Minimally invasive, multi-port approach to the lateral skull base: a first in vitro evaluation

Stenin, Igor; Hansen, Stefan; Nau-Hermes, Maria; El-Hakimi, Wissam; Becker, Meike; Bredemann, Judith; Kristin, Julia; Klenzner, Thomas; Schipper, Jörg

doi:10.1007/s11548-017-1533-5

Cited by 4 publications

(2 citation statements)

References 19 publications

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“…Further integration of intraoperative imaging devices will drastically reduce the time needed for pre- and intraoperative imaging and image processing. To introduce a complete robotic cochlear implantation approach, we are currently developing and investigating solutions for robotic inner ear access, robotic electrode insertion, multi-port scenarios [29], narrower drills (i.e. 1mm to 1.4 mm) with integrated monitoring electrodes and ultimately robotics compliant CI implant technology.…”

Section: Discussionmentioning

confidence: 99%

Robotic middle ear access for cochlear implantation: First in man

et al. 2019

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To demonstrate the feasibility of robotic middle ear access in a clinical setting, nine adult patients with severe-to-profound hearing loss indicated for cochlear implantation were included in this clinical trial. A keyhole access tunnel to the tympanic cavity and targeting the round window was planned based on preoperatively acquired computed tomography image data and robotically drilled to the level of the facial recess. Intraoperative imaging was performed to confirm sufficient distance of the drilling trajectory to relevant anatomy. Robotic drilling continued toward the round window. The cochlear access was manually created by the surgeon. Electrode arrays were inserted through the keyhole tunnel under microscopic supervision via a tympanomeatal flap. All patients were successfully implanted with a cochlear implant. In 9 of 9 patients the robotic drilling was planned and performed to the level of the facial recess. In 3 patients, the procedure was reverted to a conventional approach for safety reasons. No change in facial nerve function compared to baseline measurements was observed. Robotic keyhole access for cochlear implantation is feasible. Further improvements to workflow complexity, duration of surgery, and usability including safety assessments are required to enable wider adoption of the procedure.

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Section: Discussionmentioning

confidence: 99%

Robotic middle ear access for cochlear implantation: First in man

et al. 2019

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“…To resolve the limitations to simultaneous visualization and manipulation assistance requirements that are imposed by a single drill tunnel to the cochlea, a multiport approach was investigated for its suitability and feasibility for the RCI approach. It has previously been shown that planning multiple trajectories with adequate safety clearance despite anatomical variations was feasible [5][6][7]; as was the drilling of trajectories with the adequate accuracy [8].…”

Section: Introductionmentioning

confidence: 99%

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

Schneider

Stenin

Ansó

et al. 2019

Eur Arch Otorhinolaryngol

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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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Influence of patient-specific anatomy on medical computed tomography and risk evaluation of minimally invasive surgery at the otobasis

Schieferbein

Bredemann

Schmitt

et al. 2018

Eur Arch Otorhinolaryngol

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Minimally invasive, multi-port approach to the lateral skull base: a first in vitro evaluation

Abstract: The presented system allows the planning and drilling of multiple minimally invasive canals at the lateral skull base. Further studies are required to reduce the drilling error and evaluate the clinical application of the system.

Cited by 4 publications

References 19 publications

Robotic middle ear access for cochlear implantation: First in man

Robotic middle ear access for cochlear implantation: First in man

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

Influence of patient-specific anatomy on medical computed tomography and risk evaluation of minimally invasive surgery at the otobasis

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