Robotic and computer-assisted techniques in ear surgery

Robotic and computer-assisted systems for ear surgery are receiving growing attention as tools to overcome the challenges intrinsic to the delicate, restricted operative field of the middle and inner ear. This review highlights recent advances in robotic platforms, clinical outcomes, and emerging technologies such as augmented reality (AR), virtual reality (VR), and artificial intelligence (AI). Multiple groups worldwide have introduced robotic devices that aid or automate tasks like mastoid drilling, stapes footplate fenestration, and cochlear implant (CI) electrode insertion. Seminal studies involving systems such as HEARO, iotaSoft, and RobOtol reveal sub-millimeter accuracy and minimized trauma during CI, suggesting the potential to reduce postoperative complications and improve hearing preservation. Although these technologies have progressed from proof-of-concept prototypes to early clinical usage, significant barriers remain before they become routine. Cost is a key concern, given the relatively small patient population for otologic procedures compared to other surgical fields. Regulatory pathways also require strict safety validations, particularly for semi-autonomous or fully autonomous functions. Nevertheless, FDA and European CE approvals for certain robotic systems illustrate their growing feasibility. Meanwhile, AR- and VR-based navigation is improving intraoperative visualization by overlaying critical structures such as the facial nerve onto the surgeon's field, while AI-driven algorithms for instrument tracking and real-time monitoring offer further enhancements in safety and precision. In addition, simulation-based training in VR environments can accelerate surgical expertise and reduce learning curves. Larger-scale clinical trials that directly compare robotic and conventional approaches are still needed to quantify benefits related to complication rates, operative times, and long-term auditory outcomes. Ongoing innovations in software integration and miniaturized hardware are likely to broaden the range of feasible robotic tasks within the ear's narrow anatomical boundaries.