgery for both residents (P<0.001) and vitreoretinal experts (P<0.001). CONCLUSIONS: Compared with manual surgery, robot-assisted vitreoretinal surgery improves the stability of instrument handling and the accuracy of surgery. Robot-assisted surgeries have the potential to shorten the learning curve for residents and improve surgical performance.