Initial Surgeon Experiences With a Robotic-Assisted Cochlear Implant Electrode Array Insertion System

Rick F Nelson ¹, Amanda R Ernst ², Oliver Adunka ³

¹Department of Otolaryngology-Head & Neck Surgery, Indiana University, Indianapolis, Indiana.
²Ernst Coaching and Consulting, LLC, Iowa City, Iowa.
³Department of Otolaryngology-Head & Neck Surgery, The Ohio State University, Columbus, Ohio.
⁴Michigan Ear Institute, Farmington Hill, Michigan.
⁵Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota.
⁶Department of Otolaryngology-Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA.
⁷Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Phoenix, Arizona.
⁸Department of Otolaryngology-Head & Neck Surgery, Oregon Health and Science University, Portland, Oregon.
⁹Department of Otolaryngology-Head & Neck Surgery, University of Utah, Salt Lake City, Utah.
¹⁰Department of Otolaryngology-Head & Neck Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas.
¹¹Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston Massachusetts.

⁰Department of Otolaryngology-Head & Neck Surgery, Indiana University, Indianapolis, Indiana.

Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology +

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June 4, 2025

View abstract on PubMed

Summary

Surgeons can achieve proficiency with robotic-assisted cochlear implant (RA-CI) electrode insertion systems quickly, typically within five cases. Minor surgical adjustments and training on best practices ensure successful integration and minimal time addition during CI surgery.

Area Of Science

Otolaryngology
Medical Robotics
Surgical Innovation

Background

Cochlear implantation (CI) is a complex procedure.
Robotic-assisted surgery offers potential benefits for precision and consistency.
Integration of new robotic systems into surgical workflows requires careful assessment.

Purpose Of The Study

To evaluate the integration of a single-use robotic-assisted cochlear implant (RA-CI) electrode array insertion system.
To identify challenges and establish best practices for its use in CI surgery.
To assess the learning curve and time impact of the RA-CI system.

Main Methods

A survey was conducted among 16 surgeons across 10 US hospitals.
Data were collected on the use of a single-use RA-CI insertion system in CI surgeries.
Outcomes measured included proficiency acquisition, estimated time addition, and recommended best practices.

Main Results

121 RA-CI cases were performed, with all participating surgeons completing the survey.
Most surgeons (62.5%) felt proficient within five cases.
The RA system added an estimated 5-15 minutes to surgery duration for most users.
Key best practices involved incision size, facial recess exposure, and device placement for optimal insertion.

Conclusions

Proficiency with the RA electrode array insertion system is achievable with fewer than five cases.
Minimal adjustments to surgical approach and specific training on best practices are crucial for successful integration.
The RA-CI system can be incorporated into CI surgery with a manageable increase in operative time.

Keywords:

Cochlear implant Cochlear implantation Electrode array insertion Hearing preservation Robotic Robotic-assisted Robotics-assisted Soft surgery