Robotized Cochlear Implantation under Fluoroscopy: A Preliminary Series

Abstract

It is known that visual feedback by fluoroscopy can detect electrode array (EA) misrouting within the cochlea while robotized EA-insertion (rob-EAI) permits atraumatic cochlear implantation. We report here our unique experience of both fluoroscopy feedback and rob-EAI in cochlear implant surgery. We retrospectively analyzed a cohort of consecutive patients implanted from November 2021-October 2022 using rob-EAI, with the RobOtol®, to determine the quality of EA-insertion and the additional time required. Twenty-three patients (10 females, 61+/−19 yo) were tentatively implanted using robot assistance, with a rob-EAI speed < 1 mm/s. Only three cases required a successful revised insertion by hand. Under fluoroscopy (n = 11), it was possible to achieve a remote rob-EAI (n = 8), as the surgeon was outside the operative room, behind an anti-radiation screen. No scala translocation occurred. The additional operative time due to robot use was 18+/−7 min with about 4 min more for remote rob-EAI. Basal cochlear turn fibrosis precluded rob-EAI. In conclusion, Rob-EAI can be performed in almost all cases with a low risk of scala translocation, except in the case of partial cochlear obstruction such as fibrosis. Fluoroscopy also permits remote rob-EAI.

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 ].…”