Evaluating the Safety and Efficacy of Robot-Assisted Cochlear Implant Electrode Array Insertion

ImportanceRobotic-assisted cochlear implantation has the potential to reduce surgical variability, enhance insertion precision, and minimize intracochlear trauma; however, real-world clinical evidence remains limited.ObjectiveTo evaluate the safety, accuracy, and early hearing outcomes of robot-assisted cochlear implant (CI) electrode array insertion using the OTODRIVE^® system.DesignRetrospective cohort study.SettingA tertiary academic CI center.ParticipantsAdult patients who underwent robot-assisted cochlear implantation between the dates of February 2025 and August 2025.Intervention or ExposuresRobot-assisted electrode array insertion with preoperative planning using the OTOPLAN software.Main Outcome MeasuresIntraoperative safety outcomes; audiologic performance, including unaided and aided pure-tone averages (PTAs) and AzBio sentence scores; and imaging-based electrode insertion accuracy, including angular insertion depth (AID) and electrode contact insertion on postoperative cone-beam computed tomography.ResultsThe review identified 39 patients, mean age of 59.5 ± 19.2 years, with 59% male participants. The most common etiology of hearing loss (HL) was idiopathic sudden sensorineural HL. Mean total surgical time was 122.2 ± 49.4 minutes. No intraoperative complications or robotic-related adverse events occurred. Audiologic outcomes demonstrated significant improvement, with a mean preoperative unaided PTA of 92.4 ± 16.7 dB HL, improving to a postoperative aided PTA of 31.6 ± 6.3 dB HL. Mean AzBio sentence recognition scores increased from 18.1% preoperatively to 75.7% postoperatively, representing a 57.6% absolute improvement. Mean cochlear duct length was 34.6 ± 1.6 mm, and the planned versus achieved AIDs were 582.7° ± 35.2° and 569.0° ± 38.9°, respectively. Full insertion was achieved in 89.7% of implanted ears, with no tip fold-overs or electrode malposition identified.ConclusionsRobot-assisted cochlear implantation using the OTODRIVE^® system was safely integrated into clinical practice in this cohort, with reproducible electrode insertion and early postoperative audiologic outcomes.RelevanceThese findings support the feasibility and safety of integrating robotic systems into routine CI surgery.