A Systematic Review of Robot-assisted vs Manual Vitreoretinal Surgery: Is it Feasible?

Introduction and Objectives: Vitreoretinal surgery requires high precision and fine manipulation of instruments, which can be challenging due to human physiological barriers such as tremors, jerks, and low-frequency drifts. Robotic assistance carries the potential to overcome these limitations by providing better stability and filtering involuntary movements, therefore improving safety and future opportunities for this complex procedure. This review aims to compare the feasibility and safety of robot-assisted and manual vitreoretinal surgery. Methods: A comprehensive literature search was performed on 4 online databases: PubMed, Cochrane, ProQuest, ScienceDirect, and hand searching. Human studies comparing robot-assisted and manual vitreoretinal surgery, English language, and full-text journal available were included in this review. We identified the feasibility, safety, and duration of the robot-assisted approach for vitreoretinal surgery as the main outcome measurements. Results: Three randomized controlled trials (RCTs) with a total of 45 adults were evaluated. Robotic assistance was performed on various different vitreoretinal surgery procedures, including subretinal injection of tissue plasminogen activator (TPA), peeling of epiretinal membrane (ERM), and internal limiting membrane (ILM), with one study performed both procedures. All three studies showed surgical steps carried out with robotic assistance were successfully performed without clinical complications observed. The duration was longer in robot-assisted surgery compared to manual surgery. The number of retinal microtrauma was less frequent in robot-assisted surgery compared to manual surgery. Conclusion: Even though the duration of surgery took longer in the robot-assisted group, all studies show the feasibility and safety of robotic assistance in vitreoretinal surgery. However, further studies with larger samples are needed. Keywords:robot-assisted surgery, manual surgery, vitreoretinal surgery .