OC11.08: Robotic‐assisted platform assistance in placental laser surgery

Abstract

To evaluate the effects of using robotic assistance in the performance of placental laser surgery (PLS) in the treatment of Twin–twin transfusion syndrome (TTTS). We developed two platforms to simulate PLS using real tools and integrating a tracking system to record fetoscope trajectories. The manual platform (MP) reproduces current surgical procedure and the robotic platform (RP) incorporates a robotic arm to move the fetoscope, stabilise the trocar and laser movements. The RP allows to mark the anastomoses, can automatically guide the fetoscope to any of them and generates virtual sliding surface to avoid contact with placenta surface. Finally, it generates an interactive navigation map showing located anastomoses and fetoscope trajectories. A total of 16 fetal surgery specialist were recruited. After a period of training in both platforms, they were asked to perform a PLS using several placental images from real monochorionic pregnancies. Trajectory, duration and coagulated area were compared. In general, RP improved surgeons' performance with shorter and more structured trajectories. In addition, coagulated surface decreases in RP, maximising the preserved placenta's surface. The overall execution time has increased on the RP especially because of the velocity limitation provided. The use of a robotic assistance tool improved the performance of PLS reducing trajectory length and coagulated surface but with a slightly increase in duration of procedure. Further studies to evaluate safety and applicability in clinical setting are warranted. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.