New strategies for high precision surgery of the temporal bone using a robotic approach for cochlear implantation

Abstract

The aim of the study was to demonstrate a collision-free trajectory of an instrument through the facial recess to the site of planned cochleostomy guided by a surgery robot. The indication for cochlear implantation is still expanding toward more substantial residual hearing. A cochleostomy as atraumatic as possible will influence the preservation of inner ear function. The employment of a highly precise instrument guidance using a robot could represent a feasible solution for a constant reproducible surgical procedure. Screw markers for a point-based registration were fixed on a human temporal bone specimen prepared with a mastoidectomy and posterior tympanotomy. A DICOM dataset has been generated thereof in a 64-multislice computer tomography (CT). A virtual trajectory in a 3D model has been planned representing the path of instrumentation toward the desired spot of cochleostomy. A 1.9-mm endoscope has been mounted onto the robot system RobaCKa (Staeubli RX90CR) to visualize this trajectory. The target registration error added up to 0.25 mm, which met the desirable tolerance of <0.5 mm. A collision-free propagation of the endoscope into the tympanic cavity via the facial recess has been performed by the robot and the spot of cochleostomy could be visualized through the endoscope. Using a DICOM dataset of a high-resolution CT and a robot as a positioning platform for surgical instruments could be a feasible approach to perform a highly precise and constant reproducible cochleostomy. Furthermore, it could be a crucial step to preserve substantial residual hearing in terms of expanding the indications for cochlear implantation.

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

“…If surgery is to be successful, it is important to perform the cochleostomy in the right position (implantation being impossible otherwise). According to Adunka et al [3,8] the right position for proper cochleostomy is inferior or inferior-anterior to the round window. In our clinic we consider the proper position of the cochleostomy as to be anterior and inferior to the round window with involvement of the round window membrane in the cochleostomy.…”

Surgical planning tool for robotically assisted hearing aid implantation

“…To achieve such accuracy, a robotically assisted procedure which overcomes the inability to precisely position the surgical drill using hand held instruments [5] was suggested [6][7][8][9][10]. The safe and effective conduction of an image guided, robotically assisted DCA procedure, strongly relies on the quality of the surgical plan and the accuracy at which the surgical plan can be registered to the physical patient intraoperatively.…”

Cone Beam and Micro-Computed Tomography Validation of Manual Array Insertion for Minimally Invasive Cochlear Implantation

“…These methods aim to avoid wide mastoidectomies while at the same time targeting the cochlea, for instance at the round window (RW), at an op-timal geometric angle relative to the basal turn. In this context, patient-specific stereotactic templates Labadie et al, 2008] and skull-mounted [Kobler et al, 2012;Kratchman et al, 2011] or more conventional image-guided robotic approaches [Baron et al, 2010;Klenzner et al, 2009] have been presented. Our group recently demonstrated that a DCA tunnel (1.8 mm in diameter) could be drilled with a targeting accuracy of 0.15 ± 0.08 mm using an image-guided robotic system [Bell et al, 2013].…”