Fusion of Technology in Cochlear Implantation Surgery: Investigation of Fluoroscopically Assisted Robotic Electrode Insertion

Abstract

The HEARO cochlear implantation surgery aims to replace the conventional wide mastoidectomy approach with a minimally invasive direct cochlear access. The main advantage of the HEARO access would be that the trajectory accommodates the optimal and individualized insertion parameters such as type of cochlear access and trajectory angles into the cochlea. To investigate the quality of electrode insertion with the HEARO procedure, the insertion process was inspected under fluoroscopy in 16 human cadaver temporal bones. Prior to the insertion, the robotic middle and inner ear access were performed through the HEARO procedures. The status of the insertion was analyzed on the post-operative image with Siemens Artis Pheno (Siemens AG, Munich, Germany). The completion of the full HEARO procedure, including the robotic inner ear access and fluoroscopy electrode insertion, was possible in all 16 cases. It was possible to insert the electrode in all 16 cases through the drilled tunnel. However, one case in which the full cochlea was not visible on the post-operative image for analysis was excluded. The post-operative analysis of the electrode insertion showed an average insertion angle of 507°, which is equivalent to 1.4 turns of the cochlea, and minimal and maximal insertion angles were recorded as 373° (1 cochlear turn) and 645° (1.8 cochlear turn), respectively. The fluoroscopy inspection indicated no sign of complications during the insertion.

Robotized Cochlear Implantation under Fluoroscopy: A Preliminary Series

“…To date, several teams has reported this type of EA-insertion using RobOtol ® but none of them used fluoroscopy as visual feedback [7,17,18]. Recently, a cochlear implantation under fluoroscopy with the HEARO procedure has been reported [19]. In this interesting report, while the approach was robotized, the EA insertion was not, which is quite different from our procedure.…”

Suitable Electrode Choice for Robotic-Assisted Cochlear Implant Surgery: A Systematic Literature Review of Manual Electrode Insertion Adverse Events

“…Indeed, studies have shown that the orientation of insertion with a robotic system reduces both the error and the variability of the alignment to a defined optimal axis that it is significantly better compared with a manual insertion, even with experienced surgeons ( 102 , 103 ). The detection of premature electrode contact with the basilar membrane is expected to improve when intra-operative evoked potentials can be reliably measured ( 64 , 104 , 105 ) with advanced intra-operative imaging ( 106 ).…”

Advances in 3D Inner Ear Reconstruction Software for Cochlear Implants: A Comprehensive Review

“…Seamlessly integrated into the HEARO system for robotic cochlear interventions [ 29 ], OTOPLAN aligns insertion angles with natural cochlear anatomy, facilitating smooth electrode array insertion into the scala tympani, while preserving critical structures such as the facial nerve and chorda tympani. Additionally, it provides an electrode visualization tool, enabling surgeons to assess compatibility with the patient’s unique cochlear structure and evaluate insertion depth and tonotopic pitch match for each electrode array [ 30 ].…”