Robot-based assistance in middle ear surgery and cochlear implantation: first clinical report

Sykopetrites, Vittoria; Lahlou, Ghizlène; Torres, Renato; Daoudi, Hannah; Mosnier, Isabelle; Mazalaigue, Stéphane; Ferrary, Évelyne; Nguyen, Yann; Sterkers, Olivier

doi:10.1007/s00405-020-06070-z

Cited by 44 publications

(42 citation statements)

References 26 publications

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“…Though following up for a longer period than previously reported studies (16,17), the small case number and lacking more audiological outcomes in children are still the main limitations of the present investigation; however, the current preliminary results, that robotic-assisted insertion seems to lead to less scalar deviation, encouraged us to carry out a prospective, double-blind, randomized trial for robotic EA insertion (ChiCTR2000036534). Additionally, the realization of a fully robot-assisted AOS technique for the perimodiolar EA needs further development to reduce the influence of the biases from manual manipulation.…”

Section: Discussionmentioning

confidence: 83%

“…The EA was then robotically advanced until the round window marker reached the round window (C), then the stylet was manually retracted, and finally, the EA was robotically released (Robot-assisted AOS technique). procedure, RobOtol R was draped with a sterile cover, moved into the optimal surgical position, and then the sterilized microforceps was mounted on the arm (16)(17)(18). The surgeon controlled the robot-assisted arm with the SpaceMouse (3D-connection, Waltham, MA, USA) mounted on the rail of the operating table.…”

Section: Surgical Techniquesmentioning

confidence: 99%

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Robot-Assisted Electrode Array Insertion Becomes Available in Pediatric Cochlear Implant Recipients: First Report and an Intra-Individual Study

Jia

Pan

et al. 2021

Front. Surg.

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Background: As an advanced surgical technique to reduce trauma to the inner ear, robot-assisted electrode array (EA) insertion has been applied in adult cochlear implantation (CI) and was approved as a safe surgical procedure that could result in better outcomes. As the mastoid and temporal bones are generally smaller in children, which would increase the difficulty for robot-assisted manipulation, the clinical application of these systems for CI in children has not been reported. Given that the pediatric candidate is the main population, we aim to investigate the safety and reliability of robot-assisted techniques in pediatric cochlear implantation.Methods: Retrospective cohort study at a referral center in Shanghai including all patients of simultaneous bilateral CI with robotic assistance on one side (RobOtol® system, Collin ORL, Bagneux, France), and manual insertion on the other (same brand of EA and CI in both side), from December 2019 to June 2020. The surgical outcomes, radiological measurements (EA positioning, EA insertion depth, mastoidectomy size), and audiological outcomes (Behavior pure-tone audiometry) were evaluated.Results: Five infants (17.8 ± 13.5 months, ranging from 10 to 42 months) and an adult (39 years old) were enrolled in this study. Both perimodiolar and lateral wall EAs were included. The robot-assisted EA insertion was successfully performed in all cases, although the surgical zone in infants was about half the size in adults, and no difference was observed in mastoidectomy size between robot-assisted and manual insertion sides (p = 0.219). The insertion depths of EA with two techniques were similar (P = 0.583). The robot-assisted technique showed no scalar deviation, but scalar deviation occurred for one manually inserted pre-curved EA (16%). Early auditory performance was similar to both techniques.Conclusion: Robot-assisted technique for EA insertion is approved to be used safely and reliably in children, which is possible and potential for better scalar positioning and might improve long-term auditory outcome. Standard mastoidectomy size was enough for robot-assisted technique. This first study marks the arrival of the era of robotic CI for all ages.

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Section: Discussionmentioning

confidence: 83%

Section: Surgical Techniquesmentioning

confidence: 99%

Robot-Assisted Electrode Array Insertion Becomes Available in Pediatric Cochlear Implant Recipients: First Report and an Intra-Individual Study

Jia

Pan

et al. 2021

Front. Surg.

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“…The adaption of a slow electrode insertion speed was shown to promote the preservation of residual hearing [12]. Due to the limited force perception threshold and minimum speed of continuous hand movements in manually performed insertions [13]- [16], automated insertion tools [17]- [21] and force measuring arrays [22], [23] have been proposed. A correlation between non-optimal insertion axes, insertion forces and intracochlear trauma was observed in ex-vivo experiments [24], [25].…”

mentioning

confidence: 99%

In-Vitro Study of Speed and Alignment Angle in Cochlear Implant Electrode Array Insertions

Aebischer

Mantokoudis

Weder

et al. 2022

IEEE Trans. Biomed. Eng.

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The insertion of the electrode array is a critical step in cochlear implantation. Herein we comprehensively investigate the impact of the alignment angle and feed-forward speed on deep insertions in artificial scala tympani models with accurate macro-anatomy and controlled frictional properties. Methods: Motorized insertions (n=1033) were performed in six scala tympani models with varying speeds and alignment angles. We evaluated reaction forces and micrographs of the insertion process and developed a mathematical model to estimate the normal force distribution along the electrode arrays. Results: Insertions parallel to the cochlear base significantly reduce insertion energies and lead to smoother array movement. Non-constant insertion speeds allow to reduce insertion forces for a fixed total insertion time compared to a constant feed rate. Conclusion: In cochlear implantation, smoothness and peak forces can be reduced with alignment angles parallel to the scala tympani centerline and with non-constant feed-forward speed profiles. Significance: Our results may help to provide clinical guidelines and improve surgical tools for manual and automated cochlear implantation.

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“…Therefore, the choice of endoscope diameter is guided by the external auditory canal size allowing one to work with one tool in one-handed EES or two tools with a two-handed EES. Then, a compromise of 3.3 mm endoscope was selected, and its 25 cm in length (neuro-endoscope) happens to meet the design and need of RobOtol R , as reported recently (9). It is reasonable to presume that with the progress in camera and image processing technology, the endoscope in the future will be even thinner with a preserved excellent image quality.…”

Section: Discussionmentioning

confidence: 99%

Thermal Safety of Endoscopic Usage in Robot-Assisted Middle Ear Surgery: An Experimental Study

et al. 2021

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Objectives: The widespread application of endoscopic ear surgery (EES), performed through the external auditory canal, has revealed the limitations of the one-handed technique. The RobOtol® (Collin ORL, Bagneux, France) otological robotic system has been introduced to enable two-handed procedures; however, the thermal properties of dedicated endoscopes, which are usually used in neurosurgery, called “neuro-endoscopes,” have not yet been clarified for the robotic systems. In this study, we aimed to profile the thermal characteristics of two dedicated neuro-endoscopes, as compared to endoscopes used routinely in manual EES, called “oto-endoscopes,” and defined by a smaller diameter and shorter length, and to discuss the safe application of robotic assistance in EES.Methods: Two neuro-endoscopes (3.3 mm, 25 cm, 0°/30°) were studied using two routine light sources (LED/xenon), and two routine oto-endoscopes (3 mm, 14 cm, 0°/30°) were initially measured to provide a comprehensive comparison. Light intensities and temperatures were measured at different power settings. The thermal distributions were measured in an open environment and a human temporal bone model of EES. The cooling measures were also studied.Results: Light intensity was correlated with stabilized tip temperatures (P < 0.01, R2 = 0.8719). Under 100% xenon power, the stabilized temperatures at the tips of 0°, 30° neuro-endoscopes, and 0°, 30° oto-endoscopes were 96.1, 60.1, 67.8, and 56.4°C, respectively. With 100% LED power, the temperatures decreased by about 10°C, respectively. For the 0° neuro-endoscope, the illuminated area far away 1cm from the tip was below 37°C when using more than 50% both power, while this distance for 30° neuro-endoscope was 0.5 cm. In the EES temporal bone model, the round window area could reach 59.3°C with the 0° neuro-endoscope under 100% xenon power. Suction resulted in a ~1–2°C temperature drop, while a 10 mL saline rinse gave a baseline temperature which lasted for 2.5 min.Conclusion: Neuro-endoscope causes higher thermal releasing in the surgical cavity of ESS, which should be especially cautious in the robotic system usage. Applying submaximal light intensity, a LED source and intermittent rinsing should be considered for the safer robot-assisted EES using a neuro-endoscope that allows a two-handed surgical procedure.

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Robot-based assistance in middle ear surgery and cochlear implantation: first clinical report

Cited by 44 publications

References 26 publications

Robot-Assisted Electrode Array Insertion Becomes Available in Pediatric Cochlear Implant Recipients: First Report and an Intra-Individual Study

Robot-Assisted Electrode Array Insertion Becomes Available in Pediatric Cochlear Implant Recipients: First Report and an Intra-Individual Study

In-Vitro Study of Speed and Alignment Angle in Cochlear Implant Electrode Array Insertions

Thermal Safety of Endoscopic Usage in Robot-Assisted Middle Ear Surgery: An Experimental Study

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