Comparison of Manual Versus Robot-Assisted Piston Prosthesis Placement and Crimping in a 3D-Printed Temporal Bone...

To reduce operator-dependent variability and improve surgical precision, robot-assisted piston prosthesis placement and crimping during otosclerosis surgery may represent a promising approach. However, dedicated microsurgical forceps for this application are not yet available in clinical practice. This study aimed to assess the feasibility and precision of piston prosthesis placement and crimping, comparing manual and robot-assisted techniques.

A 3D-printed temporal bone model was modified to measure forces applied to the incus. Robot-assisted manipulation was performed using a robotic arm coupled with custom-designed microforceps. Five otologists performed two tasks (piston placement and crimping) under three conditions: (1) manual under visual control, (2) robot-assisted, both applied to placement and crimping, and (3) manual without visual feedback, applied to crimping only. This resulted in five procedures, each repeated three times (n = 15). Maximal force (N) and torque (N.mm) were recorded and compared using Mann-Whitney and Kruskal-Wallis tests.

Robot-assisted piston placement resulted in lower maximal torque compared with the manual technique (4.2 ± 3.96 vs. 7.5 ± 4.73 N.mm, p = 0.037), with no difference in maximal force. During crimping, robot-assisted manipulation generated lower maximal force (0.15 ± 0.09 vs. 0.27 ± 0.09 N, p = 0.0126) and lower maximal torque (6.1 ± 3.41 vs. 11.5 ± 3.09 N.mm, p = 0.004) than manual crimping. No difference was observed between manual crimping performed with and without visual control. Procedure duration was longer with robot-assisted manipulation for both placement and crimping (all p < 0.0001).

Robot-assisted piston prosthesis placement and crimping were feasible and were associated with reduced mechanical loads applied to the incus.

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