CBCT-guided robotic cochlear implantation precision, efficiency, and procedural standardization in a preclinical study

Cochlear implantation (CI) requires submillimeter precision to protect delicate inner ear structures. This preclinical study assesses a novel cone-beam computed tomography (CBCT)-guided robotic system for CI, aiming to improve surgical precision, reduce invasiveness, and standardize outcomes compared to traditional approaches.

This study developed a new cochlear implantation robotic system integrated with CBCT imaging, featuring a high-precision robotic arm and micro-drill to achieve sub-millimeter accuracy in drilling. Using preoperative CT and intraoperative CBCT for planning and navigation, the robot automatically creates a safe pathway and assists with accurate electrode insertion.

The robotic system achieved successful drilling in all 10 cadaveric ears. Measurements using 3D Slicer revealed the minimum distance between the drilled pathway and the facial nerve was 0.70 ± 0.12 mm, meeting clinical safety standards. Cochlear electrode implantation was attempted in 8 ears, with 7 successful placements. The primary challenge was the low CBCT contrast, which result in one unsuccessful implantation and minor deviations in endpoint localization. Individual anatomical differences were accommodated by adjusting the drilling angle and position. Overall, postoperative imaging confirmed precision of the drilling and electrode placement, demonstrating the system's high stability, accuracy, and adaptability, even in complex anatomical scenarios.

This CBCT-guided robotic system delivers a new standard of precision, efficiency, and consistency for cochlear implantation in preclinical models. Automating critical surgical steps with real-time imaging guidance fundamentally reduces operator-dependent variability and surgical invasiveness. These advancements promise to standardize CI outcomes, improve patient safety, and decrease operative workload. The system's robust performance in this study validates its potential for clinical translation, marking a critical step toward making robotic-assisted cochlear implantation a safer and more reliable clinical reality.