Robotic cochlear implantation: feasibility of a multiport approach in an ex vivo model

Abstract

Purpose

A recent clinical trial has shown the feasibility of robotic cochlear implantation. The electrode was inserted through the robotically drilled tunnel and an additional access through the external auditory canal was created to provide for means of visualization and manipulation. To obviate the need for this additional access, the utilization of multiple robotically drilled tunnels targeting the round window has been proposed. The objective of this study was to assess the feasibility of electrode insertion through a robotic multiport approach.

Methods

In four ex vivo human head specimens (left side), four trajectories through the facial recess (2x) and the retrofacial and suprameatal region were planned and robotically drilled. Optimal three-port configurations were determined for each specimen by analyzing combinations of three of the four trajectories, where the three trajectories were used for the electrode, endoscopic visualization and manipulative assistance. Finally, electrode insertions were conducted through the optimal configurations.

Results

The electrodes could successfully be inserted, and the procedure sufficiently visualized through the facial recess drill tunnels in all specimens. Effective manipulative assistance for sealing the round window could be provided through the retrofacial tunnel.

Conclusions

Electrode insertion through a robotic three-port approach is feasible. Drill tunnels through the facial recess for the electrode and endoscope allow for optimized insertion angles and sufficient visualization. Through a retrofacial tunnel effective manipulation for sealing is possible.

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Acknowledgements

The authors thank the Institute of Anatomy at the University of Bern for the preparation of the specimens.

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Correspondence to Juan Ansó.

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The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

All procedures performed in studies involving human participants (ex vivo) were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Schneider, D., Stenin, I., Ansó, J. et al. Robotic cochlear implantation: feasibility of a multiport approach in an ex vivo model. Eur Arch Otorhinolaryngol 276, 1283–1289 (2019). https://doi.org/10.1007/s00405-019-05318-7

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Keywords

  • Cochlear implantation
  • Robotic surgery
  • Multiport surgery
  • Electrode insertion