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A robot-guided minimally invasive approach for cochlear implant surgery: preliminary results of a temporal bone study

  • Omid MajdaniEmail author
  • Thomas S. Rau
  • Stephan Baron
  • Hubertus Eilers
  • Claas Baier
  • Bodo Heimann
  • Tobias Ortmaier
  • Sönke Bartling
  • Thomas Lenarz
  • Martin Leinung
Original Article

Abstract

Purpose

The aim of this study was to create an access canal to the inner ear, by drilling, and perform the cochleostomy for cochlear implant surgery using robot guidance.

Methods

A robot, a surgical drill and an Image-Guided Surgery (IGS) system were combined in a closed-loop setup. Ten temporal bones were scanned at the planning stages of the procedure. The robot guided the drill along the preplanned trajectory and created the approach. Postoperative scans were obtained.

Results

The cochleostomy was performed completely in nine out of ten cases. This did not prove possible for one of the specimens, the target site selected being in too superficial a location in relation to the round window. No violation of the facial nerve took place, although the chorda tympani nerve was violated in one case and the stapes in two. It was obvious during preoperative planning that these structures would be violated, but this was accepted in order to maintain a safety margin from the facial nerve. No other unforeseen damage occurred.

Conclusions

This preliminary study suggests that robot-guided drilling of a minimally invasive approach to the cochlea might be feasible, but further improvements are necessary before any clinical application becomes possible. Where the width of the facial recess is less than 2.5 mm, the chorda tympani nerve and the ossicles are at risk.

Keywords

Cochlear implant surgery Minimally invasive approach Robot-guided surgery Robot-assisted surgery Image-guided surgery 

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Copyright information

© CARS 2009

Authors and Affiliations

  • Omid Majdani
    • 1
    Email author
  • Thomas S. Rau
    • 1
  • Stephan Baron
    • 2
  • Hubertus Eilers
    • 2
  • Claas Baier
    • 1
  • Bodo Heimann
    • 2
  • Tobias Ortmaier
    • 2
  • Sönke Bartling
    • 3
  • Thomas Lenarz
    • 1
  • Martin Leinung
    • 1
  1. 1.Department of Otolaryngology Head and Neck Surgery, Clinic for OtolaryngologyHannover Medical SchoolHannoverGermany
  2. 2.Institute of Mechatronic Systems (former Institute of Robotics)Leibniz Universität HannoverHannoverGermany
  3. 3.Division of Medical Physics in RadiologyGerman Cancer Research CenterHeidelbergGermany

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