Robot-Assisted Electrode Insertion in Cochlear Implantation Controlled by Intraoperative Electrocochleography—A Pilot Study

Abstract

Robotics in otology has been developing in many directions for more than two decades. Current clinical trials focus on more accurate stapes surgery, minimally invasive access to the cochlea and less traumatic insertion of cochlear implant (CI) electrode arrays. In this study we evaluated the use of the RobOtol® (Collin, Bagneux, France) otologic robot to insert CI electrodes into the inner ear with intraoperative ECochG analysis. This prospective, pilot study included two adult patients implanted with Advanced Bionics (Westinghouse PI, CA, USA) cochlear implant, with HiFocus™ Mid-Scala electrode array. The standard surgical approach was used. For both subjects, who had residual hearing in the implanted ear, intraoperative and postoperative ECochG was performed with the AIMTM system. The surgeries were uneventful. A credible ECochG response was obtained after complete electrode insertion in both cases. Preoperative BC thresholds compared to intraoperative estimated ECochG thresholds and 2-day postoperative BC thresholds had similar values at frequencies where all thresholds were measurable. The results of the ECochG performed one month after the surgery showed that in both patients the hearing residues were preserved for the selected frequencies. The RobOtol® surgical robot allows for the correct, safe and gentle insertion of the cochlear implant electrode inside the cochlea. The use of electrocochleography measurements during robotic cochlear implantation offers an additional opportunity to evaluate and modify the electrode array insertion on an ongoing basis, which may contribute to the preservation of residual hearing.

Combining Intraoperative Electrocochleography with Robotics-Assisted Electrode Array Insertion

“…To date, one other group has performed a similar study. Gawęcki et al (27) previously reported the use of the RobOtol robotic system (Collin, Bagneux, France) to insert AB electrodes with simultaneous intraoperative ECochG in two adult patients. At 1-month follow-up, both patients had preserved pure tone thresholds.…”

“…Steady and slow insertion may also enhance feedback to the surgeon by facilitating intraoperative physiological measures of cochlear activity such as electrocochleography (ECochG). ECochG is based on electric potentials generated by the inner ear and auditory nerve in response to acoustically evoked stimulation (25)(26)(27). By using the cochlear implant electrode as a recording electrode, ECochG responses can be obtained intracochlearly and measured during insertion, informing the surgeon of potential trauma and loss of residual hearing (28)(29)(30).…”

Robotized Cochlear Implantation under Fluoroscopy: A Preliminary Series

“…To our knowledge, this is the first time that such remote EAI has been reported in cochlear implantation. 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 series, we did not use intraoperative electrocochleography (EcoG). It is interesting to note that intraoperatively EcoG during a rob-EAI using the RobOtol ® has been proven feasible [18]. In order to improve the chance of hearing preservation, a rob-EAI could be advantageously associated with fluoroscopy and intraoperative EcoG monitoring.…”

CochleRob: Parallel-Serial Robot to Position a Magnetic Actuator around a Patient’s Head for Intracochlear Microrobot Navigation

“…Efforts to reduce trauma through methods such as magnetic guidance have been attempted [ 20 , 21 , 22 , 23 ], but the placement of an array inside the cochlea is not considered a safe option for patients with inner ear diseases who do not require CI for hearing rehabilitation [ 14 ]. Developing robotic platforms specified for CI-based drug delivery is still a point of interest [ 24 , 25 , 26 ]. For more details about cochlear implants, the reader can refer to [ 27 , 28 ].…”