Microscopic Ophthalmic Surgery Using a Freely Movable Arm Support Robot: Basic Experiment and Clinical Experience

Abstract

<b><i>Introduction:</i></b> The disadvantage of conventional armrests is the difficulty to adjust their height and position during surgery. <b><i>Objectives:</i></b> We investigated whether a freely movable armrest (FMA) that follows the surgeon’s arm is useful for reducing surgeon fatigue and arm tremors and for improving surgical accuracy. <b><i>Methods:</i></b> In the basic study, a corneal suture was placed in porcine eyes with FMA (FMA group) or without FMA (non-FMA group). The suture was intended to pass through two points. Tremor was quantified using motion-tracking software when the needle was held. Subjective symptoms of arm-related fatigue were scored using a questionnaire. Suturing accuracy was compared between the groups. In the clinical study, the same surgeon performed corneal transplantation, cataract surgery, and glaucoma surgery with or without FMA. Fatigue scores from the questionnaire were then compared. <b><i>Results:</i></b> In the basic study, hand tremor at rest was significantly improved with FMA (<i>p</i> &#x3c; 0.0001). The subjective arm fatigue score was significantly reduced (<i>p</i> = 0.0465), while the subjective tremor score was also significantly improved (<i>p</i> = 0.0453). There were no differences in the accuracy of corneal suturing with or without FMA. In the clinical study, the total and arm-related fatigue scores during corneal transplantation and glaucoma surgery tended to improve. <b><i>Conclusions:</i></b> FMA is a useful tool for fixing the surgeon’s arm in any position and may improve the quality of ophthalmic surgery by reducing hand tremor and fatigue.