A self-developed and constructed robot for minimally invasive cochlear implantation

Abstract

Conclusion: A robot built specifically for stereotactic cochlear implantation provides equal or better accuracy levels together with a better integration into a clinical environment, when compared with existing approaches based on industrial robots. Objectives: To evaluate the technical accuracy of a robotic system developed specifically for lateral skull base surgery in an experimental set-up reflecting the intended clinical application. The invasiveness of cochlear electrode implantation procedures may be reduced by replacing the traditional mastoidectomy with a small tunnel slightly larger in diameter than the electrode itself. Methods: The end-to-end accuracy of the robot system and associated image-guided procedure was evaluated on 15 temporal bones of whole head cadaver specimens. The main components of the procedure were as follows: reference screw placement, cone beam CT scan, computer-aided planning, pair-point matching of the surgical plan, robotic drilling of the direct access tunnel, and postoperative cone beam CT scan for accuracy assessment. Results: The mean accuracy at the target point (round window) was 0.56 ± 0.41 mm with an angular misalignment of 0.88 ± 0.40°. The procedural time for the registration process through the completion of the drilling procedure was 25 ± 11 min. The robot was fully operational in a clinical environment.

Keywords::

• Computer-aided surgery
• image-guided
• navigation
• key-hole

Acknowledgments

This study was supported by the National Center for Competence in Research Computer Aided and Medical Guided Intervention, Switzerland (grant no. NCCR S1NF40-111383), the Commission for Technology and Innovation, Switzerland (grant no.KTI 9957.2), and Phonak Acoustic Implants (Lonay, Switzerland). We would like to thank Einar Nielsen, Dominik Widmer of the Interstaatliche Hochschule für Technik Buchs (Switzerland) for robot design support and Simon Roder, Jonas Salzmann, Fabio Paci, and Daniel Widmer from the ARTORG Center for Hardware/Software development and data acquisition.

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