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Cramer J, Böttcher-Rebmann G, Lenarz T, Rau TS. A method for accurate and reproducible specimen alignment for insertion tests of cochlear implant electrode arrays. Int J Comput Assist Radiol Surg 2023:10.1007/s11548-023-02930-1. [PMID: 37204650 DOI: 10.1007/s11548-023-02930-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 04/19/2023] [Indexed: 05/20/2023]
Abstract
PURPOSE The trajectory along which the cochlear implant electrode array is inserted influences the insertion forces and the probability for intracochlear trauma. Controlling the trajectory is especially relevant for reproducible conditions in electrode insertion tests. Using ex vivo cochlear specimens, manual alignment of the invisibly embedded cochlea is imprecise and hardly reproducible. The aim of this study was to develop a method for creating a 3D printable pose setting adapter to align a specimen along a desired trajectory toward an insertion axis. METHODS Planning points of the desired trajectory into the cochlea were set using CBCT images. A new custom-made algorithm processed these points for automated calculation of a pose setting adapter. Its shape ensures coaxial positioning of the planned trajectory to both the force sensor measuring direction and the insertion axis. The performance of the approach was evaluated by dissecting and aligning 15 porcine cochlear specimens of which four were subsequently used for automated electrode insertions. RESULTS The pose setting adapter could easily be integrated into an insertion force test setup. Its calculation and 3D printing was possible in all 15 cases. Compared to planning data, a mean positioning accuracy of 0.21 ± 0.10 mm at the level of the round window and a mean angular accuracy of 0.43° ± 0.21° were measured. After alignment, four specimens were used for electrode insertions, demonstrating the practical applicability of our method. CONCLUSION In this work, we present a new method, which enables automated calculation and creation of a ready-to-print pose setting adapter for alignment of cochlear specimens in insertion test setups. The approach is characterized by a high level of accuracy and reproducibility in controlling the insertion trajectory. Therefore, it enables a higher degree of standardization in force measurement when performing ex vivo insertion tests and thereby improves reliability in electrode testing.
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Affiliation(s)
- Jakob Cramer
- Department of Otolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Georg Böttcher-Rebmann
- Department of Otolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Thomas Lenarz
- Department of Otolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
- Cluster of Excellence EXC 2177/1 "Hearing4all", Hannover Medical School, Hannover, Germany
| | - Thomas S Rau
- Department of Otolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
- Cluster of Excellence EXC 2177/1 "Hearing4all", Hannover Medical School, Hannover, Germany
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Ren LJ, Yu Y, Zhang YH, Liu XD, Sun ZJ, Yao WJ, Zhang TY, Wang C, Li CL. Three-dimensional finite element analysis on cochlear implantation electrode insertion. Biomech Model Mechanobiol 2022; 22:467-478. [PMID: 36513945 DOI: 10.1007/s10237-022-01657-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/19/2022] [Indexed: 12/14/2022]
Abstract
Studying the insertion process of cochlear implant (CI) electrode array (EA) is important to ensure successful, sufficient, and safe implantation. A three-dimensional finite element (FE) model was developed to simulate the insertion process. The cochlear structures were reconstructed from an average statistical shape model (SSM) of human cochlea. The electrode is simplified as a long and tapered beam of homogeneous elastic materials, contacting and interacting with the stiff cochlear structures. A quasi-static insertion simulation was conducted, the insertion force and the contact pressure between the electrode and the cochlear wall, were calculated to evaluate the smoothness of insertion and the risk of potential cochlear trauma. Based on this model, different EA designs were analyzed, including the Young's modulus, the straight or bended shape, the normal or a more tapped section size. The influence of the insertion angle was also discussed. Our simulations indicate that reducing the EA Young's modulus, tapering and pre-bending are effective ways to ensure safe and successful EA implantation. This model is beneficial for optimizing EA designs and is potentially useful for designing patient-specific CI surgery.
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Affiliation(s)
- Liu-Jie Ren
- Department of Facial Plastic Reconstructive Surgery, ENT Institute, Eye and ENT Hospital, NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 200031, China
| | - Yi Yu
- School of Medical Instrumentation, Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Yu-Heng Zhang
- Shanghai Engineering Research Center of Cochlear Implants, Shanghai, 201318, China
| | - Xin-Dong Liu
- Shanghai Engineering Research Center of Cochlear Implants, Shanghai, 201318, China
| | - Zeng-Jun Sun
- Shanghai Engineering Research Center of Cochlear Implants, Shanghai, 201318, China
| | - Wen-Juan Yao
- School of Mechanics and Engineering Science, Shanghai Institute of Applied Mathematics and Mechanics, Shanghai University, Shanghai, 200444, China
| | - Tian-Yu Zhang
- Department of Facial Plastic Reconstructive Surgery, ENT Institute, Eye and ENT Hospital, NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 200031, China
| | - Cheng Wang
- Shanghai Engineering Research Center of Cochlear Implants, Shanghai, 201318, China.
| | - Chen-Long Li
- Department of Facial Plastic Reconstructive Surgery, ENT Institute, Eye and ENT Hospital, NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 200031, China.
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Michel G, Salunkhe DH, Bordure P, Chablat D. Literature Review on Endoscopic Robotic Systems in Ear and Sinus Surgery. J Med Device 2021. [DOI: 10.1115/1.4052516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
In otolaryngologic surgery, endoscopy is increasingly used to provide a better view of hard-to-reach areas and to promote minimally invasive surgery. However, the need to manipulate the endoscope limits the surgeon's ability to operate with only one instrument at a time. Currently, several robotic systems are being developed, demonstrating the value of robotic assistance in microsurgery. The aim of this literature review is to present and classify current robotic systems that are used for otological and endonasal applications. For these solutions, an analysis of the functionalities in relation to the surgeon's needs will be carried out to produce a set of specifications for the creation of new robots.
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Affiliation(s)
- Guillaume Michel
- ENT Department, CHU de Nantes, 1, place A. Ricordeau, Nantes 44093, France
| | - Durgesh Haribhau Salunkhe
- Laboratoire des Sciences du Numérique de Nantes, UMR CNRS 6004, 1 rue de la Noë, Nantes 44321, France
| | - Philippe Bordure
- ENT Department, CHU de Nantes, 1, place A. Ricordeau, Nantes 44093, France
| | - Damien Chablat
- Laboratoire des Sciences du Numérique de Nantes, UMR CNRS 6004, 1 rue de la Noë, Nantes 44321, France
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Aebischer P, Mantokoudis G, Weder S, Anschuetz L, Caversaccio M, Wimmer W. In-Vitro Study of Speed and Alignment Angle in Cochlear Implant Electrode Array Insertions. IEEE Trans Biomed Eng 2021; 69:129-137. [PMID: 34110987 DOI: 10.1109/tbme.2021.3088232] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE 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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5
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Fabrication of human anatomy-based scala tympani models with a hydrophilic coating for cochlear implant insertion experiments. Hear Res 2021; 404:108205. [PMID: 33618163 DOI: 10.1016/j.heares.2021.108205] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/07/2021] [Accepted: 02/06/2021] [Indexed: 11/22/2022]
Abstract
Electrode array insertion into the inner ear is a critical step in cochlear implantation, and artificial scala tympani models can be a valuable tool for studying the dynamics of this process. This technical note describes the fabrication of electrode array dummies and scala tympani models that address shortcomings of previously published cochlear models. In particular, we improve the reproduction of frictional properties with an easy-to-apply polymer brush coating that creates hydrophilic surfaces, and produce geometries with accurate macro-anatomy based on microtomographic scans. The presented methods rely only on commonly available materials and tools and are based on publicly available data. Our validation shows very good agreement of insertion forces both in terms of linear insertion depth and insertion speed compared to previously published measurements of insertions in cadaveric temporal bones.
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Rau TS, Zuniga MG, Salcher R, Lenarz T. A simple tool to automate the insertion process in cochlear implant surgery. Int J Comput Assist Radiol Surg 2020; 15:1931-1939. [PMID: 32857248 PMCID: PMC7603473 DOI: 10.1007/s11548-020-02243-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 08/03/2020] [Indexed: 12/28/2022]
Abstract
Purpose Automated insertion of electrode arrays (EA) in cochlear implant surgery is presumed to be less traumatic than manual insertions, but no tool is widely available in the operating room. We sought (1) to design and create a simple tool able to automate the EA insertion process; and (2) to perform preliminary evaluations of the designed prototype. Methods A first prototype of a tool with maximum simplicity was designed and fabricated to take advantage of hydraulic actuation. The prototype facilitates automated forward motion using a syringe connected to an infusion pump. Initial prototype evaluation included: (1) testing of forward motion at different velocities (2) EA insertion trials into an artificial cochlear model with force recordings, and (3) evaluation of device handling, fixation and positioning using cadaver head specimens and a surgical retractor. Alignment of the tool was explored with CT imaging. Results In this initial phase, the prototype demonstrated easy assembly and ability to respond to hydraulic actuation driven by an infusion pump at different velocities. EA insertions at an ultra-slow velocity of 0.03 mm/s revealed smooth force profiles with mean maximum force of 0.060 N ± 0.007 N. Device positioning with an appropriate insertion axis into the cochlea was deemed feasible and easy to achieve. Conclusions Initial testing of our hydraulic insertion tool did not reveal any serious complications that contradict the initially defined design specifications. Further meticulous testing is needed to determine the safety of the device, its reliability and clinical applicability.
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Affiliation(s)
- Thomas S Rau
- Department of Otolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
- Cluster of Excellence EXC 2177/1 "Hearing4all", Hannover Medical School, Hannover, Germany.
| | - M Geraldine Zuniga
- Department of Otolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
- Cluster of Excellence EXC 2177/1 "Hearing4all", Hannover Medical School, Hannover, Germany
| | - Rolf Salcher
- Department of Otolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
- Cluster of Excellence EXC 2177/1 "Hearing4all", Hannover Medical School, Hannover, Germany
| | - Thomas Lenarz
- Department of Otolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
- Cluster of Excellence EXC 2177/1 "Hearing4all", Hannover Medical School, Hannover, Germany
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Vadivelu AN, Liu Z, Gunawardena DS, Chen B, Tam HY, O'Leary S, Oetomo D. Integrated Force Sensor in a Cochlear Implant for Hearing Preservation Surgery. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:3819-3822s. [PMID: 31946706 DOI: 10.1109/embc.2019.8856549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Cochlear Implant is used for patients with severe hearing loss. It is a neural-prosthesis that stimulates the nerve endings within the cochlea, which is the organ of hearing. The surgical technique involves inserting the electrode array of the implant into a very small "snail-like" spiral structure. During this insertion process, the surgeon's finger tip is not able to perceive the resistance from the contact of the implant and the cochlea's internal structure, below the internal rupture threshold. This can potentially damage vital structures and result in the worsening of residual hearing and poor speech perception. Currently, there is no clinically and commercially available intra-operative force feedback system. A custom made sensor is therefore proposed, integrated within the implant to enable real-time force readings. The device will provide surgeons with the vital force feedback information related to the implants' position within the cochlea. This paper concentrates on demonstrating that the proposed sensor is capable of measuring the contact force below the rupture threshold of the cochlea's internal structure.
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8
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Banakis Hartl RM, Kaufmann C, Hansen MR, Tollin DJ. Intracochlear Pressure Transients During Cochlear Implant Electrode Insertion: Effect of Micro-mechanical Control on Limiting Pressure Trauma. Otol Neurotol 2019; 40:736-744. [PMID: 31192901 PMCID: PMC6578873 DOI: 10.1097/mao.0000000000002164] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
HYPOTHESIS Use of micro-mechanical control during cochlear implant (CI) electrode insertion will result in reduced number and magnitude of pressure transients when compared with standard insertion by hand. INTRODUCTION With increasing focus on hearing preservation during CI surgery, atraumatic electrode insertion is of the utmost importance. It has been established that large intracochlear pressure spikes can be generated during the insertion of implant electrodes. Here, we examine the effect of using a micro-mechanical insertion control tool on pressure trauma exposures during implantation. METHODS Human cadaveric heads were surgically prepared with an extended facial recess. Electrodes from three manufacturers were placed both by using a micro-mechanical control tool and by hand. Insertions were performed at three different rates: 0.2 mm/s, 1.2 mm/s, and 2 mm/s (n = 20 each). Fiber-optic sensors measured pressures in scala vestibuli and tympani. RESULTS Electrode insertion produced pressure transients up to 174 dB SPL. ANOVA revealed that pressures were significantly lower when using the micro-mechanical control device compared with insertion by hand (p << 0.001). No difference was noted across electrode type or speed. Chi-square analysis showed a significantly lower proportion of insertions contained pressure spikes when the control system was used (p << 0.001). CONCLUSION Results confirm previous data that suggest CI electrode insertion can cause pressure transients with intensities similar to those elicited by high-level sounds. Results suggest that the use of a micro-mechanical insertion control system may mitigate trauma from pressure events, both by reducing the amplitude and the number of pressure spikes resulting from CI electrode insertion.
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Affiliation(s)
- Renee M Banakis Hartl
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado
| | - Christopher Kaufmann
- Department of Otolaryngology - Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Marlan R Hansen
- Department of Otolaryngology - Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Daniel J Tollin
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado
- Department of Physiology and Biophysics, University of Colorado School of Medicine, Aurora, Colorado
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Müller S, Kahrs LA, Gaa J, Tauscher S, Kluge M, John S, Rau TS, Lenarz T, Ortmaier T, Majdani O. Workflow assessment as a preclinical development tool. Int J Comput Assist Radiol Surg 2019; 14:1389-1401. [DOI: 10.1007/s11548-019-02002-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 05/16/2019] [Indexed: 11/30/2022]
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10
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Torres R, Jia H, Drouillard M, Bensimon JL, Sterkers O, Ferrary E, Nguyen Y. An Optimized Robot-Based Technique for Cochlear Implantation to Reduce Array Insertion Trauma. Otolaryngol Head Neck Surg 2018; 159:900-907. [PMID: 30084309 DOI: 10.1177/0194599818792232] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare the intracochlear trauma induced by optimized robot-based and manual techniques with a straight electrode array prototype inserted at different lengths. STUDY DESIGN Experimental study. SETTING Robot-based otologic surgery laboratory. SUBJECTS AND METHODS A prototype array was inserted at different insertion lengths (21 and 25 mm) in 20 temporal bones. The manual insertion was performed with a microforceps. The optimized approach consisted of an optimal axis insertion provided by a robot-based arm controlled by a tracking system, with a constant speed of insertion (0.25 mm/s) achieved by a motorized insertion tool. The electrode position was determined at the level of each electrode by stereomicroscopic cochlea section analysis. RESULTS A higher number of electrodes correctly located in the scala tympani was associated with the optimized approach ( P = .03, 2-way analysis of variance). Regardless of the insertion technique used, the array inserted at 25 mm allowed complete insertion of the active stimulating portion of the array in all cases. Insertion depth was greater when the array was inserted to 25 mm versus 21 mm ( P < .001, 2-way analysis of variance). The optimized insertion was associated with less trauma than that from manual insertion regardless the length of the inserted array ( P = .04, 2-way analysis of variance). CONCLUSION Compared with a manual insertion, intracochlear trauma could be reduced with array insertion performed on an optimal axis by using motorized insertion and by applying a constant insertion speed.
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Affiliation(s)
- Renato Torres
- 1 Sorbonne Université, Inserm, Unité "Réhabilitation chirurgicale mini-invasive et robotisée de l'audition," Paris, France.,2 AP-HP, GHU Pitié-Salpêtrière, Service ORL, Otologie, implants auditifs et chirurgie de la base du crâne, Paris, France
| | - Huan Jia
- 1 Sorbonne Université, Inserm, Unité "Réhabilitation chirurgicale mini-invasive et robotisée de l'audition," Paris, France.,3 Department of Otolaryngology Head and Neck Surgery, School of Medicine, Shanghai Jiaotong University Shanghai Ninth People's Hospital, Shanghai, China
| | - Mylène Drouillard
- 1 Sorbonne Université, Inserm, Unité "Réhabilitation chirurgicale mini-invasive et robotisée de l'audition," Paris, France.,2 AP-HP, GHU Pitié-Salpêtrière, Service ORL, Otologie, implants auditifs et chirurgie de la base du crâne, Paris, France
| | | | - Olivier Sterkers
- 1 Sorbonne Université, Inserm, Unité "Réhabilitation chirurgicale mini-invasive et robotisée de l'audition," Paris, France.,2 AP-HP, GHU Pitié-Salpêtrière, Service ORL, Otologie, implants auditifs et chirurgie de la base du crâne, Paris, France
| | - Evelyne Ferrary
- 1 Sorbonne Université, Inserm, Unité "Réhabilitation chirurgicale mini-invasive et robotisée de l'audition," Paris, France.,2 AP-HP, GHU Pitié-Salpêtrière, Service ORL, Otologie, implants auditifs et chirurgie de la base du crâne, Paris, France
| | - Yann Nguyen
- 1 Sorbonne Université, Inserm, Unité "Réhabilitation chirurgicale mini-invasive et robotisée de l'audition," Paris, France.,2 AP-HP, GHU Pitié-Salpêtrière, Service ORL, Otologie, implants auditifs et chirurgie de la base du crâne, Paris, France
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Insertion forces and intracochlear trauma in temporal bone specimens implanted with a straight atraumatic electrode array. Eur Arch Otorhinolaryngol 2017; 274:2131-2140. [PMID: 28238160 DOI: 10.1007/s00405-017-4485-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 01/25/2017] [Indexed: 10/20/2022]
Abstract
The aim of the study was to evaluate insertion forces during manual insertion of a straight atraumatic electrode in human temporal bones, and post-implantation histologic evaluation of the samples to determine whether violation of intracochlear structures is related to insertion forces. In order to minimize intracochlear trauma and preserve residual hearing during cochlear implantation, knowledge of the insertion forces is necessary. Ten fresh frozen human temporal bones were prepared with canal wall down mastoidectomy. All samples were mounted on a one-axis force sensor. Insertion of a 16-mm straight atraumatic electrode was performed from different angles to induce "traumatic" insertion. Histologic evaluation was performed in order to evaluate intracochlear trauma. In 4 of 10 samples, dislocation of the electrode into scala vestibuli was observed. The mean insertion force for all 10 procedures was 0.003 ± 0.005 N. Insertion forces measured around the site of dislocation to scala vestibuli in 3 of 4 samples were significantly higher than insertion forces at the same location of the cochleae measured in samples without trauma (p < 0.04). Mean force during the whole insertion process of the straight atraumatic electrode is lower than reported by other studies using longer electrodes. Based on our study, insertion forces leading to basilar membrane trauma may be lower than the previously reported direct rupture forces.
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Three-Dimensional Force Profile During Cochlear Implantation Depends on Individual Geometry and Insertion Trauma. Ear Hear 2017; 38:e168-e179. [DOI: 10.1097/aud.0000000000000394] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Dillon NP, Mitchell JE, Geraldine Zuniga M, Webster RJ, Labadie RF. Design and Thermal Testing of an Automatic Drill Guide for Less Invasive Cochlear Implantation1. J Med Device 2016. [DOI: 10.1115/1.4033223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Neal P. Dillon
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235
| | - Jason E. Mitchell
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235
| | - M. Geraldine Zuniga
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN 37235
| | - Robert J. Webster
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235
| | - Robert F. Labadie
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN 37235
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Evaluation of Sensor Configurations for Robotic Surgical Instruments. SENSORS 2015; 15:27341-58. [PMID: 26516863 PMCID: PMC4634404 DOI: 10.3390/s151027341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 09/26/2015] [Accepted: 10/19/2015] [Indexed: 11/18/2022]
Abstract
Designing surgical instruments for robotic-assisted minimally-invasive surgery (RAMIS) is challenging due to constraints on the number and type of sensors imposed by considerations such as space or the need for sterilization. A new method for evaluating the usability of virtual teleoperated surgical instruments based on virtual sensors is presented. This method uses virtual prototyping of the surgical instrument with a dual physical interaction, which allows testing of different sensor configurations in a real environment. Moreover, the proposed approach has been applied to the evaluation of prototypes of a two-finger grasper for lump detection by remote pinching. In this example, the usability of a set of five different sensor configurations, with a different number of force sensors, is evaluated in terms of quantitative and qualitative measures in clinical experiments with 23 volunteers. As a result, the smallest number of force sensors needed in the surgical instrument that ensures the usability of the device can be determined. The details of the experimental setup are also included.
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Individual Optimization of the Insertion of a Preformed Cochlear Implant Electrode Array. Int J Otolaryngol 2015; 2015:724703. [PMID: 26448764 PMCID: PMC4581552 DOI: 10.1155/2015/724703] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 08/06/2015] [Indexed: 11/21/2022] Open
Abstract
Purpose. The aim of this study was to show that individual adjustment of the curling behaviour of a preformed cochlear implant (CI) electrode array to the patient-specific shape of the cochlea can improve the insertion process in terms of reduced risk of insertion trauma. Methods. Geometry and curling behaviour of preformed, commercially available electrode arrays were modelled. Additionally, the anatomy of each small, medium-sized, and large human cochlea was modelled to consider anatomical variations. Finally, using a custom-made simulation tool, three different insertion strategies (conventional Advanced Off-Stylet (AOS) insertion technique, an automated implementation of the AOS technique, and a manually optimized insertion process) were simulated and compared with respect to the risk of insertion-related trauma. The risk of trauma was evaluated using a newly developed “trauma risk” rating scale. Results. Using this simulation-based approach, it was shown that an individually optimized insertion procedure is advantageous compared with the AOS insertion technique. Conclusion. This finding leads to the conclusion that, in general, consideration of the specific curling behaviour of a CI electrode array is beneficial in terms of less traumatic insertion. Therefore, these results highlight an entirely novel aspect of clinical application of preformed perimodiolar electrode arrays in general.
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Cochlear Dummy Electrodes for Insertion Training and Research Purposes: Fabrication, Mechanical Characterization, and Experimental Validation. BIOMED RESEARCH INTERNATIONAL 2015; 2015:574209. [PMID: 26247024 PMCID: PMC4506834 DOI: 10.1155/2015/574209] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 03/09/2015] [Indexed: 12/05/2022]
Abstract
To develop skills sufficient for hearing preservation cochlear implant surgery, surgeons need to perform several electrode insertion trials in ex vivo temporal bones, thereby consuming relatively expensive electrode carriers. The objectives of this study were to evaluate the insertion characteristics of cochlear electrodes in a plastic scala tympani model and to fabricate radio opaque polymer filament dummy electrodes of equivalent mechanical properties. In addition, this study should aid the design and development of new cochlear electrodes. Automated insertion force measurement is a new technique to reproducibly analyze and evaluate the insertion dynamics and mechanical characteristics of an electrode. Mechanical properties of MED-EL's FLEX28, FLEX24, and FLEX20 electrodes were assessed with the help of an automated insertion tool. Statistical analysis of the overall mechanical behavior of the electrodes and factors influencing the insertion force are discussed. Radio opaque dummy electrodes of comparable characteristics were fabricated based on insertion force measurements. The platinum-iridium wires were replaced by polymer filament to provide sufficient stiffness to the electrodes and to eradicate the metallic artifacts in X-ray and computed tomography (CT) images. These low-cost dummy electrodes are cheap alternatives for surgical training and for in vitro, ex vivo, and in vivo research purposes.
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Kobler JP, Wall S, Lexow GJ, Lang CP, Majdani O, Kahrs LA, Ortmaier T. An experimental evaluation of loads occurring during guided drilling for cochlear implantation. Int J Comput Assist Radiol Surg 2015; 10:1625-37. [PMID: 25673073 DOI: 10.1007/s11548-015-1153-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 01/26/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE During guided drilling for minimally invasive cochlear implantation and related applications, typically forces and torques act on the employed tool guides, which result from both the surgeon's interaction and the bone drilling process. Such loads propagate through the rigid mechanisms and result in deformations of compliant parts, which in turn affect the achievable accuracy. In this paper, the order of magnitude as well as the factors influencing such loads are studied experimentally to facilitate design and optimization of future drill guide prototypes. METHODS The experimental setup to evaluate the occurring loads comprises two six degree of freedom force/torque sensors: one mounted between a manually operated, linearly guided drill handpiece and one below the specimens into which the drilling is carried out. This setup is used to analyze the influences of drilling tool geometry, spindle speed as well as experience of the operator on the resulting loads. RESULTS The results reveal that using a spiral drill results in lower process loads compared with a surgical Lindemann mill. Moreover, in this study, an experienced surgeon applied lower interaction forces compared with untrained volunteers. The measured values further indicate that both the intraoperative handling of the bone-attached drill guide as well as the tool removal after completing the hole can be expected to cause temporary load peaks which exceed the values acquired during the drilling procedure itself. CONCLUSIONS The results obtained using the proposed experimental setup serve as realistic design criteria with respect to the development of future drill guide prototypes. Furthermore, the given values can be used to parameterize simulations for profound stiffness analyses of existing mechanisms.
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Affiliation(s)
- Jan-Philipp Kobler
- Institute of Mechatronic Systems, Leibniz Universität Hannover, 30167, Hanover, Germany.
| | - Sergej Wall
- Institute of Mechatronic Systems, Leibniz Universität Hannover, 30167, Hanover, Germany
| | | | | | - Omid Majdani
- Hannover Medical School, 30625, Hanover, Germany
| | - Lüder A Kahrs
- Institute of Mechatronic Systems, Leibniz Universität Hannover, 30167, Hanover, Germany
| | - Tobias Ortmaier
- Institute of Mechatronic Systems, Leibniz Universität Hannover, 30167, Hanover, Germany
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Kobler JP, Schoppe M, Lexow GJ, Rau TS, Majdani O, Kahrs LA, Ortmaier T. Temporal bone borehole accuracy for cochlear implantation influenced by drilling strategy: an in vitro study. Int J Comput Assist Radiol Surg 2014; 9:1033-43. [PMID: 24728770 DOI: 10.1007/s11548-014-0997-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 03/21/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE Minimally invasive cochlear implantation is a surgical technique which requires drilling a canal from the mastoid surface toward the basal turn of the cochlea. The choice of an appropriate drilling strategy is hypothesized to have significant influence on the achievable targeting accuracy. Therefore, a method is presented to analyze the contribution of the drilling process and drilling tool to the targeting error isolated from other error sources. METHODS The experimental setup to evaluate the borehole accuracy comprises a drill handpiece attached to a linear slide as well as a highly accurate coordinate measuring machine (CMM). Based on the specific requirements of the minimally invasive cochlear access, three drilling strategies, mainly characterized by different drill tools, are derived. The strategies are evaluated by drilling into synthetic temporal bone substitutes containing air-filled cavities to simulate mastoid cells. Deviations from the desired drill trajectories are determined based on measurements using the CMM. RESULTS Using the experimental setup, a total of 144 holes were drilled for accuracy evaluation. Errors resulting from the drilling process depend on the specific geometry of the tool as well as the angle at which the drill contacts the bone surface. Furthermore, there is a risk of the drill bit deflecting due to synthetic mastoid cells. CONCLUSIONS A single-flute gun drill combined with a pilot drill of the same diameter provided the best results for simulated minimally invasive cochlear implantation, based on an experimental method that may be used for testing further drilling process improvements.
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Affiliation(s)
- Jan-Philipp Kobler
- Institute of Mechatronic Systems, Leibniz Universität Hannover, 30167 , Hannover, Germany.
| | - Michael Schoppe
- Institute of Mechatronic Systems, Leibniz Universität Hannover, 30167 , Hannover, Germany
| | | | - Thomas S Rau
- Hannover Medical School, 30625 , Hannover, Germany
| | - Omid Majdani
- Hannover Medical School, 30625 , Hannover, Germany
| | - Lüder A Kahrs
- Institute of Mechatronic Systems, Leibniz Universität Hannover, 30167 , Hannover, Germany
| | - Tobias Ortmaier
- Institute of Mechatronic Systems, Leibniz Universität Hannover, 30167 , Hannover, Germany
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