Application of a new computer‐assisted robotic visualization system in cochlear implantation—Proof of concept

Riepl, Ricarda; Greve, Jens; Schild, Leon; Böhm, Felix; Goldberg‐Bockhorn, Eva; Hoffmann, Thomas; Schuler, Patrick J.

doi:10.1002/rcs.2301

Cited by 6 publications

(12 citation statements)

References 16 publications

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“…In general, the exoscope proved its usefulness as all procedures were successfully performed and with comparable outcomes as would have been achieved with the OM. This finding is in line with previous studies investigating the use of the exoscope, although these have been mainly restricted to neurosurgical procedures (5,8–10,12,15).…”

Section: Discussionsupporting

confidence: 92%

The Feasibility of the Three-Dimensional Footswitch-Operated Robotic Arm Exoscope for Cochlear Implant Surgery

Karinen,

Iso-Mustajärvi,

Dietz

2023

Otol Neurotol

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Objective To compare the three-dimensional (3D) footswitch-operated robotic arm exoscope with the operating microscope (OM) in cochlear implant surgery. Study design Matched case–control study. Patients Cochlear implantation was performed with the exoscope on unselected patients with normal temporal anatomy. The control group that underwent cochlear implantation with the OM was case matched with respect to age, anatomy, surgical technique, and type of anesthesia. Interventions Cochlear implantation performed with the 3D exoscope. Main Outcome measures Surgical time, occupation of the operation theater, surgical results, and user experience evaluated by a questionnaire. Results Eleven patients (13 ears) were successfully operated on with the exoscope. In the exoscope group, we observed one minor intraoperative complication, where the middle dura was exposed during mastoidectomy. Although no clear preference was evident for either device in the overall rating, the subdomain rating revealed that the exoscope’s image quality was deemed inferior, especially at higher magnifications where pixelation became noticeable. The exoscope received higher scores for usability, particularly excelling in terms of surgeon’s ergonomic and comfortability. There was a statistically significant difference in mean surgical time, 146 and 129 min for the exoscope and OM group, respectively. Conclusions Cochlear implant surgery was found to be feasible with a 3D exoscope. However, there is a learning curve to overcome regarding handling and the different quality of the image. The exoscope provides better ergonomics for the surgeon.

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Section: Discussionsupporting

confidence: 92%

The Feasibility of the Three-Dimensional Footswitch-Operated Robotic Arm Exoscope for Cochlear Implant Surgery

Karinen,

Iso-Mustajärvi,

Dietz

2023

Otol Neurotol

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“…RoboticScope was originally introduced by targeting the fields of otology or neurosurgery, but it is now expanding its scope to the field of super micro surgery. [2–5] A case report of LVA with this scope has already been published in 2021. [1] However, this scope has not yet been officially launched in the Asian market, and demonstrations have been underway at several hospitals since 2022.…”

Section: Discussionmentioning

confidence: 99%

First experience of lymphaticovenular anastomosis using BHC RobotiScope: A case report

et al. 2023

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Rationale: The RoboticScope (BHS Technologies GmbH, Innsbruck, Austria) is a robotic exoscope, which consists of a robotic arm that holds a 3-dimensional camera. It has an advantage that a surgeon can perform an operation comfortably with a favorable ergonomic position. Also, it allows the delivery of clear and high-quality visualization for surgeons. In this study, we would like to share our initial experience with this newly developed microscope technology in lymphaticovenular anastomosis (LVA). To the best of our knowledge, it is the first experience of LVA using this microscope in Asia.Patient concerns: A 65-year-old woman presented with bilateral lower extremity lymphedema after a hysterectomy that was performed 25 years back. Despite complex decongestive physiotherapy, an edematous symptom in both legs worsened.Diagnoses: In lymphoscintigraphy, a decreased visualization of main lymphatic flow in both the lower extremities was evident which was further suggestive of lymphatic obstruction.Intervention: Although both sides showed edematous symptoms, we decided to proceed with the surgery on the left side first, because of the worsened condition. Four LVAs were performed at the dorsum of the foot (×2), ankle, and the superior edge of the knee using RoboticScope Outcomes: At 6-months follow-up after operation, the postoperative circumference diameters were improved than preoperative in 10 cm above the knee (45 cm vs 49 cm), 10cm below the knee (37 cm vs 41 cm) and lateral malleolus (25 cm vs 28 cm). The lower extremity lymphedema index was also improved from 346.7 to 287.4 postoperatively. The RoboticScope provided a highresolution image and a favorable ergonomic position during an operation.Lessons: The results represent the possibility of the application of a robotic microscope in the field of microsurgery, and further studies are necessitated to confirm the efficacy of this system.

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“…otorhinolaryngology, such as cochlear implants and oncological surgery, 14,15 and in the neurosurgical resection of intracranial tumors. 8 To the best of our knowledge, we are the first to describe the use of the system for targeted muscle reinnervation (TMR) surgery.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…visualization. 6,14 Reports of this approach have described a more comfortable and consistent working environment, being preferred in over 90% of surgeons, who have tried both approaches. 17,20,21 Another issue to consider is the controlled distance using the HMD.…”

Section: Manuscriptmentioning

confidence: 99%

How a Robotic Visualization System Can Facilitate Targeted Muscle Reinnervation

Brauckmann

Mayor

Ernst

et al. 2023

J Reconstr Microsurg Open

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Background:To enable and further improve microsurgical outcomes, different loupes and optic based microscopes have been proposed in recent years. In amputation surgery continuous progress and prosthetic developments have provided amputees with improved degree of function and quality of life.We present a 17-year-old patient who suffered traumatic loss of the left upper limb and underwent TMR-surgery facilitated by a 3D-robotic-exoscope-system. Methods:The rerouting of the distal ends of the arm-nerves (Targeted Muscle Reinnervation) was performed in the upper limb of a traumatic transhumeral amputee patient using 3D-robotic-exoscope-system (RS, RoboticScope). Perioperative data was collected and compared to standard. Users’ evaluation of the system during the surgical procedure was done using a 5-point-Likert-Scale. Results:Operation time was 311 minutes, the robotic system was used for 101 minutes. Overall users´ evaluation revealed 4,5 for selected items on the Likert-Scale. The evaluation showed similar results in evaluation of the system by main and assistant surgeons. No special training was required beforehand. The bimanual control allowed for improved personal freedom in the surgical field at a comfortable position. The imaging of colors will need future improvements until authentic representation of in situ structures is achieved. Conclusions:Major advantages of a robotic Scope-3D-exoscope-system are improved image quality, ergonomic position, and increased accessibility in a wider operating field due to system implied features. Another benefit is digital documentation, simultaneous education through possibility of capturing images and videos and easy transportation between operating rooms without risk to harm the vulnerable optic. Digital microscopes are still not yet implemented as standard of care.

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Application of a new computer‐assisted robotic visualization system in cochlear implantation—Proof of concept

Cited by 6 publications

References 16 publications

The Feasibility of the Three-Dimensional Footswitch-Operated Robotic Arm Exoscope for Cochlear Implant Surgery

The Feasibility of the Three-Dimensional Footswitch-Operated Robotic Arm Exoscope for Cochlear Implant Surgery

First experience of lymphaticovenular anastomosis using BHC RobotiScope: A case report

How a Robotic Visualization System Can Facilitate Targeted Muscle Reinnervation

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