Accelerating the Learning Curve in Retinal Surgery: Training the Next Generation in a Micrometric Field

In retinal surgery, precision is measured in microns.Learning, on the other hand, is often measured in hundreds of procedures.

Becoming a retinal surgeon requires years of progressive exposure to clinical cases, repeated practice of highly demanding gestures, and close transmission of expertise across generations. Yet access to complex cases remains uneven, while expectations around patient safety have never been higher.

Against this backdrop, a question is increasingly emerging in discussions among surgeons: can the learning curve be accompanied differently — not by artificially shortening it, but by making it safer, more progressive, and more reproducible?

Through observations of surgeons using the LUCA® robotic platform developed by AcuSurgical, this article explores how robotic assistance may help reduce gesture variability, secure critical steps, and facilitate gradual access to complex maneuvers in retinal surgery.

Retinal surgery today

Regardless of their level of experience, retinal surgeons describe a shared reality: vitreoretinal surgery is a discipline where learning relies on gradual exposure to cases, rigorous repetition of gestures, and a slow accumulation of confidence. Junior surgeons and fellows frequently mention the difficulty of gaining early access to the most critical steps, which are often reserved for the most experienced operators. The immediate proximity of the retina, depth control, gesture stability, and the stress associated with first procedures as a primary surgeon represent major challenges.

For senior surgeons, the challenge lies elsewhere. Training the next generation requires constant arbitration between transmitting expertise and ensuring patient safety. Inter-operator variability, operating time constraints, and heterogeneous training pathways make this responsibility particularly demanding. Many emphasize that mastering a gesture does not automatically guarantee its reproducibility in complex or unpredictable clinical situations.

These field observations are strongly supported by the scientific literature. Multiple studies have shown that the learning curve in retinal surgery is long, progressive, and measurable, with a performance plateau often reached only after 100 to 200 procedures, depending on the indication and the gestures studied¹,². Complication rates tend to decrease later than technical mastery alone, and operative times for novice surgeons are initially significantly longer than those of experienced operators¹,². Together, these data reflect a slow progression toward competence, requiring high case volumes and prolonged exposure.

In other words, the learning curve exists, it is long, and it remains difficult to secure using traditional tools alone.

Addressing a real clinical need

LUCA® was born from the ambition to push the limits of retinal surgery by delivering levels of precision, stability, and reproducibility that are difficult to achieve with the human hand alone, within an operative field measured in microns. From the outset, AcuSurgical’s goal was to develop a robotic platform capable of supporting surgeons during the most demanding gestures, while preserving their full control over the surgical act.

Through ongoing dialogue with retinal surgeons, this vision was progressively confronted with real-world clinical practice. Several recurring needs became clear: improving gesture stability, reducing inter-operator variability, and limiting the impact of tremor and fatigue — without ever replacing clinical judgment.

In this context, the question of training and learning curve support naturally emerged as an extension of the project. If robotics can stabilize gestures and reduce variability, it may also help secure and structure skill acquisition for a broader range of surgeons.

LUCA® was therefore not designed to replace surgeons, nor to artificially “shorten” the learning curve, but to provide technological support that can accompany progression — without substituting experience or expertise.

Early field feedback: the LUCA experience today

To date, approximately 30 surgeons, from France, Europe and the United States, have already interacted with the LUCA® platform during demonstrations and wet labs. Most participants have been senior surgeons and recognized experts in the field, though junior surgeons and fellows have also been exposed to the platform — a limitation that is clearly identified and acknowledged at this stage of development.

During first interactions, feedback is marked by a sense of positive surprise. Surgeons consistently highlight the rapid onboarding, the fluidity of movements, and the near-imperceptible latency between the surgeon’s action and the instrument’s response. As summarized by a senior retinal surgeon based in Los Angeles:

“The amount of attention to details and the negligible lag.”

Beyond these initial impressions, discussions quickly evolve. Once the novelty effect fades, attention shifts away from technical characteristics and toward how the gesture itself is perceived, understood, and executed.

This is where the LUCA® experience takes on its full meaning.

When surgeons take control of LUCA®

When surgeons truly take control of LUCA®, what emerges most often are subtle yet structurally significant differences in how gestures are perceived and performed.

Several surgeons describe a sense of continuity between intention and action. Latency is perceived as negligible, to the point that the system quickly fades from conscious awareness. Attention then moves toward elements that are often more difficult to master early in one’s career: trajectory control, depth management, and the relationship between hand movement and instrument response.

“What stood out was not the robot itself, but how quickly it disappeared from my attention.” — Senior retinal surgeon, North America

This perceived reduction in variability changes how delicate maneuvers are approached. Surgeons explain that they can focus more on gesture strategy rather than continuously compensating for instability. For critical steps — such as circular trajectory tracking, membrane manipulation, or approaching deeper structures — this added stability alters the perceived relationship to risk.

Another frequently mentioned aspect is fatigue and ergonomics.

“It helps separate the gesture from the noise around it — fatigue, stress, micro-instability.” — Surgical trainer, Europe

Several surgeons note that posture and mechanical support reduce muscular tension, particularly during prolonged exercises. This dimension, rarely formalized in surgical training, directly influences precision and consistency over the course of a procedure.

Discussions then naturally shift toward learning. Many surgeons emphasize that this type of assistance does not make gestures “easier,” but rather more readable.

“The robot doesn’t make the gesture easier. It makes it clearer,” summarizes a senior retinal surgeon.

By reducing sources of noise — tremor, fatigue, instability — the system highlights the fundamental elements of the gesture: trajectory, timing, and interaction with tissue.

“When you remove tremor and instability, you start seeing what actually matters in the movement,” explains another surgeon.

For some, this could allow earlier understanding of what defines a high-quality expert gesture.

Among senior surgeons, LUCA® is often viewed as a potential transmission tool. The ability to secure certain steps and reduce variability opens the door to more progressive delegation of complex maneuvers within a more controlled framework.

“Becoming a retinal surgeon is not only about doing more cases. It’s about understanding the gesture, gaining confidence, and learning how to reproduce it consistently — and that takes time and transmission.” — Senior retinal surgeon, Europe

From the perspective of younger surgeons, fellows, or trainees, the perceived value is different yet complementary. LUCA® may offer an environment where confidence can be built earlier — not by removing difficulty, but by allowing it to be approached in a more structured and reproducible way.

“You don’t just need repetition. You need a way to understand what you’re doing right — and what you’re not — early on.” — Retinal surgery fellow, Europe

Supporting a gesture learned over a lifetime

The learning curve in retinal surgery cannot be reduced to case volume or individual dexterity alone. It is built on confidence, gesture readability, controlled repetition, and progressive transmission across generations.

In this context, LUCA® appears neither as a shortcut nor as an alternative to traditional training. Instead, it positions itself as an accompanying tool — capable of reducing certain sources of variability, securing key steps, and making the gesture more readable, both for those learning and those teaching.

Retinal surgery will remain a demanding discipline, grounded in experience, clinical judgment, and real-time decision-making. Yet as tools evolve, a broader question emerges: not how to train faster, but how to better accompany progression — in a field where every micron matters, and where every gesture is transmitted.

Scientific references

1.  Radeck et al., The learning curve of retinal detachment surgery, Retina, 2021

2.  Martín-Avià et al., Analysis of the vitreoretinal surgery learning curve, Eye, 2017

3.  Puri et al., Vitreoretinal surgical training: assessment of simulation-based training, Annals of Eye Science, 2022

4.  Jacobsen et al., The learning curve of robot-assisted vitreoretinal surgery, Wiley Online Library, 2021