Feasibility of Pediatric Robotic Cochlear Implantation in Phantoms

Abstract

Objective: To demonstrate the feasibility of robotic cochlear implant surgery in subject specific pediatric phantoms. Study Design: Pilot study. Materials and Methods: Computed tomographic preoperative encrypted data of 10 pediatric subjects (total of 20 sides) between 8 months and 48 months old, who underwent cochlear implant surgery were studied. Four datasets (n = 8 sides) were selected for investigation of the complete robotic procedure including middle and inner ear access and electrode insertion. Results: The planning of the safe trajectory for the robotic approach was possible in 17 of the cases. In three sides, planning the trajectory was not possible due to the small size of the facial recess. Bone thickness study demonstrated average sufficient bone thickness at the site of screw implantation in general. The complete robotic procure including the drilling and insertion was successfully carried out on all the created phantoms. Conclusion: With this work we have demonstrated the feasibility of planning and performing a robotic middle and inner ear access and cochlear implantation (CI) in phantom models of pediatric subjects. To develop and validate the proposed procedure for use in children, next stage optimization of the current surgical workflow and adaptation of the surgical material to pediatric population is necessary.

Application of a new computer‐assisted robotic visualization system in cochlear implantation—Proof of concept

“…4,5 Minimally invasive approaches, including a key-hole tunnel drilled through the facial recess, have been introduced and demonstrated in adults. 4,[6][7][8] In Otolaryngology-Head and Neck Surgery (OHNS), robotic systems are mostly used for the treatment of oropharyngeal cancers. [9][10][11] Several efforts have been made to transfer the benefits of robot assisted surgery to ear surgery: in 2017, Caversaccio et al…”

In Silico Assessment of Safety and Efficacy of Screw Placement for Pediatric Image-Guided Otologic Surgery

“…Meanwhile, the template-based technique from Vanderbilt University uses 3 titanium anchors of 4 mm wide and 8 mm long with 4 mm of this length screwed into the skull (7). Currently, the Bern group (mechatronic arm) uses five 4 mm thread length titanium screws implanted on the skull, either bone screws intended for orthognathics (3,8) or task-specific screws for image-guided application on the lateral skull base (9,10). All these technologies are presently only used for adult patients.…”

“…Dura exposure during well preparation and facial nerve vulnerability at the mastoid tip are common in early childhood. In general, the posteroinferior portion of the temporalis muscle and along the supra-mastoid crest bear a bone thickness between 3-6 mm depending on age (10,12,13). Additionally, the growth process of the mastoid bone during childhood is accompanied by the increase in mastoid pneumatization.…”

“…Another obstacle posed by the most recently described IGS techniques that can be applied in pediatrics for CI surgery is the need of a dynamic reference screw placement to bear the tracker as described in previous studies (3,8,10). This screw is usually placed towards the occipital region of the calvarium, increasing the chances of dura and vascular trauma.…”

“…This screw is usually placed towards the occipital region of the calvarium, increasing the chances of dura and vascular trauma. Recent studies for the use of IGS in pediatric subjects in CI surgery have demonstrated not enough bone support in some areas of the temporal bone, raising the need for age-specific screw designs (10). However, in the future it might not be necessary anymore to place multiple fiducial screws.…”