New strategies for high precision surgery of the temporal bone using a robotic approach for cochlear implantation

  • Thomas Klenzner
  • Chiu Chun Ngan
  • Felix Bernhard Knapp
  • Hayo Knoop
  • Jan Kromeier
  • Antje Aschendorff
  • Evangelos Papastathopoulos
  • Joerg Raczkowsky
  • Heinz Wörn
  • Joerg Schipper
Otology

DOI: 10.1007/s00405-008-0825-3

Cite this article as:
Klenzner, T., Ngan, C.C., Knapp, F.B. et al. Eur Arch Otorhinolaryngol (2009) 266: 955. doi:10.1007/s00405-008-0825-3

Abstract

The aim of the study was to demonstrate a collision-free trajectory of an instrument through the facial recess to the site of planned cochleostomy guided by a surgery robot. The indication for cochlear implantation is still expanding toward more substantial residual hearing. A cochleostomy as atraumatic as possible will influence the preservation of inner ear function. The employment of a highly precise instrument guidance using a robot could represent a feasible solution for a constant reproducible surgical procedure. Screw markers for a point-based registration were fixed on a human temporal bone specimen prepared with a mastoidectomy and posterior tympanotomy. A DICOM dataset has been generated thereof in a 64-multislice computer tomography (CT). A virtual trajectory in a 3D model has been planned representing the path of instrumentation toward the desired spot of cochleostomy. A 1.9-mm endoscope has been mounted onto the robot system RobaCKa (Staeubli RX90CR) to visualize this trajectory. The target registration error added up to 0.25 mm, which met the desirable tolerance of <0.5 mm. A collision-free propagation of the endoscope into the tympanic cavity via the facial recess has been performed by the robot and the spot of cochleostomy could be visualized through the endoscope. Using a DICOM dataset of a high-resolution CT and a robot as a positioning platform for surgical instruments could be a feasible approach to perform a highly precise and constant reproducible cochleostomy. Furthermore, it could be a crucial step to preserve substantial residual hearing in terms of expanding the indications for cochlear implantation.

Keywords

Minimal invasive surgeryCASCochlear implantationCochleostomyPoint-based registration

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Thomas Klenzner
    • 1
  • Chiu Chun Ngan
    • 2
  • Felix Bernhard Knapp
    • 1
  • Hayo Knoop
    • 2
  • Jan Kromeier
    • 3
  • Antje Aschendorff
    • 4
  • Evangelos Papastathopoulos
    • 5
  • Joerg Raczkowsky
    • 2
  • Heinz Wörn
    • 2
  • Joerg Schipper
    • 1
  1. 1.Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Hospital of DüsseldorfDüsseldorfGermany
  2. 2.Institute for Process Control and Robotics (IPR)University of Karlsruhe (TH)KarlsruheGermany
  3. 3.Department of RadiologyUniversity Hospital of FreiburgFreiburgGermany
  4. 4.Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Hospital of FreiburgFreiburgGermany
  5. 5.Institute of Applied Optics (ITO)University of StuttgartStuttgartGermany