Robotic middle ear access for cochlear implantation: First in man

Area of Science:

• Otolaryngology
• Medical Robotics
• Neurosurgery

Background:

• Severe-to-profound hearing loss necessitates cochlear implantation.
• Minimally invasive surgical techniques are being explored to improve outcomes.
• Robotic systems offer potential for enhanced precision in otologic surgery.

Purpose of the Study:

• To assess the feasibility of robotic middle ear access for cochlear implantation.
• To evaluate the safety and efficacy of robotically drilled keyhole access to the tympanic cavity.
• To determine the potential of robotic assistance in targeting the round window for electrode insertion.

Main Methods:

• A clinical trial involving nine adult patients undergoing cochlear implantation.
• Preoperative CT imaging for robotic surgical planning and keyhole tunnel creation.
• Robotic drilling to the facial recess and round window, with intraoperative imaging for guidance.
• Manual completion of cochlear access and electrode array insertion by the surgeon.

Main Results:

• Successful cochlear implantation in all nine patients using the robotic approach.
• Robotic drilling to the facial recess was completed in all cases.
• Three patients required conversion to a conventional approach due to safety considerations.
• No adverse effects on facial nerve function were observed post-procedure.

Conclusions:

• Robotic keyhole access is a feasible technique for cochlear implantation.
• The procedure demonstrated safety regarding facial nerve function.
• Improvements in surgical workflow, duration, usability, and safety are necessary for wider clinical implementation.