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Emmanuel Vander Poorten

Emmanuel Vander Poorten
Celestijnenlaan 300 - box 2420
3001 Leuven
Belgium
room: 04.214

tel: +32 16 32 25 28 or +32 16 3 22 480
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Publications

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  • Gruijthuijsen, C; 2019. Synergistic Robotic Surgery: Novel Techniques to Harmonize Surgeon and Robot.
    LIRIAS2859084
    description
    During the last 150 years, surgery has evolved from a last resort solution to the highly specialized discipline that it is today. Technological advancement has substantially contributed to this evolution. Thanks to the combined efforts of doctors and engineers, minimally invasive surgery has become a reality, where trauma to the patient is kept so small that recovery is much faster. Yet, this is not the end. The continuing technological progress provides the surgeon with more and more options to improve the quality of treatment. Today, robotic surgery is a prominent representative of this technological innovation. Robots offer the possibility to operate with higher accuracy, speed up the learning process, enhance surgeon comfort and control the motion of complex tools. However, the clinical deployment of these advantages is not straightforward and also substantially differs between surgical disciplines. The focus of this dissertation lies on robotic laparoscopy. Within this medical specialization, telemanipulation systems are presently the standard. With this type of system, the robot copies the movements that the remotely located surgeon executes with a sophisticated joystick. So far, it has however proven difficult to justify the hefty price tag of these robots. The existing systems only employ a fraction of the full potential of robotics. Especially the opportunity to embed intelligent behavior in these robots is hardly exploited. At the same time, the surgeon needs to make compromises to integrate the system by completely revisiting his/her normal approach and workflow. This can for instance be witnessed by the long set-up time of the devices and the distance they create between the surgeon, the team and the patient. This dissertation aims to reduce the distance, both physically and psychologically, that exists between surgeon and robot. It proposes methods that optimize the synergy between both. This allows the surgeon to operate more effectively and safely, supported by a robot that provides assistance in a way that seamlessly fits in with his/her expectations. Based on this starting point, a number of important design guidelines for synergistic robotic surgery are formulated. They promote the comanipulation principle for robotic laparoscopy. In comanipulation, the surgeon and the robot jointly hold and manipulate the surgical instruments, in contrast to the remote control in telemanipulation. To further reduce the impact of the comanipulation system on the surgical practices, it is of importance that the robot can be moved without resistance and that it can automatically align itself with the incision point in the patient. If synergy is to be guaranteed, a careful approach is also required towards robot perception, which is necessary for more advanced robot assistance. The surgeon cannot be burdened with extra steps to collect or interpret data. While these design guidelines are valuable for the surgeon, their practical implementation implies a number of technical challenges, which are studied and tackled in the remainder of this dissertation. The outcomes are every time applied to the particularly demanding discipline of fetal surgery. The first part of the challenges is related to the incision point in laparoscopy and has an impact on the robot control strategy. To ensure that the robot can automatically align itself with the incision point, a robust and responsive method is developed to measure the position of the incision point. Knowledge of this point is subsequently utilized to enhance the performance of the proposed type of comanipulation robot. On the one hand, it is shown how this knowledge of the incision point allows for improved accuracy, precision and bandwidth of instrument tip position measurements. On the other hand, an algorithm is designed that applies this knowledge to expand the stability margins of the robot. The combination of the developed techniques results in safer, more effective and more synergistic robot assistance. The second part of the challenges is related to robot perception. Perception-related problems are elaborated for two clinical use cases: contactless surgery and endoscope guidance. For these use cases, sensors are selected that can be integrated in laparoscopic instruments suitable for fetal surgery. Techniques to process the sensor data into actionable computer models are then developed. These techniques work entirely automatically, without requiring the attention of the surgeon to collect, enrich or verify the data. Through a series of in-vitro and in-vivo experiments, the feasibility of robot assistance for both clinical cases is demonstrated. From this dissertation, it thus follows that intelligent and effective robot assistance can be successfully realized while taking into account all design guidelines for synergy, even for demanding fetal interventions.

    Published
  • Schoevaerdts, Laurent; Borghesan, Gianni; Ourak, Mouloud; Reynaerts, Dominiek; Vander Poorten, Emmanuel; 2019. Electrical Bio-Impedance Proximity Sensing for Vitreo-Retinal Micro-Surgery. IEEE Robotics and Automation Letters; 2019; Vol. 4; iss. 4; pp. 4086 - 4093
    LIRIAS2836335
    description
    This work was supported by KULeuven under C3-fund 3E160419.
    Publisher: Institute of Electrical and Electronics Engineers
    Published
  • Vander Poorten, Emmanuel; Riviere, Cameron N; Abbott, Jake J; Bergeles, Christos; Nasseri, Ali; Kang, Jin U; Sznitman, Raphael; Faridpooya, Koorosh; Iordachita, Iulian; 2019. Robotic Retinal Surgery. Handbook of Robotic and Image-Guided Surgery; 2019; pp. 627 - 672 Publisher: Elsevier
    LIRIAS2345958
    description
    Retinal surgery has long drawn the attention of engineers and clinicians who identified a clear use case for robotics and assistive technology. In retinal surgery, precision is paramount. Skilled practitioners operate on the boundaries of human capability, dealing with minuscule anatomic structures that are both fragile and hard to discern. Surgical operations on the retina, a hair-thick multilayered structure that is an integral part of the central nervous system responsible for vision, spurred the development of robotic system that enhance perception, precision, and dexterity. This chapter provides an encompassing overview of the progress that has been made during the last two decades in terms of sensing, modeling, visualization, stabilization, and control. The chapter reports on recent breakthroughs with first-in-human experiences, as well as on new venues that hold the potential to expand retinal surgery to techniques that would be infeasible or challenging without robotics.

    Published
  • Schoevaerdts, L; 2019. Bio-impedance Sensor Technology for Robot-Assisted Vitreo-retinal Surgery.
    LIRIAS2823832
    description
    At present, vitreoretinal surgery is performed purely manually by highly specialized, welltrained surgeons. The surgeons need superior handeye coordination and precise positioning. When applying even small forces tangential to the surface of the eye, e.g. by means of the inserted instruments, the eye rotates and a different part of the eye becomes visible under the microscope. Microsurgeons are trained to pivot the instruments around the incision point so as to keep the eye from rotating. However, there is a limit to the surgeon's ability to perform pure pivotal motion. Furthermore small vibrations by the surgeon's hand (physiological tremor) are amplified by the leverage effect, resulting in larger vibrations of the instrument tip. It is thus extremely difficult to maintain a stable position down at the retinal surface. All targets are extremely small - ranging from 5 to 500 microns - and fragile. Tremor not only complicates reaching the required precision, it also causes the eye to rotate undeliberately, which results in surgeons aiming on a moving target. Furthermore, the surgeon is forced to work under very tight spatial constraints. Overall the surgeons are under very stringent requirements on safety and reliability as damage to the delicate retina leads to blind spots in the patient's vision and causes partial or full blindness. Within the framework of this PhD robotassisted technology will be developed to improve vitreoretinal surgery in terms of reliability and performance. More in particular the focus is on the development of sensorbased control algorithms that making use of sensory inputs such as e.g. force, proximity, oct, stereocamera, provide various operating modes that allow microsurgeons to operate in a comfortable and reliable manner. Shared control algorithms will be developed specifically for this pplications. Through these methods guidance and motion compensation is offered to the surgeon. Maximal use of surgical skill is possible as the envisioned shared control methods are fully compatible with surgeon input commands. Apart from sensordevelopment and sensorintegration, this work will progress humanrobot interaction and surgical skill in a realistic and demanding scenario. The work foresees in ample clinical validation on exvivo setups.

    Published
  • Bano, Sophia; Vasconcelos, Francisco; Tella-Amo, Marcel; Dwyer, George; Gruijthuijsen, Caspar; Deprest, Jan; Ourselin, Sebastien; Vander Poorten, Emmanuel; Vercauteren, Tom; Stoyanov, Danail; 2019. Deep Sequential Mosaicking of Fetoscopic Videos. Medical image computing and computer-assisted intervention : MICCAI ... International Conference on Medical Image Computing and Computer-Assisted Intervention; 2019 Publisher: Springer
    LIRIAS2835242
    description


    Accepted
  • Vandebroek, Tom; Ourak, Mo; Gruijthuijsen, C; Javaux, A; Legrand, J; Vercauteren, T; Ourselin, Sébastien; Deprest, J; Vander Poorten, E; 2019. Macro-Micro Multi-Arm Instrument for Single-Port Access Surgery. Proceedings of the ... IEEE/RSJ International Conference on Intelligent Robots and Systems. IEEE/RSJ International Conference on Intelligent Robots and Systems; 2019 Publisher: IEEE
    LIRIAS2815646
    description


    Accepted
  • Gruijthuijsen, Caspar; Borghesan, gianni; Reynaerts, Dominiek; Vander Poorten, Emmanuel; 2019. A Hybrid Active/Passive Wrist Approach for Increasing Virtual Fixture Stiffness in Comanipulated Robotic Minimally Invasive Surgery. IEEE Robotics and Automation Letters; 2019; Vol. 4; iss. 3; pp. 3029 - 3036
    LIRIAS2815651
    description
    This work was supported by an internally funded project at KU Leuven (PRESLICE-3E160397).
    Publisher: Institute of Electrical and Electronics Engineers
    Published
  • Portoles Diez, S; 2019. Haptic Feedback for Soft-Tissue Robotic Surgery: from Training Palpation to Haptic Augmentation.
    LIRIAS2801209
    description
    Robotic minimally invasive surgery (RMIS) is a field in full development. Since evidence of the benefits of robotic approaches are surfacing the field, RMIS is receiving an increased interest by both academia and industry. There are nevertheless some major hurdles to this technology. Apart from the cost, a major impediment to its adoption is the long learning curve. As in RMIS the surgeon is decoupled from the patient and only interacts through the robotic system, she/he is to less extent aware of what is going on at the patient side. Critical situations can therefore go unnoticed. In a response robotic systems are increasingly being equipped with all sorts of sensors to measure various aspects of the patient's internals. The challenge remains how to communicate this information back to the surgeon so that this information is easy to interpret. A seemingly convenient approach consists in decoding the acquired information and presenting it via a visual overlay to the surgeon. However, the visual channel is already heavily in use and there is thus a risk of an increased mental load. Instead, the haptic sense, which is the sense related to touch, remains unused. Indeed while in traditional surgery surgeons rely heavily on haptics, due to the decoupling, in RMIS this feedback channel is not available anymore. Nevertheless the haptic sensorimotor system is fast, natural and elicits reactions that are much faster than the visual ones. This thesis, develops and introduces novel haptic technology to aid the surgeon in surgical training and enhance her/his awareness in RMIS. A novel encountered-type haptic display is proposed and developed for palpation training. Palpation is a crucial skill that is important both during diagnosis and surgical interventions. Surgeons rely on it to detect anomalies in organs and delineate tissue margins. Conventional systems fail to replicate natural palpation as they force the user to interact via a stylus or pen-based interface. On the contrary the proposed encountered-type display allows unrestricted freehand palpation. Two prototypes were developed to render three surface haptic features: normal stiffness, 1st order geometry and lateral forces. The realism of the interface is validated with experimental campaigns. Haptic feedback, which is missing in current robotic solutions for RMIS, has been implemented in a new bimanual surgical teleoperation platform. The validity of haptic feedback has been investigated on a challenging gynaecological intervention, namely endometriosis surgery. ESE, a dedicated training model that replicates endometriosis surgery, has been developed for this purpose. The benefit of force feedback for RMIS during complex surgical interventions has been demonstrated through user experiments on the ESE model. User experiments showed improved awareness reducing interaction forces and lower amounts of errors with force fed back. As far as the author is aware of these were the most sophisticated experiments investigating the role of haptic feedback in RMIS up to date. Finally, haptic augmentation has been investigated. Beyond feedback of interaction forces the haptic channel can be used to encode various sensory information, force feedback and control can also be used to simplify and automate parts of surgical procedures. Two applications, a first introducing haptic fixture and a second introducing force fixtures, both showing the potential of haptic augmentation, have been developed. First, in cardiovascular surgery, haptic guidance is used to help the interventionalist guide a robotic catheter along the centre-line of the aortic arch. In a haptic shared-control approach, the control is shared with the surgeon. The latter remains responsible for decision-making but does not have to worry too much about intricate catheter steering. Second, automatic tissue tensioning is explored. This may help during gynaecological surgery where surgeons need to remove diseased tissue via laser ablation. The teleoperated robot takes control over the tissue tension task presenting it in an optimal condition for the surgeon who can then ablate it. The surgeon teaches the system to apply a required force level. This becomes possible through the force feedback system which allow the surgeon to feel and thus set a desirable force level. User experiments show improved manipulation when using this new feature. The haptic sensorimotor system is a sophisticated distributed perceptual system, the result of a long evolutionary process. While the understanding of this perceptual system is improving and already very mature, methods to interface and interact with it are still under development. RMIS is one particularly interesting field that could benefit from such interactive technology. This thesis presents contributions in hardware, software and control, as well as experimental validation, bringing haptic interactive technology for RMIS to a next level.

    Published
  • Portoles Diez, Sergio Jol; Borghesan, Gianni; Joyeaux, Luc; Meuleman, Christel; Deprest, Jan; Stoyanov, Danail; Ourselin, Sebastien; Vercauteren, Tom; Reynaerts, Dominiek; Vander Poorten, Emmanuel; 2019. Evaluation of Haptic Feedback on Bimanually Teleoperated Laparoscopy for Endometriosis Surgery.. IEEE Trans Biomed Eng; 2019; Vol. 66; iss. 5; pp. 1207 - 1221
    LIRIAS2242550
    description
    Robotic minimal invasive surgery is gaining acceptance in surgical care. In contrast with the appreciated 3D vision and enhanced dexterity, haptic feedback is not offered. For this reason robotics is not considered beneficial for delicate interventions such the endometriosis. Overall, haptic feedback remains debatable and yet unproven except for some simple scenarios such as Fundamentals of Laparoscopic Surgery exercises. OBJECTIVE: The present work investigates the benefits of haptic feedback on more complex surgical gestures, manipulating delicate tissue through coordination between multiple instruments. METHODS: A new training exercise, "Endometriosis Surgery Exercise" (ESE) has been devised approximating the setting for monocular robotic endometriosis treatment. A bimanual bilateral teleoperation setup was designed for laparoscopic laser surgery. Haptic guidance and haptic feedback are respectively offered to the operator. User experiments have been conducted to i) assess the validity of ESE and to ii) examine possible advantages of haptic technology during execution of bimanual surgery. RESULTS: i) Content and face validity of ESE was established by participating surgeons. Surgeons suggested ESE also as a means to train lasering skills, ii) interaction forces on endometriotic tissue were found to be significantly lower when a bilateral controller is used. Collisions between instruments and the environment were less frequent and so were situations marked as potentially dangerous. CONCLUSION: This study provides some promising results suggesting that haptics may offer a distinct advantage in complex robotic interventions were fragile tissue is manipulated. SIGNIFICANCE: Patients need to know whether it should be incorporated. Improved understanding of the value of haptics is important as current commercial surgical robots are widely used but do not offer haptics.
    Publisher: Institute of Electrical and Electronics Engineers
    Published
  • Al-Ahmad, Omar; Ourak, Mouloud; Vlekken, Johan; Vander Poorten, Emmanuel; 2019. Contact Force Compensation of a Catheter Tip for Minimally Invasive Cardiovascular Surgery.
    LIRIAS2802516
    description


    Published
  • De Smet, Jozef; Deprest, Jan; Vander Poorten, Emmanuel; 2019. In Vivo Force Sensing During Laparoscopic Sacrocolpopexy Vaginal Vault Manipulation. Journal of Medical Robotics Research; 2019; Vol. 4; iss. 2
    LIRIAS2783572
    description

    Publisher: World Scientific Publishing Co. Pte. Ltd.
    Published online
  • presentation
    Smits, Jonas; Gijbels, Andy; Reynaerts, Dominiek; Vander Poorten, Emmanuel; 2019. Development of a 3-DOF impedance-type manipulator for cooperative surgical port alignment during microsurgery..
    LIRIAS2783511
    description


    Published
  • De Smet, Jef; Deprest, Jan; Vander Poorten, Emmanuel; 2019. Combined Force- and Pose Sensing to Characterize Vaginal Wall Stiffness during Laparoscopic Sacrocolpopexy. https://www.cras-eu.org; 2019 Publisher: CRAS
    LIRIAS2783335
    description


    Published online
  • Ahmad, Mirza Awais; Gruijthuijsen, Caspar; Ourak, Mouloud; Deprest, Jan; Vander Poorten, Emmanuel; Vercauteren, Tom; 2019. Shared Control of an Automatically Aligning Endoscopic Instrument Based on Convolutional Neural Networks.
    LIRIAS2783966
    description


    Published
  • journal-article
    Schoevaerdts, Laurent; Esteveny, Laure; Gijbels, Andy; Smits, Jonas; Reynaerts, Dominiek; Vander Poorten, Emmanuel; 2019. Design and evaluation of a new bioelectrical impedance sensor for micro-surgery: application to retinal vein cannulation. International Journal Of Computer Assisted Radiology And Surgery; 2019; Vol. 14; iss. 2; pp. 311 - 320
    LIRIAS2118501
    description
    PURPOSE: Nowadays, millions of people suffer from retinal vein occlusion, a blind-making eye disease. No curative treatment currently exists for this vascular disorder. However, a promising treatment consists in injecting a thrombolytic drug directly inside the affected retinal vessel. Successfully puncturing miniature vessels with diameters between 50 and 400 [Formula: see text] remains a real challenge, amongst others due to human hand tremor, poor visualisation and depth perception. As a consequence, there is a significant risk of double-puncturing the targeted vessel. Sub-surfacic injection of thrombolytic agent could potentially lead to severe retinal damage. METHODS: A new bio-impedance sensor has been developed to visually display the instant of vessel puncture. The physical working principle of the sensor has been analysed, and a representative electrical model has been derived. Based on this model, the main design parameters were derived to maximise the sensor sensitivity. A detailed characterisation and experimental validation of this concept were conducted. RESULTS: Stable, repeatable and robust impedance measurements were obtained. In an experimental campaign, 35 puncture attempts on ex vivo pig eyes vessels were conducted. A confusion matrix shows a detection accuracy of 80% if there is a puncture, a double puncture or no puncture. The 20% of inaccuracy most probably comes from the limitations of the employed eye model and the experimental conditions. CONCLUSIONS: The developed bio-impedance sensor has shown great promise to help in avoiding double punctures when cannulating retinal veins. Compared to other puncture detection methods, the proposed sensor is simple and therefore potentially more affordable. Future research will include validation in an in vivo situation involving vitreoretinal surgeons.
    Publisher: Springer Verlag
    Published
  • Ourak, M; Smits, J; Esteveny, L; Borghesan, G; Gijbels, A; Schoevaerdts, L; Douven, Y; Scholtes, J; Lankenau, E; Eixmann, T; Schulz-Hildebrandt, H; Huettmann, G; Kozlovszky, M; Kronreif, G; Willekens, K; Stalmans, P; Faridpooya, K; Cereda, M; Giani, A; Staurenghi, G; Reynaerts, D; Vander Poorten, EB; 2019. Combined OCT distance and FBG force sensing cannulation needle for retinal vein cannulation: in vivo animal validation. International Journal Of Computer Assisted Radiology And Surgery; 2019; Vol. 14; iss. 2; pp. 301 - 309
    LIRIAS1995630
    description
    PURPOSE: Retinal vein cannulation is an experimental procedure during which a clot-dissolving drug is injected into an obstructed retinal vein. However, due to the fragility and minute size of retinal veins, such procedure is considered too risky to perform manually. With the aid of surgical robots, key limiting factors such as: unwanted eye rotations, hand tremor and instrument immobilization can be tackled. However, local instrument anatomy distance and force estimation remain unresolved issues. A reliable, real-time local interaction estimation between instrument tip and the retina could be a solution. This paper reports on the development of a combined force and distance sensing cannulation needle, and its experimental validation during in vivo animal trials. METHODS: Two prototypes are reported, relying on force and distance measurements based on FBG and OCT A-scan fibres, respectively. Both instruments provide an 80 [Formula: see text] needle tip and have outer shaft diameters of 0.6 and 2.3 mm, respectively. RESULTS: Both prototypes were characterized and experimentally validated ex vivo. Then, paired with a previously developed surgical robot, in vivo experimental validation was performed. The first prototype successfully demonstrated the feasibility of using a combined force and distance sensing instrument in an in vivo setting. CONCLUSION: The results demonstrate the feasibility of deploying a combined sensing instrument in an in vivo setting. The performed study provides a foundation for further work on real-time local modelling of the surgical scene. This paper provides initial insights; however, additional processing remains necessary.
    Publisher: Springer Verlag
    Published
  • Javaux, Allan; Bouget, David; Gruijthuijsen, Caspar; Stoyanov, Danail; Vercauteren, Tom; Ourselin, Sebastien; Deprest, Jan; Denis, Kathleen; Vander Poorten, Emmanuel; 2018. A mixed-reality surgical trainer with comprehensive sensing for fetal laser minimally invasive surgery. International Journal Of Computer Assisted Radiology And Surgery; 2018; Vol. 13; iss. 12; pp. 1949 - 1957
    LIRIAS1999243
    description
    PURPOSE: Smaller incisions and reduced surgical trauma made minimally invasive surgery (MIS) grow in popularity even though long training is required to master the instrument manipulation constraints. While numerous training systems have been developed in the past, very few of them tackled fetal surgery and more specifically the treatment of twin-twin transfusion syndrome (TTTS). To address this lack of training resources, this paper presents a novel mixed-reality surgical trainer equipped with comprehensive sensing for TTTS procedures. The proposed trainer combines the benefits of box trainer technology and virtual reality systems. Face and content validation studies are presented and a use-case highlights the benefits of having embedded sensors. METHODS: Face and content validity of the developed setup was assessed by asking surgeons from the field of fetal MIS to accomplish specific tasks on the trainer. A small use-case investigates whether the trainer sensors are able to distinguish between an easy and difficult scenario. RESULTS: The trainer was deemed sufficiently realistic and its proposed tasks relevant for practicing the required motor skills. The use-case demonstrated that the motion and force sensing capabilities of the trainer were able to analyze surgical skill. CONCLUSION: The developed trainer for fetal laser surgery was validated by surgeons from a specialized center in fetal medicine. Further similar investigations in other centers are of interest, as well as quality improvements which will allow to increase the difficulty of the trainer. The comprehensive sensing appeared to be capable of objectively assessing skill.
    Publisher: Springer Verlag
    Published
  • Perret, Jeromeb; Vander Poorten, Emmanuel; 2018. Review Paper: Commercial Haptic Gloves. Proceedings of the 15th Annual EuroVR Conference; 2018; pp. 39 - 48 Publisher: VTT Technology
    LIRIAS2316401
    description


    Published
  • Degreef, Jorge; Poliakov, Vladimir; Gruijthuijsen, Caspar; Javaux, Allan; Ahmad, Mirza Awais; Philips, Johan; Portoles Diez, Sergio; Vander Poorten, Emmanuel; 2018. Evaluating the Benefit of Assistive AR Technology through Eye Tracking in a Surgical Simulation System. The Industrial Track of EuroVR 2018 – Proceedings of the 15th Annual EuroVR Conference; 2018; pp. 32 - 39 Publisher: VTT Technology
    LIRIAS2316400
    description


    Published
  • journal-article
    Gijbels, Andy; Smits, Jonas; Schoevaerdts, Laurent; Willekens, Koen; Vander Poorten, Emmanuel B; Stalmans, Peter; Reynaerts, Dominiek; 2018. In-Human Robot-Assisted Retinal Vein Cannulation, A World First. Annals Of Biomedical Engineering; 2018; Vol. 46; iss. 10; pp. 1676 - 1685
    LIRIAS1985681
    description
    Retinal Vein Occlusion (RVO) is a blinding disease caused by one or more occluded retinal veins. Current treatment methods only focus on symptom mitigation rather than targeting a solution for the root cause of the disorder. Retinal vein cannulation is an experimental eye surgical procedure which could potentially cure RVO. Its goal is to dissolve the occlusion by injecting an anticoagulant directly into the blocked vein. Given the scale and the fragility of retinal veins on one end and surgeons' limited positioning precision on the other, performing this procedure manually is considered to be too risky. The authors have been developing robotic devices and instruments to assist surgeons in performing this therapy in a safe and successful manner. This work reports on the clinical translation of the technology, resulting in the world-first in-human robot-assisted retinal vein cannulation. Four RVO patients have been treated with the technology in the context of a phase I clinical trial. The results show that it is technically feasible to safely inject an anticoagulant into a [Formula: see text]-thick retinal vein of an RVO patient for a period of 10 min with the aid of the presented robotic technology and instrumentation.
    Publisher: Springer (part of Springer Nature)
    Published