Will robotic cataract surgery ever match the skill of a human surgeon?
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Robotic cataract surgery will match and then exceed the skills of a human surgeon, at least for routine cases.
The human eyes perceive 25 to 30 frames per second as fluid and smooth, which is why video streaming is limited to this frame rate. With a robotic surgical system, we can have real-time imaging with OCT and video at a frame rate much higher than this, including the ability to detect clear structures such as the posterior capsule.
When it comes to reaction time, the limit of human ability is about 100 milliseconds, and that is for the world’s best F1 race car drivers. For world-class surgeons, our reaction times will be 200 milliseconds or more. A robotic cataract surgical system can react in just a few milliseconds.
Putting these two factors together, a frame rate of more than 1,000 frames per second along with a reaction time of just a few milliseconds mean that the robotic devices, supervised by human surgeons, will allow for an improvement of 100 times. This will help to decrease complications such as posterior capsule rupture because the robotic machines will be able to instantly detect and then react to anterior chamber instability or erratic movement of the delicate ocular tissues.
Even in situations in which the surgeon is going to manually perform a delicate task, such as peeling an epiretinal membrane that is just a few microns thin, the robot can aid in providing more precision. There can be a step down in the movement by a factor of 20 or more so that a 1-mm movement by the surgeon outside the eye translates to a 0.05-mm movement inside the eye. We can even add tactile feedback through the robotic controls in a procedure that usually has zero tactile sensation for the surgeon.
For routine cases, I anticipate the robotic surgical system performing most of the procedure under surgeon supervision, much like we do now when using a femtosecond or excimer laser. More complex cases, such as those involving zonulopathy, irregular irides or unusual anatomy, will still require the hands of a skilled surgeon, perhaps with some robotic assistance. Then, further into the future, when we incorporate self-learning with these robotic systems, perhaps these cases will also be best performed by nonhuman hands.
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