Crossing borders in Cochlear Implantation – from research to clinical application of minimally invasive drilling

Introduction The surgical procedure of cochlear implantation remained mainly unchanged for decades. Today, robotics in otologic surgery aim for two main goals as we have summarized in [1]: 1) Access to a target structure in a minimally invasive manner with high accuracy 2) Assisting the insertion of electrodes.

Methods We addressed (1) in an ongoing study (MHH IRB 9030_BO_S_2020) with 11 adult patients undergoing cochlear implantation. The first six patients involved sham drill bits, as reported in [2]. In this work, we present the results (usability, accuracy and surgical workflow analysis) of the remaining five patients, involving actual drilling the access tunnel with the help of a mini-stereotactic frame and patient specific positioning jigs.

Results The facial nerve and other risk structures were preserved as planned and the trajectory was deemed suitable for electrode insertion. No post-operative study-related adverse events were reported. In two cases the surgery was reverted to the conventional approach due to technical issues with the steam sterilizer.DiscussionJig-guided access to the middle is both, feasible and safe. It is possible to integrate in the operating workflow requiring neither setting up a robotic arm, nor a navigation system. This benefit, combined with a single bone-screw fixation concept contributed to the success, showing that the required accuracy was reached in challenging clinical conditions and showcase a successful transfer of basic research into a product realization.

• References

• 1 Lenarz et al. Robotics in Neurotology. In Robotics in Skull-Base Surgery. pp. 73-92 ) Springer Nature; 2023
• 2 Salcher et al. Minimally invasive cochlear implantation: first-in-man of patient-specific positioning jigs. Frontiers in Neurology. 2022

Publication History

Article published online:
19 April 2024