Robotic cochlear implantation: surgical procedure and first clinical experience

Abstract

Conclusion: A system for robotic cochlear implantation (rCI) has been developed and a corresponding surgical workflow has been described. The clinical feasibility was demonstrated through the conduction of a safe and effective rCI procedure.

Objectives: To define a clinical workflow for rCI and demonstrate its feasibility, safety, and effectiveness within a clinical setting.

Method: A clinical workflow for use of a previously described image guided surgical robot system for rCI was developed. Based on pre-operative images, a safe drilling tunnel targeting the round window was planned and drilled by the robotic system. Intra-operatively the drill path was assessed using imaging and sensor-based data to confirm the proximity of the facial nerve. Electrode array insertion was manually achieved under microscope visualization. Electrode array placement, structure preservation, and the accuracy of the drilling and of the safety mechanisms were assessed on post-operative CT images.

Results: Robotic drilling was conducted with an accuracy of 0.2 mm and safety mechanisms predicted proximity of the nerves to within 0.1 mm. The approach resulted in a minimal mastoidectomy and minimal incisions. Manual electrode array insertion was successfully performed through the robotically drilled tunnel. The procedure was performed without complications, and all surrounding structures were preserved.

Keywords:

• Robotic surgery
• cochlear implantation
• facial nerve monitoring
• image guidance
• minimally invasive techniques
• surgical planning
• computed tomography imaging

Acknowledgments

This work was presented at the Collegium ORL Amicitiae Sacrum annual meeting, Bordeaux, August 28–31, 2016. The authors would like to acknowledge Brett Bell, Manuel Stebinger, Marco Matulic, Leatitia Perroud, Fabian Zobrist, Masoud Assadi, Claude Jolly, Mauricio Reyes, Philippe Zysset, and Philippe Büchler for the scientific contributions made to the presented system and related work. Additionally, the authors would like to thank the department of ENT surgery and Neuroradiology of the Bern University Hospital, particularity Susanne Hoffman, Nadja Feusi, Nexhmedin Avdija, and Patrick Mühlethaler, for their contributions to the presented clinical case.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Additional information

Funding

This work received funding from the Swiss National Science Foundation (Nano-Tera initiative, HearRestore project), the European commission (under the HEAR-EU project, grant number: 304857), the Swiss Commission for Technology and Innovation, CAScination AG (Bern, Switzerland), and MED-EL GmbH (Innsbruck, Austria).