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Laboratory science
Robotic microsurgery: corneal transplantation
  1. J-L Bourges1,2,3,
  2. J-P Hubschman1,3,
  3. B Burt1,3,
  4. M Culjat3,
  5. S D Schwartz1,3
  1. 1
    Department of Ophthalmology, David Geffen School of Medicine at UCLA, Jules Stein Eye Institute, Los Angeles, California, USA
  2. 2
    Université Paris Descartes, Assistance Publique des Hôpitaux de Paris, Hôpital Hôtel-Dieu, Paris, France
  3. 3
    Centre for Advanced Surgical and Interventional Technology (CASIT), David Geffen School of Medicine at UCLA, Los Angeles, California, USA
  1. Correspondence to Dr J-L Bourges, Jules Stein Eye Institute, UCLA, 100 Stein Plaza, Los Angeles, CA 90095, USA; jlbourges{at}


Background: Robotic ocular microsurgery including corneal suturing has been proven to be feasible in porcine eyes.

Aim: To determine whether or not bimanual teleoperated robotic penetrating keratoplasty (PK) can be performed in porcine and human eyes.

Methods: Three arms of the da Vinci surgical robot were loaded with a dual-channel video and two, 360°-rotating, 8 mm, wrested-end effector instruments and placed over porcine eyes or over a human cadaver head. The surgeon remotely performed mechanical trephination, cardinal sutures, continuous 10.0 nylon sutures and suture adjustments on both eyes. The procedures were documented with still and video photography.

Results: Using the da Vinci robot, penetrating keratoplasty procedures were successfully performed on both porcine eyes and human eyes in natural anatomical conditions. The precise placement of continuous sutures was facilitated by the wrested-end forceps. Orbital rims and nose did not limit surgical motions.

Conclusion: Teleoperated robotic penetrating keratoplasty is technically feasible in humans. Further studies are pending to implement the procedure with femtosecond laser and other automated steps.

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  • Competing interests None.

  • Ethics approval Ethics approval was provided by the institutional review board, and the Institutional Animal Care and Use Committee, UCLA.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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