OT  explores: micro-surgical robots for retinal therapies

Researchers at King’s College London shared developments in the field of surgical robots that could support surgeons to deliver regenerative therapy in the eye

The operating room of the future might not be so distant, at least if the team at King’s College London’s School of Biomedical Engineering & Imaging Sciences have anything to do with it.

OT visited Dr Christos Bergeles at the department of Surgical and Interventional Engineering to meet a team of researchers developing micro-surgical robotic systems to help provide therapies in the retina.

Vitreoretinal surgery is very mature, Bergeles explained: “Our collaborators at Moorfields Eye Hospital, for example Lyndon da Cruz [consultant ophthalmic surgeon], are extremely skilled at doing conventional surgeries.

“But what surgeons cannot do, is access parts of the human eye within the retina, in order to be prepared for the upcoming regenerative therapies that will appear,” he said.

These therapies would be deployed within the hair-thin structure of the retina, something that could not be achieved by the human hand.

“We are developing technology to improve surgical dexterity and improve surgical perception and cognition,” Bergeles said.

Researchers have named the device ‘VIPER,’ which stands for Versatile Intraocular Precision Enhancing Robot.

“This is exactly what our device is doing. It goes inside the eye and increases the performance and dexterity of the human surgeon,” Bergeles explained.

The arm of the robot, on which the device is mounted, can move with a snake-like flexibility.

Taking OT through the features of the instrument the researchers are developing, Bergeles shared that through a geared system deployed on an actuation system, small elements allow for a tiny tool to be controlled, extended and rotated.

“Depending on how I reorient and control these flexible tubes, I will be able to offer the surgeon dexterity as if they had their hand inside the eye,” he said.

This would enable the surgeon to manoeuvre in the way they need to delaminate or provide an injection.

We are developing technology to improve surgical dexterity and improve surgical perception and cognition

Dr Christos Bergeles, professor in surgical robotics at King’s College London
Ross Henry, a research assistant at Moorfields Eye Hospital, demonstrated how a microscope foot pedal has been connected to the robotic system to activate a guidance control and to move the tip of the device.

Bergeles explained: “A lot of the algorithms we are trying to make are a lot to do with: how do you make these motions smoother?”

The project has been a journey of eight to nine years, and first began in 2014 when Bergeles was supervising a student as a postdoctoral researcher.

“We created a very crude version of the system with hobby electronics,” he shared, with a key question: “Can we make something that has this sort of functionality?”

“Since then, we have attracted grants and charitable donations, and taken this to the development of better controllers, optimising how the tube should be, securing intellectual property, and now working with the quality management team and a manufacturing facility in-house to understand what is needed to satisfy a risk reduction for this sort of device,” Bergeles said.

“There is a clear roadmap on taking this device, not only to first in human, but clinical practice, and we are investigating the elements that we need to have in place in order to achieve that,” he shared.

Work is ongoing to create a technical file, required by the MHRA for permission for first in human.

“We hope to have this ready within a year to a year and a half, then proceed to a first in human evaluation of a simpler concept of our system within two to two and a half years,” Bergeles told OT.

“Really, it is within reach, and we are eager to take it all the way,” he added.

Asked what it means to the team to be involved in these forward-looking developments in medical technology, Bergeles reflected: “It’s exciting to be at the frontier of medical progress.”

“If I wasn’t in that domain, I wouldn’t know about stem cell, gene therapies, upcoming therapies, clinical trials. You don’t have your foot in that other world, but you are osmotically gathering information,” he said.

On the medical technology side specifically, Bergeles shared: “What is extremely exciting to me is to see something that we started developing in 2015 with hobby electronics and how you are able to take it as much as you can to something that is ultimately reaching the patients.”

In this kind of translational pathway, he suggested, “the more you dig, the more questions you uncover.”

“Everything ends up being more complicated and it requires much more digging and research, and eventually becomes a nice body of work that you see you’ve taken from a very low starting point to something where the leap to the patient in the imagination is not that big,” he concluded.