Control Modes of Teleoperated Surgical Robotic System’s Tools in Ophthalmic Surgery

The introduction of a teleoperated surgical robotic system designed for minimally invasive procedures enables the emulation of two distinct control modes through a dedicated input device of the surgical console: (1) Inside Control Mode, which emulates tool manipulation near the distal end (i.e., as if the surgeon was holding the tip of the instrument inside the patient's body), and (2) Outside Control Mode, which emulates manipulation near the proximal end (i.e., as if the surgeon was holding the tool externally). The overarching aim of this reported research is to study and compare the surgeon's performance utilizing these two control modes of operation along with various scaling factors in a simulated vitreoretinal surgical setting. The console of Intraocular Robotic Interventional Surgical System (IRISS) was utilized but the surgical robot itself and the human eye anatomy was simulated by a virtual environment (VR) projected microscope view of an intraocular setup to a VR headset. Five experienced vitreoretinal surgeons and five subjects with no surgical experience used the system to perform fundamental tool/tissue tasks common to vitreoretinal surgery including: (1) touch and reset; (2) grasp and drop; (3) inject; (4) circular tracking. The results indicate that Inside Control outperforms Outside Control across multiple tasks and performance metrics. Higher scaling factors (20 and 30) generally provided better performance, particularly for reducing trajectory errors and tissue damage. This improvement suggests that larger scaling factors enable more precise control, making them the preferred option for fine manipulation tasks. However, task completion time was not consistently reduced across all conditions, indicating that surgeons may need to balance speed and accuracy/precision based on specific surgical requirements. By optimizing control dynamics and user interface, robotic teleoperation has the potential to reduce complications, enhance surgical dexterity, and expand the accessibility of high-precision procedures to a broader range of practitioners.