In eye surgery, a millimeter tremor can mean the difference between sight and blindness.

Imagine grasping a single grain of salt with your index and thumb. Pretty tricky, I imagine. And so, how simple would it be for, let’s say — an ant? Those tiny precise pincers work without muscle tremors, achieving perfect precision every time.

Now imagine if surgeons could have that same precision when operating on the most sensitive organ we have — the human eye.

Most likely grabbing grains of salt does not seem too interesting to you, but this becomes critical when it comes to ophthalmic surgeries (eye surgeries). The eye contains 2 million working parts crammed into our most delicate sensory organ. I gurante you’ve felt how sensitive your eye is — even the tiniest speck causes irritation you can feel but can’t see. And when it comes for eye surgeons to operate on its thinnest layer such as the retina it is of extreme importance to be precise, as damage or improper procedure may lead to blindness or vision disparity. Most often, surgeries on the eye of this sort such as macular hole surgery (removing 2–3 mm internal membranes of the eye) have to be operated on more than once on a patient as there are remains of tissue to be removed.

1. The Human Challenge

Another issue when it comes to highly precise surgeries is nature: the human body. We as humans have muscle tremors. Test it out yourself — put your hand out and see how muscles twitch, the hand moves slightly up and down. This is completely normal due to blood flow, muscle tension, and basic human physiology. But in eye surgery, these millimetric movements become catastrophic. Surgeons, though, have better control over these tremors and their hand dexterity improves with experience. Yet, it is near impossible to achieve 0 hand tremors. The hand moves millimeters in all directions even with concentration, and experience. Still, hand/eye surgeons face this every corneal surgery. This makes ophthalmic surgeries last hours, be slightly imprecise, and mentally draining. And for the patient, it may mean having to go to surgeries various times, or not ending with 100% of the issue resolved as it should have. It is worth to mention, each time surgeons are better with their skills and there is nuance tech to improve such thin and precise millimetric surgical procedures such as membrane peeling and macular hole.

Biomedical engineers realized they needed to solve this fundamental human limitation. But instead of replacing surgeons with robots, they created something more elegant: a tool that eliminates tremors while preserving surgical skill. Enter the Fiber-optic OCT sensor guided ‘SMART’ micro-forceps.

To be a surgeon is to be both scientist and artist, merging the precision of logic with the intuition of creativity.

What I love is that each time we become more accurate and precise, and this device is no exception. Its motors allow the forceps to move nanometers at a time — that’s incredibly accurate, smaller than half a grain of sand.

The purpose of the SMART micro-forceps is to help solve surgeons’ tremors when operating with millimetric precision. There are many different ways in which this issue could have been resolved, keeping that in mind, this solution provides impact and access while remaining ethical. Let’s find out more about it:

The SMART micro-forceps will help improve patient’s outcomes, meaning fewer surgeries, more removal of malignant tissue, and better post-operative results. A huge advantage for patients. Another reason why the SMART forceps represent such a significant advancement — it doesn’t replace surgical skill, but rather eliminates the fundamental human limitation of physiological tremor that made these procedures so challenging and risky with traditional manual techniques.

The solution could have been a costly and large surgical robot, but this would have taken away the surgeon’s long-term acquired skill and knowledge, and it would not have been as accessible to hospitals around the world, as robotic surgery costs large amounts. So this device maintains the surgeon’s skills and allows for a big world impact as it isn’t as costly and can be given to less skilled or let’s say inexperienced surgeons and still operate on patients’ eyes with incredible precision. That is wonderful, as now more people would get better treatment.

I hope until this point you understand the concept of what this SMART micro-forceps mean to society and surgeons. So, let’s get closer to what it actually is, how it works, and how its technology is helping both surgeons and patients. Let’s go from big details to small details. The design of the forceps is ergonomic, surgeons say it feels like a pen. Now why is this important? Well of course working with something that is comfortable to grasp is key, Remember that eye surgeries are incredibly time-consuming, they take a lot of dexterity and concentration, so surgeons need something they can hold for hours at a time without getting their hand tired. So that’s a great ideation by the engineers who have created the device.

It’s important to not only think about making the tool/device effective, with a modern design and powerful, but also think about who is going to use it and in what sort of situation. Is the glove of the surgeon going to be slippery, is it going to be held for long periods of time, is it going to be held by two hands or one — these sorts of questions are important for the impact of the tool.

2. Engineering Precision

Let’s dive deeper, because there is a lot to explore in this device. One thing that I haven’t told you before, is that there is a fiber-optic sensor at the tip of the forceps which measures its milimetric ditance to the tissue. Why is this important? Well remember that the solution this tool provides is to counteract hand tremors in tight situations. So the device must have something to tell it how much it’s moving and where. If the hand is moving slightly forward, the fiber-optic OCT measures that distance and retracts the micro-forceps to keep them at safe distance from the tissue at focus — in this case the eye. This cable is unnoticable, it is barely seen at first sight — it is truly amazing how we are getting that precise with optics to the point where we can measure millimeters with a tiny camera. Think about it: a tiny camera continuously measuring distances to the millimeter, sending that information 500 times per second to a motor that responds in nanometers. It’s like having a surveillance system for surgical precision.

Next, I already hinted at this before, so let’s talk about it. The motor, but not just any motor — a Piezoelectric motor, that adjusts 500 times each second. Imagine how much control it has. What this motor does is use the information from the fiber-optic, which tells it how far the forceps are from the tissue, to then adjusts the position of the forceps so they are at a safe distance from the tissue. This motor is no joke. If you think the fiber optic was already precise with its measurements, this motor moves in nanometers — for reference, that is less than an average grain of sand. This is incredibly precise, and down to the detail, it gives the surgeon the power to have complete control over the surgery and not be worried about drifting slightly from the focus point.

What does all of this mean? It means that this tool will not replace (automate) surgeons’ skills but rather augment them, and improve other less experienced surgeons. This tool can be easily implemented into surgeries and does not need a heavy understanding of how to manipulate as a surgical robot would. Meaning that the learning curve is short, it’s quickly implemented. More benefits and higher chance of successful procedures. Higher accessibility to less experienced surgeons to use the device and help more people around the world, all of that for a lower cost. This technology represents the future where precision enhances rather than replaces human expertise.

3. Personal Reflection

I have always been around precision and details. My toys when I was smaller were paper, tape, and scissors. I made small and large crafts all with those tools and the positioning of things had to be perfect. It was many times a hassle to position the paper in the right place or make the correct fold or cut, and even more with the tape, as sometimes I had to cut it as small as a centimeter because I didn’t want it to be seen on the surface of the craft. So I had to get creative with ways to first grasp the tape and then stick it. This sounds similar to what this tool is resolving. It’s giving surgeons control over their procedure, helping with a natural cause which is hand tremors, and providing an incredible impact to the patients. It’s truly incredible how now motors can move in nanometers, you can’t even see that measurement in a regular ruler, as I said that it’s half a grain of sand.

We are getting far, biomedical engineers are doing better for this world and for surgeons and operations. These types of tools give access, impact, and improvement. The Fiber-optic OCT sensor guided “SMART” micro-forceps for microsurgery is a tool that helps surgeons improve their performance without removing their honed-in skill, or even knowledge; it is an assistive technology which enhances skill. It is like the beeping sound sensors when you are parking the car — you could probably park it without it, because of your experience parking and skills, but that reference improves your spatial skills in order to make a better parking of your car.

This micro-forceps solves that same fundamental challenge, but with life-changing consequences.