Robotic cochlear implantation: surgical procedure and first clinical experience

Area of Science:

• Otorhinolaryngology
• Medical Robotics
• Neurosurgery

Background:

• Cochlear implantation (CI) is a vital treatment for severe to profound hearing loss.
• Current CI procedures rely on manual surgical techniques, posing risks to delicate neural structures.
• Advancements in surgical robotics offer potential for enhanced precision and safety in CI.

Purpose of the Study:

• To establish a clinical workflow for robotic cochlear implantation (rCI).
• To demonstrate the feasibility, safety, and effectiveness of an image-guided robotic system for rCI.
• To evaluate the precision and safety mechanisms of robotic drilling for electrode insertion.

Main Methods:

• Developed a clinical workflow utilizing an image-guided surgical robot for rCI.
• Planned and executed robotic drilling of a tunnel to the round window based on pre-operative imaging.
• Assessed drill path accuracy and facial nerve proximity using intra-operative imaging and sensor data.
• Performed manual electrode array insertion through the robotic tunnel and evaluated outcomes via post-operative CT scans.

Main Results:

• Robotic drilling achieved an accuracy of 0.2 mm, with safety mechanisms predicting nerve proximity within 0.1 mm.
• The robotic approach resulted in minimal mastoidectomy and incisions.
• Successful manual electrode insertion was completed through the robotically drilled tunnel.
• The procedure was performed without complications, preserving all surrounding structures.

Conclusions:

• A safe and effective clinical workflow for robotic cochlear implantation (rCI) has been successfully developed and demonstrated.
• Robotic guidance ensures high precision and safety during the drilling phase of cochlear implantation.
• This robotic system holds promise for advancing cochlear implantation techniques, potentially improving patient outcomes.